Health Reform

HealthyCT was created to provide Connecticut consumers with a different choice in healthcare. Our goal is to build a different kind of health plan; one focused on and run by consumers.

We understand that when it comes to health care, the more you know, the better you can decide what’s best for you. So we’d like you to have some information about health care reform.

You may have heard about the Affordable Care Act (ACA). The purpose of this new law is to improve the quality of health care and make it more affordable. Health reform gives everyone access to a basic set of health services, including preventive care. Also, no one can be denied health insurance because of a pre-existing condition.

What does this mean for you?

Starting January 2014, the new law required that you must have health insurance coverage. Depending on how much you earn, you may be able to get aid from the federal government to help pay for your health care insurance.

For example, if you are a healthy individual and your income is less than the equivalent of about $94,000 for a family of four, you may get tax credits to help pay for insurance. If your employer doesn’t offer insurance, you will be able to buy coverage directly through state health insurance exchanges, known as Access Health CT in Connecticut. All new plans are required to include state-specific essential health benefits that are mandated by each state’s government.

If you are a family with children: Insurers can’t deny or exclude coverage to any child under age 19 based on a pre-existing condition. As of 2014, plans cannot deny or exclude anyone, or charge more for a pre-existing condition (including a disability). Essential benefits required in new plans include vision and dental coverage for children and pregnancy and newborn care for women. Children who cannot receive coverage through work can remain on their parents’ plan until age 26. Insurance companies can no longer impose lifetime limits on the amount they will pay to cover required or essential health benefits.

If you are a family may qualify for Medicaid: Medicaid eligibility in some states to 133 percent of the federal poverty level ($15,282 for an individual or $31,322 for a family of four). Children in these families who are now covered by the Children’s Health Insurance Program (CHIP) would be transitioned to Medicaid. CHIP is continued through at least 2019.

If you are an individual, in some states Medicaid was expanded in 2014 to include coverage for people who are unemployed with limited income under 133 percent of the federal poverty level. Beginning in 2014, people buying coverage on their own through health insurance exchanges became eligible for federal tax credits to subsidize the cost if their income level is less than 400 percent of the federal poverty level and they aren’t eligible for Medicaid. No matter what your situation, you’ll want to get quality coverage at a good price.

Key features of Healthcare Reform

The ACA works to improve the quality of health care and make insurance more affordable. It also helps you and your caregivers manage long-term care, preventive care and how and where you get your care.

Here are some of the key features and changes that took effect in 2014:

  • Affordable Health Insurance. If you don’t have health insurance coverage from an employer, you can purchase it yourself at a lower cost than is currently available.
  • Mandatory Insurance. Everyone is required to have healthcare insurance. If you don’t sign up for a healthcare plan, you may get a tax penalty.
  • Tax credits to help you pay for insurance. If your income is below a certain level, you may be able to get tax credits to help pay for your coverage. Whether you qualify will depend on your household size and your income.
  • No Termination of Coverage. Your insurance company can no longer end your coverage if you become ill. As long as you’re paying your premiums, your insurance company must continue to cover you.
  • Coverage for Pre-Existing Conditions. Your insurance company must cover pre-existing health conditions. This rule is already in place for children under19; as of January 1, 2014 it applies to everyone.
  • Preventive Care. Health insurance companies must now offer preventive care services at no cost to you. These services include mammograms, colonoscopies, immunizations, high blood pressure and diabetes screenings, and counseling for weight loss and stopping smoking. View a full list of these covered services.
  • No coverage limits. There are no more lifetime or annual limits on the amount of money your insurance company will pay for your health care. This means that if you get sick, your benefits will not run out when you reach a certain dollar amount.
  • Extended coverage. Your dependents will continue to be covered under your insurance plan until age 26. Coverage ends the last day of their birthday month. For example, a child who turns 26 on September 12 is covered through the end of September.

The U.S. government website, www.healthcare.gov, was created to answer your questions about health care reform and how it will affect you. You can get information on insurance coverage, benefits, costs, and how to choose a health plan for yourself or your family.

General Health Reform

Connecticut Specific Health Reform

Small Business Health Reform