The Affordable Care Act of Connecticut is a Supreme Court ruling that mandates affordable healthcare for all citizens in this state. This ruling went into effect recently and has shifted the landscape for medical insurance in Connecticut as well as in other states throughout the nation. Individuals have rights and responsibilities that they didn’t have before. It is important for all residents to become informed, enrolled, and covered.
It’s important to learn about the various plans, benefits, and coverage options that are available. There is a public marketplace available to consumers called Access Health CT that allows individuals to sign up for healthcare plans. Enrollment for these plans is open during specific windows each calendar year. If a person or family misses that window, there will be another opportunity to enroll by the end of the year for the next calendar year. The next scheduled enrollment period begins in November 2014 for coverage that starts in 2015. Some exceptions to this rule may be allowed for individuals who had unexpected changes such as cancelation of COBRA, loss of healthcare coverage due to divorce, and/or lack of affordable insurance premiums through employers.
Healthcare coverage plans are available in three tiers: Gold, Silver, and Bronze. The Gold plan pays the highest percentage toward claims and the Bronze plan pays the least amount toward claims. Percentages are:
- Gold pays 80% of medical bills
- Silver pays 70% of medical bills
- Bronze pays 60% of medical bills
With each of these tiers, the balance of unpaid medical bills would be paid out-of-pocket by the consumer. For example, Gold policyholders would pay 20% of their costs, Silver would pay 30%, and Bronze would pay 40% of amounts due.
Benefits of each plan are broad and comprehensive to cover an array of hospital and doctor bills. For example, emergency room visits, hospital stays, preventative check-ups, mental healthcare, prescription medications, and substance abuse counseling are covered in varying degrees, depending on the plan.
With this Supreme Court ruling on the books, citizens have new rights. For example, patients with pre-existing conditions cannot be denied health care coverage. Most plans allow for young adults up to age 26 to be covered under the umbrella of their parents’ policies. Patients have the right to select the doctor or hospital they want to go to, as long as the physician and medical facility are on the list of providers in their network.
With all the rights and privileges that come with the Affordable Care Act ruling, there are also some responsibilities that residents of Connecticut must accept.
- Residents must sign up for coverage during the enrollment period.
- Individuals must select the plan that is a fit for them.
- Citizens must pay a tax penalty if they do not have health insurance by 2014. This penalty is a percentage of their household annual income or a flat fee, whichever is greater. There are some exemptions based on income and length of time without coverage, and these should be discussed with an administrator.
The Affordable Care Act has changed the way Americans think about healthcare. In Connecticut, individuals who are residents, U.S. citizens, and not in jail are eligible for medical care that is covered by budget-friendly insurance.