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Affordable Care Act: Insurance exchange begins Oct. 1

weston-pills-drugs-medicineThe Affordable Care Act — known as Obamacare — goes into effect in 2014, but Connecticut is readying its insurance exchange program now, set to begin enrollments on Tuesday, Oct. 1.

That’s when people may browse through the plans at the exchange website — accesshealthct.com — which will function essentially as a marketplace for insurance policies. There are three carriers participating for individual policies: Anthem, ConnectiCare and Healthy CT. Aetna had been on board but withdrew earlier this month.

For small businesses, policies will be offered by Anthem, HealthyCT and United.

The enrollment period will extend from Oct. 1 through March 31, 2014. After that, people who remain uninsured will pay a penalty of $95 or 1% of income, whichever is greater, the first year. Fines will increase in future years to $325 or (2% of income) in 2015 and $695 or 2.5% of income in 2016. (There are some exceptions for low-income individuals.)

The coverage period begins in January. Like other insurance programs, there will be an annual open enrollment period going forward. In addition to enrolling online, consumers may enroll via a toll-free telephone number.

Connecticut’s health insurance exchange is called Access Health CT. It is a quasi-public state agency established as part of the Affordable Care Act with the endorsement of the Connecticut Legislature. It will also coordinate eligibility and enrollment with state Medicaid and children’s health insurance programs.

Through the website, individuals, families and small businesses may compare plans, find out if they are eligible for discounts and enroll. The website is functional now, and consumers may use the savings calculator to see how much of a tax credit they may be eligible for. According to the agency, single consumers who earn up to $45,960 a year or a family of four earning up to $94,200 a year may qualify for a discount in the form of a tax credit.

Based on the calculator, a 50-year-old individual earning $45,000 would be expected to pay a monthly health insurance premium of $523 and would receive a tax credit of $167, leaving a monthly total of $356. The estimated annual out-of-pocket costs would be $6,350.

A family of two adults and two children where the oldest adult is 50 years old, earning $80,000 a year would be expected to pay a monthly premium of $1,419. They would be eligible for a tax credit of $786 leaving a payment of $633. That amounts to $12,700 a year in premium payments.

According to Kathleen Tallarita at Access Health CT, premium prices are driven by age, income and geographic location. The only way to receive a tax credit for purchasing a health insurance policy is by doing so through the exchange, she said.

Not everyone is eligible to purchase insurance on the exchange. In general, anyone over 65 or anyone with health insurance offered through their employer is not eligible, Ms. Tallarita said.

Although the initial enrollment period is from Oct. 1 through March 31, eligible consumers who experience a life-altering event such as loss of a job, marriage or divorce may purchase health insurance on the exchange at any time.

Assisters

Navigating through the website and completing the application information could take computer-savvy consumers up to an hour to complete, according to Emilia Skene with Access Health CT. To aid those who have difficulty using a computer or who speak a foreign language, her office has recruited organizations as “navigators” and individuals who will act as “assisters.”

Navigators are agencies whose mission focuses on public health or have the capacity to reach out to the community, she said. Assisters are those who will offer help one-on-one help to consumers.

“In Fairfield County we have 50 assisters that are concentrated by ZIP code in territories where the rates of uninsurance are highest,” Ms. Skene said.

Closest to Wilton are two assisters based in the Norwalk Health Department and one at NEON (Norwalk Economic Opportunity Now).

There are also eight assisters in Danbury at: AIDS Project of Greater Danbury, Americares Free Clinic, Christian Activities Council, MCAA, Danbury Children First, the Hispanic Center of Greater Danbury and the Community Action Committee, as well as Brookfield Social Services.

“If you are trying to register through the portal, you can create an account online and request an assister,” Ms. Skene said. A list will pop up based on ZIP code.

All assisters have gone through a rigorous training and certification program, she said, and were required to pass a comprehensive background check and Social Security verification. In addition, upon certification each assister had to pass with a minimum score of 80% an exam on the Affordable Care Act, privacy, security, outreach and management strategies as well as technical training on the web portal. Each will receive an ID card and badge and a secure laptop that will be used only for the open enrollment period. It cannot store or save any information.

The assister program — officially known as the In Person Assistance Program — was funded with a $2.1 million grant from the federal Department of Health and Human Services.

Businesses

Small businesses with fewer than 50 full-time employees are not required to provide health insurance. However, those that offer insurance may be able to receive new tax credits valued at up to 50% of their contributions towards their employees’ premiums. Small businesses with more than 50 employees will be required to provide insurance or they will pay a fine.

For more information, visit accesshealthct.com .

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