Health Care Reform and You
Click here for a handy quick-guide to the newly-opened affordable insurance marketplace and more information on how the Affordable Care Act is already helping millions of Americans access care.
Since becoming law in 2010, the Affordable Care Act has already done a lot to help lower costs and help Americans get better health care. However, many of the most important parts of the law go into effect in 2014.
The Affordable Care Act is designed to lower overall health care costs and provide access to affordable health insurance to the uninsured. It also provides free preventive care to millions of Americans, prohibits insurers from denying coverage to many people previously excluded, and provides tax credits to small businesses and individuals to help defray their health insurance costs.
So far, the Affordable Care Act has helped lower 2012 health insurance premiums by $18.5 million, provide 945,000 preventive services like immunizations or mammograms to Connecticut residents, and save seniors over $42 million on prescription drug costs. Additionally, more than 23,000 young adults in Connecticut are now insured, insurers are no longer allowed to impose lifetime limits on coverage, and children with pre-existing conditions cannot be denied coverage.
Affordable Health Insurance for Individuals and Families
Beginning October 1, 2013, individuals and families will be able to purchase health insurance plans through an online, transparent, affordable health care exchange. Instant tax credits help defray the cost of health insurance premiums for many low- and middle-income individuals and families.
Connecticut's exchange is Access Health CT. If your employer doesn’t offer insurance, you will be able to choose a private plan directly in this one-stop marketplace – the same insurance choices I and other Members of Congress will have. This coverage will begin January 1, 2014.
Many individuals and families will receive instant tax credits to reduce the cost of health insurance purchased through the Connecticut exchange. Because this credit can be applied directly to your monthly premiums, you get the lower costs instantly. To see if you qualify for an instant tax credit, check Access Health CT’s savings calculator.
Example: a family of four bringing in $70,650 a year might purchase a plan through Access Health CT with an initial monthly premium of $1,041. However, the Instant Premium Tax Credit would reduce this premium by $482 per month (46% of the premium cost), for a reduced premium of $559 per month.
Example: An individual making $28,725 per year could purchase a plan through Access Health CT with an initial monthly premium of $416. With the Instant Premium Tax Credit paying $224 (or 54%) of this amount, the new, reduced monthly premium would be $192.
And keep in mind, these plans would provide comprehensive health insurance, not just the catastrophic coverage many people could only afford.
Below is a chart showing the maximum amount a family of a particular size could make while still qualifying for a reduced rate on the exchange:
Maximum income to qualify for instant health insurance tax credit
Call Center: Get Your Healthcare Questions Answered
People who have questions about the new exchanges can get their questions answered by calling 1-800-318-2596 (TTY: 1-855-889-4325). This call center is open 24/7 and is available in 150 languages.
From June through September, the call center will be able to answer general inquiries about the new exchanges, including "What's a premium?" "I have insurance; how will I be impacted?" and "Where can I go to get additional information?"
From October 2013 to March 2014, the call center will be able to assist you with every stage of the process, including completing your application, comparing plans, determining tax credit eligibility, and purchasing your new plan.
New Options for Small Businesses that Provide Health Insurance to Employees
Small businesses with fewer than 50 employees will be able to purchase affordable health insurance plans through the Small Business Health Options Program (SHOP) Marketplace, a one-stop shop for comparing plans and controlling your business’s contributions and coverage. Qualifying businesses will receive a Small Business Health Care Tax Credit to make providing care to their employees even more affordable. This instant tax credit can be worth up to 50% of the contribution businesses make toward employees’ premium costs.
Businesses that purchase their plan through the SHOP and that have with fewer than 25 full-time-equivalent employees making an average of $50,000 a year or less may qualify for an employer health care tax credit. To qualify, businesses must pay at least 50% of their full-time employees’ premium costs. Businesses do not need to offer coverage to part-time employees or dependents to qualify for this tax credit. The tax credit is highest for companies with fewer than 10 employees who are paid an average of $25,000 or less. The smaller the business, the bigger the credit.
Example: An employer with 10 employees who pays an average of $25,000 per employee ($250,000 total) and contributes $70,000 to employee premiums will receive a $35,000 tax credit, equal to 50% of their contribution.
To find out if your small business qualifies for a tax credit, click here.
Call Center for Businesses
Business owners with questions about the new SHOP Marketplace can get answers at the new SHOP Marketplace Call Center. The call center is open Monday through Friday from 9am to 5pm; hours will expand after October 1.
The SHOP Marketplace Call Center can be reached at: 1-800-706-7893 (TTY: 1-800-706-7915 ).
Another resource for employers is a health care wizard for employers available at http://business.usa.gov/healthcare.
How the Affordable Care Act is Already Expanding Access to Care and Reducing Costs
While this page is focused on providing information about the Affordable Care Act provisions that will go into effect this coming year, it is important to remember that many provisions in the new law are already expanding access to health care and reducing costs.
- Insurance companies must now spend at least 80% of the premiums they collect on health care for those they insure – and if not, they must refund some of the premium to make up the difference. As a result, Connecticut families already received about $18.5 million in rebates in 2012 and 2013. Learn more about the "80/20 Rule."
- Insurance companies must now provide certain preventive services for free. Since the law’s enactment, Connecticut residents have been provided with 945,000 free preventive services, including mammograms, well-child visits, flu shots, and colonoscopies.
- The Medicare Prescription Drug “Donut Hole” is closing. Before the new health care law passed, some seniors faced a gap in prescription drug coverage through Medicare, which forced them to pay thousands of dollars in out-of-pocket costs. The health care reform law is closing that gap. In 2012, the average Connecticut resident facing this coverage gap saved $880, and the savings will increase annually. The "donut hole" will be closed completely by 2020. Learn more about closing the "donut hole."
- Insurance companies can no longer impose lifetime limits on coverage; starting in 2014, annual limits will also be prohibited.
- Young adults up to age 26 can stay on a parent's health insurance plan. To date, more than 23,000 Connecticut residents between the ages of 21 and 25 have remained insured thanks to the health care reform law. Learn more about coverage for young adults.
- To help ensure the health care system has the capacity to care for a larger patient base, Connecticut's Community Health Centers – which provide preventive and primary health care services to 315,992 residents in underserved communities – have received $60 million to support ongoing health center operations and to establish new health center sites, expand services, and support improvement projects.
To summarize some of the major aspects of the new law that have come into effect and those that will:
TIMELINE: What Happens, and When
October 1, 2013 - March 31, 2014
The affordable insurance marketplace opens. This is the open enrollment period, at which time anyone who needs health insurance can compare plans and purchase the plan that's right for them. Connecticut residents will be able to shop for plans at Access Health CT. Before October 1, you will not find information about specific policy pricing, but you can get answers to many questions about coverage. Once October 1 arrives, you can use the site to shop for a plan. Or, you will be able to get help by phone or in person from a specially-trained insurance agent or non-profit organization.
January 1, 2014
Previously uninsured people in Connecticut have access to health insurance. This includes people with pre-existing conditions.
Insurance companies can no longer impose annual limits on coverage.
Women can not be charged more than men for comparable health insurance plans.
The Small Business Tax Credit is expanded.
The biggest health care change coming in 2014 is this: the tens of million of Americans who are currently uninsured can begin getting affordable coverage.
Please refer to healthcare.gov for a more detailed description of the new law, inlcuding:
- Your Rights and Protections
- The Health Insurance Marketplace
- Coverage for Pre-existing Conditions
- Preventive Care at No Cost to You
- Getting a Summary of Your Benefits and Coverage
- Coverage for Young Adults
- Your Right to Appeal Coverage Decisions
- and more
A Spanish-language version of healthcare.gov is available at cuidadodesalud.gov/es/.