Frequently asked questions

Frequently asked questions

Get answers to your health care coverage questions.

General
What is Access Health CT?
Access Health CT is Connecticut’s official health insurance marketplace. It offers Connecticut residents and small employers a range of qualified health care coverage options from health insurance carriers and public health care programs. You can get the coverage you need online, over the phone or in person.

Access Health CT is also the only place in Connecticut where individuals, families, and small businesses can get financial help with their health care coverage costs, if they qualify.

Access Health CT was established to meet the requirements of the federal Health Care Reform law (or Affordable Care Act), which gave states the opportunity to either establish their own “health insurance exchange” (or marketplace) or allow the Federal government to operate an exchange on behalf of their state’s residents. Such exchanges became operational on October 1, 2013.

Can anyone use Access Health CT?
Access Health CT is open to all legal residents of Connecticut. To obtain health care coverage through Access Health CT, you must live in Connecticut, be a U.S. citizen or lawfully present, and cannot currently be incarcerated.

Access Health CT is for you if:

  • You need healthcare coverage

  • Your employer doesn’t insure you or doesn’t offer affordable coverage

  • You’re self-employed

  • You’ve been denied insurance due to a pre-existing condition

  • You’re insured but looking for cost savings

When should I go to Access Health CT and when should I go to ConneCT?
Go to Access Health CT to shop for health care coverage. You can see if you are eligible for a Qualified Health Plan (QHP) or HUSKY A, HUSKY D or HUSKY B-CHIP. You should report any changes in your personal information to Access Health CT – including address, income, and number of household members – as these changes may qualify you for additional health subsidies.

Go to ConneCT to see if you are eligible for benefits administered by the Department of Social Services (DSS), such as food assistance, cash assistance and medical benefits for adults, children, elderly, and disabled people. At ConneCT, you can get information about your DSS benefits, manage your application and renewals for those programs, and find out about other DSS programs you may be eligible for.

When I call Access Health CT (855-805-4325), why am I asked for my social security number and date of birth?
It helps us to serve you better. With this information, we can keep a secure and confidential record of your calls and questions, which benefits you in two important ways:
  1. You will not need to repeat the same information each time you call.
  2. Our representatives can quickly see what issues are important to you and focus their responses on those topics and related topics.
Will my personal data be safe and secure?
We’ve put safeguards into place to ensure that any information you provide to us is secure. As noted in our Privacy Policy, we may share personal information that you provide to us with state and federal government agencies and private data clearinghouse firms to verify and supplement this information. Otherwise, we do not share any information with third parties (unless we’ve informed you about it or have prior consent). Our policy is to respect and protect the privacy of our users, consistent with the applicable laws of the United States and the State of Connecticut. For more information, please refer to our Privacy Policy.
Enrollment
When can I enroll through Access Health CT?
The open enrollment period for 2014 ends on March 31, 2014. If you don’t enroll by March 31st and you don’t have a special enrollment qualifying event at another point in the year, you won’t be able to purchase insurance on the exchange until the next open enrollment period which will be for the 2015 plan year. To get health care coverage for 2015, you can enroll anytime during the next open enrollment period, which is scheduled to run from November 15, 2014, through February 15, 2015. Coverage purchased in that period will begin as early as January 1, 2015.
Can I get coverage through Access Health CT before the start of 2015 open enrollment in November 2014?
It depends on whether you or someone currently on the same health insurance plan as you has a “qualifying event” which may allow you to purchase coverage outside of the open enrollment period. If you qualify for Medicaid or CHIP (Children’s Health Insurance Program), you can enroll at any time for only those programs. See if you’re eligible now by entering your household Modified Adjusted Gross Income.

Qualifying events are significant economic or life change, such as getting married or divorced, losing your job, losing your current health insurance coverage, having a child, or moving from another state into Connecticut. If you have one of these “qualifying events,” you will get a special enrollment period which lasts 60 days from the date of the qualifying event. During this time, you can enroll in a health insurance plan, change your plan (either metal tier, insurance carrier or both), or add a newly eligible beneficiary to your current plan. It is important to report the qualifying event early so that you’ll have as much time as possible to enroll.

To request a special enrollment period, please call Access Health CT at 1-855-805-4325.

What economic or life changes are considered “qualifying events”?
Examples of qualifying events include:
  • Getting married

  • Having or adopting a child

  • Permanently moving to Connecticut from another state

  • Losing other affordable, minimum essential health care coverage – for example, due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health care plan being decertified. (Note that voluntarily stopping other affordable, minimum essential health care coverage or being terminated for not paying your premiums are not considered loss of coverage. This does not apply to stopping COBRA early where your employer has ceased their contributions)

  • For people already enrolled, having a change in income or household status that affects eligibility for tax credits or cost-sharing reduction plans

If you have a qualifying life event, you can get a health insurance plan outside the annual open enrollment period. You’ll get a special enrollment period that will give you 60 days from the date of the qualifying event to get coverage. Your complete enrollment must take plan within this 60 day period.

To request a special enrollment period, please call Access Health CT at 1-855-805-4325. You may be asked to provide documentation showing you qualify for this enrollment exception.

(You can also print a summary of this.) (También puede imprimir un resumen de esto.)

How long will the enrollment process take?
For those individuals or small households that don’t require assistance, we estimate that it may take about 30–45 minutes to complete the enrollment process. For larger households, or those with complex situations or eligibility issues, it may take longer.
Do I have to enroll online?
No. While our website provides an easy and convenient way to compare plans, get financial help (if you qualify), and enroll in health care coverage, you can also:
  • Apply in person through a trained and certified insurance broker or In-Person Assister – either at an Enrollment Center or at one of our Enrollment Fairs throughout Connecticut.

  • Call us at 855-805-4325 to talk with a trained specialist who can answer your questions and guide you through the enrollment process – in many different languages.

Who can help me enroll?
Access Health CT has trained and certified individuals to help you enroll:

Brokers are licensed insurance agents who can recommend a plan and enroll you.

Navigators and In-Person Assisters are certified and can give you general guidance about health care coverage and help you enroll.

Certified Application Counselors are in community health centers, hospitals, health care providers, and certain governmental entities and can also help you enroll.

Find contact information for certified brokers, In-Person Assisters and Certified Application Counselors in your area now.

How do I know who is trained and certified to help?
Call us at 855-805-4325 and/or search through our list of certified brokers, In-Person Assisters and Certified Application Counselors (CACs).
If I have a problem with a broker, In-Person Assister, or other Access Health CT representative, who should I contact?
Please contact our call center at 855-805-4325 for further assistance.
Will Access Health CT provide any help for non-English speakers?
Yes! We offer telephone support in over 30 languages. In-person support is also available in a number of languages. Please search through our list of certified brokers, In-Person Assisters and Certified Application Counselors (CACs) to find an individual who is fluent in your language.
Can I enroll in Medicaid through Access Health CT?
Yes. Almost all Medicaid applicants should use the Access Health CT website, call center, or visit one of our Enrollment Centers to apply for Medicaid coverage. Coverage chosen from the Access Health CT system may take effect immediately, once your eligibility is confirmed by the Connecticut Department of Social Services (DSS). Those who are eligible for Medicaid due to the fact that they are aged (Medicare dual-eligibles), blind, or disabled should still apply through DSS directly.

If you qualify for Medicaid (or CHIP), you can enroll any time – you do not have to wait for the open enrollment period.

I enrolled in a health plan or program and want to change to a different option. How can I do this?
You may only change your plan during open enrollment or a special enrollment period. Once you enroll in a health plan or program, you cannot change your selection through change reporting unless you have a special enrollment Qualifying Life Event. If you do not have a Qualifying Life Event, please return during the next open enrollment period to pick a new plan.
Once I enroll and pay my premium, when does my health care coverage begin?
In most cases, if you enroll by the 15th of the month, your coverage will begin on the 1st day of the next month. If you enroll after the 15th of the month, in most cases your coverage will be delayed a month longer than if you had enrolled by the 15th. If you enroll during a special enrollment period and you are eligible due to a non-voluntary loss of your current affordable minimum essential coverage or you are eligible due to a marriage to a currently enrolled person, your coverage will begin on the first of the next month no matter what day you complete your enrollment in the preceding month. During the next open enrollment period, which starts on November 15, 2014, in order to have your coverage begin on January 1, 2015, you must enroll no later than December 15, 2014, and follow your carrier’s instructions on how and when to pay your premium.
After enrollment
I’ve just enrolled in a plan through Access Health CT. What happens next?
Now that you’ve enrolled, you’ll be receiving some additional materials from Access Health CT and your new insurance carrier. Please note that these materials may vary depending on the plan you chose.

Confirmation Letter: About 3 days after enrolling through Access Health CT. Access Health CT will send you a letter confirming your enrollment and the carrier and plan you chose. Please note that if your application was incomplete, you may receive a letter requesting additional information to complete your enrollment.

First Bill: About 10–14 days after your enrollment is complete. Your insurance carrier will send you a bill with directions on how to make your first payment and when it is due.

Member ID Card: About 1–2 weeks after you receive your first bill. You’ll receive your Member ID card from your carrier after you’ve made your first premium payment. This is the card you’ll share with medical providers and pharmacies when you receive service. Your carrier may allow you to print a temporary ID card if you need care prior to receiving your Member ID card(s).

Pharmacy and Provider Directories: See your carrier’s website: anthem.com connecticare.com healthyct.org

Your Pharmacy Directory lists pharmacies in your carrier’s network that you can use to fill prescriptions. Your Provider Directory lists doctors, specialists, and hospitals in your carrier’s network that provide covered services.

(You can also print a summary of this.) (También puede imprimir un resumen de esto.)

Who do I contact for information about my plan benefits and payments?
Once you’ve enrolled in a health care plan through Access Health CT, you should direct any questions about that plan to the plan provider you chose.

Anthem: 1-855-738-6644 or anthem.com ConnectiCare Benefits Inc.: 1-860-674-5757 or 1-800-251-7722 or connecticare.com Healthy CT: 1-855-458-4928 or healthyct.org

Access Health CT will not be able to assist you with questions about your individual plan. If you have not yet enrolled in a plan and are still shopping for coverage, feel free to contact us at 1-855-805-4325.

I was deemed eligible for HUSKY Health. Who do I contact if I need more information?
Please contact the Department of Social Services at 1-855-6-CONNECT (1-855-626-6632) (TTD/TTY 1-800-842-4524 for persons with speech or hearing difficulties). Follow the prompts to find the information you need. You can also visit the Husky Health website.
Eligibility
Can I really get coverage if I have a pre-existing health condition?
Yes. Coverage for those with pre-existing conditions was one of the big changes made possible by the Federal government’s Affordable Care Act. As of 2014, you cannot be denied coverage or charged more for medical coverage just because you have a pre-existing health condition. In Connecticut, your cost will be calculated based on the person seeking coverage’s age, geographic location (county), whether you smoke and the coverage you choose. Insurance purchased from Access Health CT will not consider whether you smoke or not.
I live in Connecticut, but work in another state. Where should I apply for coverage?
Apply in the state where you are working if you wish to be covered by employer-sponsored health insurance. If you choose not to be covered by your employer’s insurance, you could obtain individual or family coverage through Access Health CT if you are a Connecticut resident, but you would only be eligible for subsidies (such as premium tax credits and/or cost sharing reduction plans) if the employer-sponsored coverage was unaffordable or did not meet certain minimum essential coverage requirements.
Can I still get coverage if I am not a U.S. citizen?
Under the Affordable Care Act, you may be able to get coverage as long as you are living in the U.S. legally. To determine if you may be legally present, see if you fit into one of the following categories:
  1. Lawful Permanent Residents (LPR). You are a lawful permanent resident if you have permission to live and work in the U.S. Applicants for LPR status may also qualify.
  2. Refugees and others who can’t return to their home country. This group includes people who were granted asylum, and those whose deportation or removal was temporarily paused.
  3. Humanitarian immigrants, including:
    • Certain Cuban and Haitian nationals

    • Individuals paroled into the U.S. or granted temporary protected status

    • Children who have applied for special immigrant juvenile status

  4. Survivors of domestic violence, trafficking, and other serious crimes, including:
    • Abused spouses and children who qualify for protection under the Violence Against Women Act (VAWA), as well as parents and/or children of an abused spouse or child

    • Immigrant survivors of human trafficking

    • U-Visa holders

  5. People with valid non-immigrant status, including:
    • Visa holders such as tourists, students and visitors on business

    • Citizens of Micronesia, the Marshall Islands or Palau

  6. Longtime residents, including:
    • Non-citizens who gained legal status under the Immigration Reform and Immigrant Control Act of 1986

    • Individuals who qualify for Family Unity status, protecting them from deportation or removal

    • Individuals whose removal would cause extreme hardship to themselves or others

There are other situations where non-citizens or immigrants may be eligible for health care coverage. For further details, please talk to an Access Health CT representative.
I am an illegal immigrant but I pay income tax. Can I get coverage?
Sorry, you will not be able to obtain health care coverage through the Access Health CT marketplace. Generally, only Connecticut residents who are U.S. citizens or lawful residents can obtain coverage through Access Health CT.
What are my options if I have a work or student visa?
If you have a work or student visa, you will qualify for coverage through Access Health CT.
Can a same-sex married couple obtain health care coverage through Access Health CT in the same way that heterosexual married couples do?
Yes. In Connecticut, “marriage” is defined as the legal union of two persons. Also, the IRS recognizes a marriage of same-sex spouses that was entered into validly in a state whose laws authorize the marriage of two individuals of the same sex. This area of the law is still evolving and this answer may be updated as more guidance is issued.
What if I get divorced?
If you get divorced or experience another special enrollment qualifying event (including moving to a new state, certain changes in your income, and losing your current coverage), you may be eligible to obtain health care coverage through Access Health CT during a special enrollment period outside of the open enrollment period. Talk to an Access Health CT representative if you would like more information about this.

If you have employer-sponsored coverage through your former spouse, you may also be able to purchase federal or state COBRA continuation coverage for a limited time. If you buy COBRA continuation coverage and your employer continues to contribute toward such policy, you may not be eligible for premium tax credits or cost sharing reduction plans. If your employer stops contributing to such coverage, it may become “unaffordable” which may allow you to qualify for premium tax credits.

What is the age limit for keeping my child on my plan?
The Affordable Care Act allows parents to keep their children on their health insurance plan until age 26.
My employer doesn’t offer coverage, but my spouse’s employer does. Can I still get individual coverage through Access Health CT?
Yes, you can buy individual insurance through Access Health CT. However, if you could be covered by the plan offered by your spouse’s employer – and this plan was affordable and met certain other requirements – you would not be eligible for premium tax credits or cost-sharing reductions for the coverage you obtain through Access Health CT.
Even if my employer offers insurance, can I still purchase an individual plan through Access Health CT?
Yes, but if you buy an individual plan through Access Health CT, you may not qualify for financial help, such as lower costs on your monthly premiums or lower out-of-pocket costs. It will depend in part on your income and in part on whether the insurance your employer offers meets certain standards for cost and coverage.
What if I’m on Medicare?
If you are on Medicare, you don’t need to do anything. You are considered covered and will not owe a penalty for not having health coverage. Note that Access Health CT does not offer Medicare supplement insurance or Part D drug plans. If you’d like more information on these programs, you can visit Medicare.gov.
Can I qualify for a catastrophic plan if I am over age 30?
Yes, but you must first be approved for an individual exemption based on affordability or hardship (including those whose former plans were dropped or cancelled due to the Affordable Care Act). To see if you qualify for these exemptions, check out the exemption form [PDF]. While those who are under 30 years old may enroll in a catastrophic plan without an exemption, if you are 30 or older you will only be able to shop for catastrophic plans if your exemption application is approved.
Coverage
What should I do if I need coverage before January 1, 2015?
If you need coverage before Access Health CT plans become effective on January 1, 2015, you have a few options:
  1. HUSKY Healthcare offers coverage to eligible children, parents, relative caregivers, elders, individuals with disabilities, adults without minor children, and pregnant women. If eligible, you may enroll in Medicaid or CHIP at any time of the year. Eligibility is based on your family’s income level. Call 877-284-8759 or visit http://www.huskyhealth.com.
  2. The Charter Oak Health Plan offers a health benefits package to uninsured adults (age 19-64) of all incomes. Call toll-free at 1/877-841-2353, or visit http://www.healthinsurancesort.com/ppc/charter-oak
  3. You can also look into an individual policy from a commercial insurance company.
Can I keep my current doctor who is out of state?
You may be able to keep all of your current physicians, but keep in mind that some doctors outside of our state may be out-of-network. While you can still see them, your insurance provider may not cover as much (or any) of the cost of an out-of-network non-emergency visit. It is important that you contact the insurance company to ask them about their network outside of Connecticut and make sure that you know if your specific doctor is in-network or not.

Lists of in-network providers are available through the insurance company’s website and will also tell you whether the provider is accepting new patients. There is a link for each carrier in our plan selection page as well.

How do I know that Access Health CT offers quality health care coverage?
The coverage offered by Access Health CT includes Medicaid, CHIP and plans from name-brand insurance companies. All of the insurance companies in our marketplace will offer plans with competitive pricing and benefits. You can be sure that the plan you choose will cover at least 60% of your annual medical costs. Some plans will cover 70% or 80%. In addition, all coverage offered through Access Health CT will provide a common set of “Essential Health Benefits” as required under the Affordable Care Act, and will meet standards for quality and value set by the State.
Which health insurance companies offer individual and family coverage through Access Health CT?
We’re happy to offer you several choices:
  • ConnectiCare

  • HealthyCT

  • Anthem (medical coverage plus stand-alone dental coverage)

  • MetLife (stand-alone dental coverage only)

What’s the difference between the Gold, Silver, and Bronze plans?
The Gold, Silver, and Bronze plan categories cover different percentages of your medical expenses (see chart below). These three basic categories of coverage make it easy to compare plans in the same category or across categories. Health insurance plans that cover more of your expenses when you receive health care services – for example, when you visit the doctor or go to the hospital – will typically have a higher monthly premium.
Plan Tier Expenses paid by plan Expenses paid by individual
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
What benefits are covered?
All coverage offered through Access Health CT provides the same set of “essential health benefits,” which include:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • Emergency services

  • Hospitalization (such as surgery)

  • Maternity and newborn care (care before and after your baby is born)

  • Mental health and substance use disorder services, including behavioral health treatment (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 and chronic disease management

  • Pediatric services

Essential health benefits represent the minimum services that all plans must cover, inside or outside the Access Health CT marketplace. Some plans may offer additional covered benefits or even more reduced cost sharing for some services.

When you sign up, the Evidence of Coverage (EOC) on the plan information page will show you each plan’s coverage so you can compare the benefits side-by-side. In addition, once you choose a plan, the carrier will send you a Summary of Plan Benefits that should be used as a reference. You may contact the carrier for clarification of the coverage provided by your plan if you need further assurances or guidance.

Do you offer “catastrophic” coverage?
Yes. People under age 30, or those who are older than 30 and have an Access Health CT-approved hardship or affordability exemption, may purchase a “catastrophic” health plan through Access Health CT from the following individual marketplace insurers:
  • Anthem

  • ConnectiCare

  • Healthy CT

“Catastrophic” health plans protect you from very high medical costs caused by an unanticipated condition or event. You are generally required to pay all of your medical costs up to a certain amount, as determined by the IRS yearly. Costs for essential health benefits over that amount are generally paid by the insurance company. You will also get three primary care visits per year at no cost, as well as key preventive benefits at no cost.

Premiums tend to be lower with a catastrophic plan as compared to a traditional health insurance plan. However, if you qualify for and buy a catastrophic plan, you won’t be eligible for tax credits that may lower your premium costs or for other subsidies.

When you fill out an application for coverage, you’ll see catastrophic plans listed as an option if you qualify for them. If you don’t qualify, you won’t see them as an option to select.

Can I get a plan with a Health Savings Account (HSA) through Access Health CT?
HSAs might be offered by the insurance carriers or outside vendors, but Access Health CT does not offer them. A consumer who purchases a plan through us may enroll in an HSA only if that plan is a High Deductible Health Plan (HDHP). Only catastrophic plans in our health insurance marketplace may pass for HDHPs.
Can I get dental coverage through Access Health CT?
All of our plans cover pediatric dental services as a minimum dental benefit. Some pediatric dental services that are preventative are free of all cost sharing. In addition, we currently offer stand-alone dental coverage. You can purchase this coverage in addition to your health insurance plan for anyone who does not have dental coverage or wants increased benefits.

Please note that the dental benefits are not subject to the out-of-pocket maximum established by the Affordable Care Act. Also, any advanced premium tax credits that a person receives through the Access Health marketplace cannot be used to help pay for the costs of stand-alone dental plans.

Note that the Affordable Care Act treats dental coverage differently for children versus adults. For children, dental coverage is an “essential health benefit,” which means it must be made available either as part of a health plan or a stand-alone plan. Insurers do not have to offer adult dental coverage.

Tax penalties
Who will be subject to a tax penalty?
As of January 1, 2014, most U.S. residents are required to have health care coverage. You (and each person in your tax household who doesn’t have coverage) may be assessed a tax penalty unless you qualify for an exemption.
When do I need to have coverage to avoid a tax penalty?
If you signed up for health care coverage by March 31, 2014, or are enrolled in coverage from another program or an employer plan by March 31, 2014, and maintain that coverage throughout the year, you will not be subject to the tax penalty for not having health coverage for 2014.

If you need health care coverage for 2015, you must enroll between November 15, 2014 and February 15, 2015 to avoid a tax penalty.

What are the tax penalties for individuals and how will they be assessed?
For each month of 2014 that you did not have coverage, you will be assessed a penalty equivalent to 1/12 of the yearly penalty.

The federal government has set the following yearly tax penalties for individuals who do not have coverage:

  • For 2014, 1% of your gross household income over the federal income tax filing threshold, or $95 per individual – whichever is greater.

  • For 2015, 2% of your gross household income over the federal income tax filing threshold, or $325 per individual – whichever is greater.

  • For 2016, 2.5% of your gross household income over the federal income tax filing threshold, or $695 per individual – whichever is greater.

The law provides exemptions for certain individuals, including those below a certain income and those who are without coverage for fewer than three consecutive months.

What are the tax penalties for small businesses that do not sign up for health care coverage?
If you are a business owner with fewer than 50 full time or full-time-equivalent (FTE) employees, you will not have to pay a penalty if you do not provide insurance to your employees. If you have 51-99 employees there is no penalty for not providing affordable or minimum essential coverage until 2016, however, you will be required to report to the IRS and DOL as to your FTE counts and any coverage you do provide starting in 2015. If you have 100 or more FTE employees and do not provide minimum essential coverage or affordable insurance to your employees, you may be subject to penalties starting in 2015.
What kind of coverage do I need to avoid the tax penalty?
If you are covered by any of the following throughout 2014, you will not have to pay a tax penalty:
  • Any plan you get through Access Health CT or any individual insurance plan you already have

  • Any employer plan that qualifies as minimum essential coverage, including COBRA or retiree plans

  • Medicare

  • Medicaid

  • The Children’s Health Insurance Program (CHIP)

  • TRICARE

  • Veterans Affairs Health Program

  • Peace Corps Volunteer Plans

  • Other plans may also qualify. Ask Access Health CT if you’re not sure.

Is anyone exempt from the tax penalty?
Currently, there are a number of situations where someone may be exempt from the tax penalty, including:
  1. Religious objections (that is, you are a member of a recognized religious sect with religious objections to insurance or elements of minimum essential coverage)
  2. Member of a recognized health care sharing ministry
  3. Incarcerated individuals
  4. Member of a federally-recognized American Indian tribe (a non-member spouse can be exempt if they apply for a hardship exemption)
  5. Certain hardships such as homelessness or foreclosure – see healthcare.gov/exemptions for full list
  6. Income too low for you to be required to file a tax return
  7. Inability to afford health care coverage – the cheapest bronze option would cost more than eight percent of your household MAGI income
  8. Short coverage gaps (fewer than 3 consecutive months), although if you do not become covered before the end of the 3 month period, you cannot take advantage of this exemption.
  9. Persons not lawfully present in the United States

To apply for an exemption, you’ll have to fill out an exemption form [PDF].

(You can also print a summary of this.) (También puede imprimir un resumen de esto.)

Financial help
What are the income limits to qualify for financial help on coverage offered through Access Health CT?
Depending on your income and household size, you may qualify for different types of financial help.

If your income is below a certain level – for example, $15,856 or less for a single person or $43,567 or less for a family of four – you may qualify for Medicaid.

If you earn up to $45,960 a year as a single person, you may qualify for tax credits to help cover your monthly health insurance payments. Families may also be eligible, depending on income and size. For example, a family of four earning up to $94,200 a year might qualify. Tax credits are applied toward your monthly health insurance premiums.

Finally, if you choose coverage from the “Silver” category and your income is below 250% of the poverty level (estimated at about $29,000 for an individual or $60,000 for a family of four in 2014), you may be eligible for cost-sharing reductions. These subsidies would reduce the amount you pay out of pocket for essential health benefits.

Do I qualify for Medicaid?
Eligibility for Medicaid has expanded in many states, including Connecticut.

Whether you qualify will depend on your income level. Single or Connecticut residents without children with household incomes up to 138% of the federal poverty level may be eligible. There are higher income thresholds for pregnant women (263%), children (201%) and parents or caregivers of Medicaid eligible children (201%).

Connecticut residents above these income levels may be eligible for financial help with a qualified health plan purchased through Access Health CT.

When you fill out an application with Access Health CT, you’ll learn if you or your children qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Do I qualify for tax credits to help pay my health insurance premiums?
Yes, if you meet the following criteria:
  1. You are not eligible for qualifying health care coverage, such as affordable employer-sponsored coverage, or a government program, such as Medicaid.

  2. You are a Connecticut resident and a citizen or lawful resident of the United States, and not incarcerated (other than pending final disposition of charges).

  3. Your household income is between 100% and 400% of the federal poverty level.

  4. You enroll in coverage through Access Health CT.

You must also file a tax return (a joint return, if married) and not be claimed as a dependent on anyone else’s return.

How will I receive the tax credit?
Your tax credits will be paid monthly, directly to the health insurer that you enrolled with through Access Health CT.
I understand the amount of the tax credit I receive is based on my MAGI income. What happens if my income changes during the year?
If your actual MAGI income at the end of the 2014 tax year is lower than you projected on your application for coverage, you may be entitled to additional financial help. If that is the case, the additional amount may be returned to you in the form of a tax refund (or subtracted from your balance due).

On the other hand, if your MAGI income is higher during the 2014 tax year than you projected, you may have received more financial help than you should have. In this case, you may need to reimburse the government for some of the tax credit that was paid on your behalf to your insurer (or it may be subtracted from your refund).

Should I claim the tax credit on my taxes?
Yes. Although the tax credit is paid directly to an insurer on a monthly basis, it is in fact a tax credit that must be claimed on your annual income tax return.
Can my husband and I qualify for the tax credit if we file separately?
Sorry. The Affordable Care Act prohibits married couples who file their taxes separately, rather than jointly, from receiving premium tax credits.
Should I include veteran disability benefits in my household income?
Your household income is one of several items used to determine your eligibility for premium tax credits. While we cannot provide tax advice, when applying for subsidies through Access Health CT, veterans’ disability benefits should not be included in your household income.
What is the difference between copayment and coinsurance?
Copayment is a fixed amount (for example, $15) that you pay for a covered health care service, usually at the time you receive the service. The amount can vary by the type of covered health care service.

Coinsurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any annual deductibles you owe in the plan year. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance plan pays the rest of the allowed amount.

Small business
Can my small business use Access Health CT?
Yes, if you own or operate a small business with 50 or fewer full-time-equivalent employees, you can start offering AHCT Small Business coverage to your employees at any time of the year. Sole proprietors with no employees are not eligible for employer plans through the AHCT Small Business Marketplace.

Your business may also be eligible for small employer tax credits to help you offer such coverage to your employees and, if you choose, their beneficiaries. The small business tax credits, up to a 50% insurance contribution reimbursement, are available to those businesses with less than 25 FTEs and where their employers make less than an average of $50,000 per year. (The owner and their direct family members are not counted in such calculations).

What happens if I don’t offer coverage to my employees?
If you have fewer than 50 employees, you are not required to offer coverage and there is no penalty. Your employees can get health care coverage from Access Health CT’s individual marketplace.

If you have 50 or more employees, you might have to pay penalties each year beginning in 2015 if you don’t offer coverage or if the coverage you offer doesn’t meet certain minimum standards.

Where can I find the Employer ACA notice that I was required to show my employees by October 1, 2013?
The Affordable Care Act required employers to notify their employees about the new government-run health insurance marketplaces by October 1, 2013. Employers must also provide this notice to each new employee at the time of hiring (for 2014, this means within 14 days of the employee’s start date). The Department of Labor (DOL) has provided employer notices that you may use.
Some of my employees don’t live in CT. How do I handle that?
Eligibility is based on an employer’s address. So, if you offered coverage through Access Health CT’s SHOP program (Small Business Health Options Program), your out-of-state employees could take advantage of it. If you do not offer health care coverage, your out-of-state employees would not be able to use Access Health CT’s marketplace for individuals since they are not Connecticut residents. Instead, they would need to get coverage in their home state.
Which health insurance companies offer small business coverage through AHCT?
We’re happy to offer you several choices:
  • HealthyCT

  • United Healthcare

  • Anthem (medical coverage plus stand-alone dental coverage)

  • MetLife (stand-alone dental coverage only)

What kind of plan choices can I offer my employees?
There are three basic categories of coverage offered through Access Health CT– Gold, Silver and Bronze. Different plan categories will cover different percentages of an individual’s medical expenses (see chart below). Health insurance plans that cover more expenses will typically have a higher monthly premium.
Plan Tier Expenses paid by plan Expenses paid by individual
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%

Through Access Health CT, you can offer plans from either a single insurance carrier covering all three categories or plans from multiple carriers covering only a single category.

How does the small business tax credit work?
Small businesses that qualify may receive a tax credit that will pay up to 50% of their contribution to their employees’ premiums (up to 35% for qualifying non-profits). The small business tax credit will be available for two consecutive years beginning in 2014. For the 2014 calendar year, businesses will receive the tax credit when they file their income taxes in 2015.

To qualify, a small business must do the following:

  • Have fewer than 25 full-time-equivalent (FTE) employees

  • Contribute at least 50% of each employee’s insurance premium

  • Pay an average annual wage of less than $50,000

Sole proprietors, shareholders of more than 2% of an “S” corporation and owners of more than 5% of other businesses (and any family members of these owners) are not counted as employees and their incomes and hours worked are not factored into any calculations relating to the tax credit.

How do I calculate the number of full-time-equivalent (FTE) employees I have?
The number of FTE employees you have is based on the total hours that your employees put in, not the number of people you employ. You can calculate this number by first totaling the hours worked by your employees. (Do not include any time worked over 2,080 hours by any employee when totaling the number of hours worked.) Then divide the total hours by 2,080 (2,080 is the number of hours worked in 40-hour work week for a single year), and round down to the nearest whole number.

The IRS also permits employers to use other methods to calculate the total number of hours of service, based on a days-worked equivalency (where the employee is credited with 8 hours of service for each day for which payment is made or due, including days of paid leave) or weeks-worked equivalency (where the employee is credited with 40 hours of service for each week for which payment is made or due, including weeks of paid leave).

When determining FTEs and average annual wages, don’t count seasonal employees – that is, those who work 120 or fewer days a year – and don’t count certain business owners (sole proprietors, shareholders of more than 2% of an “S” corporation and owners of more than 5% of other businesses), partners in a partnership, or their families.

Will providing health care coverage be difficult to manage?
No. Even though you can offer your employees a choice of plans that vary in cost and coverage, your costs won’t change. You control the amount of your contribution, so you’ll have a very predictable health insurance budget.

Paying for insurance through Access Health CT is simple. Again, even if your employees choose different plans, you’ll only have to make one payment each month to Access Health CT.

You can also choose when to participate in Access Health CT, the types of coverage you want to offer, and whether you want to contribute to family or dependent premiums.

Brokers
How will I benefit from using Access Health CT?
Due to the new Health Care Reform law, many more people are now required to have health care coverage. A large percentage of them will need help enrolling, which means you have a great opportunity to generate more business. Even better, you will get full commission for enrolling people in qualified health plans, even if they are eligible for tax credits.
What are the requirements for brokers?
To sell qualified health plans through Access Health CT, you must first be trained and certified by Access Health CT. Once you’ve done that, you can use our marketplace to enroll individuals and small businesses in the health care coverage they need. A great option is to get involved at an:
  • Access Health CT Enrollment Center – a drop-in “storefront” location that provides Connecticut residents with an easy way to get one-on-one help

  • Access Health CT Enrollment Fairs – three-hour events, mostly in the evening, held throughout the state

  • At our Enrollment Centers and Enrollment Fairs, we will pre-qualify people for a qualified health plan (as opposed to Medicaid) and make sure they have the information they need to start an application. You’ll take it from there.

    To learn more about getting trained and certified and to get further details about the opportunities available to brokers, please visit the dedicated broker page on our website.

Using our website
What are the browser requirements to optimally view the AccessHealthCT.com website?
The AccessHealthCT.com website is compatible with Internet Explorer 8+, and any version of Google Chrome, Mozilla Firefox, Safari and Opera downloaded within the last four years.
Can I have multiple windows or tabs open as I use the AccessHealthCT.com website?
No, the system is not designed to work with multiple tabs or windows open at the same time. When you start your browser application, make sure only one window is open at a time. The system also works best when you delete cookies and temporary Internet files when you log out.
How do I upload a requested verification document to the AccessHealthCT.com website?
The system will only allow you to upload one verification document. Before uploading a verification document, follow these steps:
  1. If several sources of verification information are required, scan all of them and combine them into a single Word document.
  2. Save the document as a .pdf or .bmp
  3. Ensure that the document size is 2 MB or less

If you are having issues combining your information into a single verification document, send the documents by mail to the Access Health CT processing center:

Access Health CT P.O. Box 670 Manchester, CT 06045-0670