Access Health Enrollment Starts Sunday; Uninsured To Face Steeper Fines

Open enrollment for consumers to buy health insurance through the Access Health CT marketplace begins Sunday, and 2016 will bring considerably steeper fines for consumers who lack insurance.

Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years.

The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Consumers, particularly those who are uninsured, may have noticed AHCT’s increased marketing efforts.

AHCT has increased its public awareness campaign, she said, including identifying 640 “community influencers” at more than 330 locations across the state to help spread the word. Those people include politicians, teachers, nurses, faith-based leaders and others within various communities that have a large uninsured population, she said.

The organization also reached about 270,000 people during the summer, when representatives attended dozens of community events statewide as part of a campaign to boost awareness, Ravitz said.

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment, which runs from Sunday through Jan. 31, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2016, consumers can shop on the marketplace for plans offered by Anthem, ConnectiCare, HealthyCT and United Healthcare. Coverage begins as early as Jan. 1, but those who want coverage to start on that date must enroll by Dec. 15.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Sunday to enroll in plans, enrollment is open year-round to people who have experienced a qualifying life event, such as the birth of a child, a death in the household, a marriage, or a loss of coverage.

Also, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

The number of insured Connecticut residents is on the rise, according to U.S. Census Bureau figures and AHCT.

AHCT officials said earlier this month that an analysis by the marketplace found 3.8 percent of Connecticut residents are uninsured this year, down from 4 percent last year.

Census figures paint a slightly different picture, but still show steady improvement in the state. The Census estimates 7 percent of Connecticut residents lacked health insurance in 2014, down from nearly 10 percent in 2013, according to data released in September.

Paying The Price For No Insurance

Those who don’t have health insurance will face heftier fines in 2016. Most people without coverage in 2016 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2016 returns in early 2017, and will be asked on their returns whether they had insurance coverage in 2016.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

In 2015, consumers with no coverage will pay 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay the fine will see it deducted from future tax refunds.

Update And Compare Plans for 2016

People enrolled in the health insurance marketplace can re-enroll or choose a new plan for 2016.

Consumers should update their income and household information for 2016 and review all new insurances plans and pricing.

Even those who plan to keep their current plans should update their household information; it’s the only way to ensure any tax credits they may be eligible for in 2016 are accurate. Consumers can update household information as soon as Sunday.

Plans and prices change each year and those who don’t research 2016 options may spend more than they need, get an outdated premium tax credit or be enrolled in a plan for which they are no longer eligible. Some may mistakenly get a higher tax credit than they qualify for, meaning they will have to pay back some or all of it when they file federal taxes.

“Go check your options,” Ravitz said. “There could be some extra savings.”

Rules Changing For Businesses

Under the federal law, employers with 50 or more full-time-equivalent employees must offer their full-time, eligible workers “minimal essential coverage” that is affordable, or face penalties.

Starting in 2016, however, “how you count those employees is different,” said Ken Comeau, senior vice president of the Connecticut Business & Industry Association. The change could result in businesses having to offer coverage to more workers.

Currently, businesses must provide insurance coverage to full-time workers if they have 50 full-time-equivalent employees, which historically has referred to those who work full time. But beginning Jan. 1, businesses must calculate their full-time-equivalents by taking into account all full-time workers and prorating hours worked by part-time employees, Comeau said.

The change will impact businesses that have few full-time employees but many part-timers, such as restaurants, he said. Full-timers work 30 hours a week or more; part-timers work fewer than 30 hours.

Additionally, through this year, businesses with 50 to 100 full-time-equivalent employees that haven’t offered the required coverage haven’t been penalized. But as of Jan. 1, that “transitional relief” disappears and businesses not complying with the law may face penalties, Comeau said.

Sources: Healthcare.gov, Access Health CT, Connecticut Business & Industry Association