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Choices and lower than expected premiums in the new Health Insurance Marketplace

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A recent report, released on September 25, 2013 by the Department of Health and Human Services (HHS), finds that consumers will see increased competition in the new Health Insurance Marketplace. Increased competition leads to new and affordable choices for consumers, as corroborated by the ~16% lower-than-expected premiums nationwide.

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The HHS report gives an overview of pricing and the number of coverage options across the nation, including Connecticut. The report also finds that individuals in the states where HHS will fully or partly run the Marketplace will have an average of 53 qualified health plan choices. Plans in the Marketplace are categorized as either “gold,” “silver,” “bronze,” or “platinum,” depending on the coverage. The average premium in Connecticut for the lowest cost bronze plan will be $340 before tax credits and $397 for the lowest cost silver plan before tax credits (national averages: bronze plan, $249; silver plan $310). These premiums are below projections based off of Congressional Budget Office estimates.

Because of the Affordable Care Act (also known as, Obamacare), the 92% of Connecticut residents who have insurance will now have more choices and stronger coverage than before. Also, the 8% of Connecticut residents who don’t have insurance (and Connecticut families and small businesses who buy their coverage but are not happy with it) will be able to find affordable health coverage that fits their needs and budget.

Connecticut has chosen to develop a state-specific Exchange (as opposed to an Exchange developed and implemented by the federal HHS). Access Health CT (the Connecticut Exchange) will operate at no cost to the state. It is funded by federal grant dollars through 2014. Beginning October 1, 2013, you can use the Exchange to find out whether you qualify for premium assistance and to compare plans side-by-side based on pricing, quality and benefits. If you have job-based health insurance you are satisfied with, you can keep it. You're considered covered. If you already have Medicare, your benefits will not change and your coverage will continue.

Premiums for plans in the Exchange would fluctuate based on the level of plan that you choose, the carrier chosen, and your age. For example, in Connecticut, a 25-year old making $20,000 a year may pay $85 per month for a quality health insurance plan ($209 tax credit on a $294/month-premium plan); while a married couple (both aged 40 years) with 1 child and an annual household income of $40,000 may pay $216 per month ($533 tax credit on a $749/month-premium plan). Young adults (<30 years of age) will also have the option of purchasing a “catastrophic” plan. Catastrophic plans have lower premiums and cover 3 annual primary care visits at no cost. Catastrophic plans will generally have higher deductibles and copayments, but will protect against high out-of-pocket costs.

Under the Affordable Care Act, no one can be denied coverage because of a pre-existing condition. The Act also requires all plans to cover Essential Health Benefits. Plans may offer additional coverage, but the Essential Health Benefits include:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services at no additional cost (e.g., shots and screening tests with no co-pays and no deductibles)
  • Chronic disease management
  • Pediatric services

“We are excited to see that rates in the Marketplace are even lower than originally projected,” said Kathleen Sebelius, Secretary of HHS. “In the past, consumers were too often denied or priced-out of quality health insurance options, but thanks to the Affordable Care Act consumers will be able to choose from a number of new coverage options at a price that is affordable.”

For more information, go to HealthCare.gov. Additionally, for Connecticut residents also check out AccessHealthCT.com.

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