What Is Access Health Insurance and Who Is Eligible?

Access Health CT is Connecticut’s official health insurance marketplace. This platform was established under the federal Affordable Care Act (ACA) to provide a centralized location for residents to compare and enroll in health and dental insurance plans. Its purpose is to increase the number of insured individuals and families across the state. Small businesses can also utilize this marketplace to offer coverage options to their employees.

Eligibility and Enrollment Times

Individuals seeking health coverage through Access Health CT must meet specific residency and status requirements. Applicants must be residents of Connecticut and cannot be currently incarcerated. Those eligible for Medicare cannot enroll in a health plan through Access Health CT, though they may access standalone dental plans.

Some individuals with employer-sponsored health coverage may still qualify for plans through the marketplace. This occurs if the employer’s plan is not considered “affordable” or does not meet “minimum value” standards as defined by ACA guidelines. A plan is not affordable if an employee’s premium contribution exceeds a certain percentage of their household income. A plan meets minimum value if it covers at least 60% of the total allowed costs for covered benefits, including physician and inpatient hospital services.

For most people, the primary time to enroll or change plans is during the annual Open Enrollment Period (OEP). Access Health CT’s OEP runs from November 1st through January 15th for coverage beginning the following year. Enrolling by December 15th allows coverage to start on January 1st, while enrollment between December 16th and January 15th results in coverage beginning on February 1st.

Outside of the OEP, a Special Enrollment Period (SEP) allows individuals to enroll due to a qualifying life event. Common qualifying life events include losing existing health coverage, such as through job loss or divorce, or moving permanently to Connecticut. Other events like getting married, having a baby, or adopting a child also trigger an SEP. Individuals have 60 days from the date of the qualifying event to enroll in coverage through a SEP.

Understanding Health Plan Options

Access Health CT offers various health plan structures:
Health Maintenance Organizations (HMOs) require members to choose a primary care provider and get referrals for specialists, offering coverage primarily within a specific network.
Preferred Provider Organizations (PPOs) provide more flexibility, allowing members to see out-of-network providers for a higher cost and without referrals.
Exclusive Provider Organizations (EPOs) cover services only within their network, similar to HMOs, but may not require referrals.
Point of Service (POS) plans combine features of both HMOs and PPOs, requiring referrals for in-network care but allowing out-of-network services at a higher cost.

Plans available through Access Health CT are categorized into “metal tiers”: Bronze, Silver, Gold, and Platinum. These tiers reflect the percentage of healthcare costs the plan is expected to cover, on average.

Bronze Plans

Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs, such as deductibles and copayments.

Silver Plans

Silver plans balance moderate premiums with moderate out-of-pocket costs. They are the only plans eligible for Cost-Sharing Reductions.

Gold Plans

Gold plans feature higher monthly premiums but lower out-of-pocket costs when care is received.

Platinum Plans

Platinum plans have the highest monthly premiums but the lowest out-of-pocket expenses, making them suitable for individuals who anticipate frequent medical services.

Financial assistance is available to help make coverage more affordable. Advance Premium Tax Credits (APTCs) reduce the amount of the monthly premium individuals pay. These credits are based on household income and family size relative to the Federal Poverty Level (FPL) and are paid directly to the insurance company. People with household incomes between 100% and 400% of the FPL qualify for APTCs, with enhanced subsidies available for those at lower income levels.

Cost-Sharing Reductions (CSRs) are another form of financial assistance that lowers out-of-pocket costs, including deductibles, copayments, and coinsurance. CSRs are available to individuals and families with household incomes between 100% and 250% of the FPL. To receive CSRs, individuals must enroll in a Silver-level plan, as these reductions are not applicable to other metal tiers.

Applying for Coverage

The application process for health coverage through Access Health CT begins with creating an online account on their official website. This involves providing personal details, including your first and last name, a valid email address, and establishing a secure password. Users also select and answer security questions for future account access.

Once an account is established, the next step involves completing the online application. This application requires detailed information for all household members, even those not seeking coverage, such as dates of birth, Social Security Numbers, and any relevant immigration documents. Income information, including recent W2s, Form 1040s, 1099s, or pay stubs, is necessary for an accurate determination of eligibility for financial assistance. Information about any current health coverage is also requested.

After submitting the application, the system processes the provided information to determine eligibility for health plans and financial assistance. Users can then review and compare the available plan options presented on the portal. The interface allows filtering plans by various criteria, enabling individuals to select a plan that aligns with their healthcare needs and financial situation.

Selecting a plan involves adding the chosen option to a cart. The final step is to confirm the selection and complete the enrollment process within the online system. Following successful enrollment, pay the first premium directly to the chosen insurance company to activate the coverage. After enrollment and the first premium payment, individuals receive confirmation, insurance ID cards, and welcome packets from their selected carrier.