Individuals will be able to submit an application to determine eligibility for lower cost medical insurance when they enroll for coverage in Connecticut’s Health Insurance Marketplace. This on line enrollment site is called Access Health CT and people can start to apply October 1st when the Open Enrollment period for January 2014 coverage begins.
This post is share some points on what federal health reform regulations say about eligibility for help and how this new program will work:
● Eligibility is based on the person’s modified adjusted income (MAGI) and its percent of the Federal Poverty Level (FPL). Single individuals whose MAGI is at 400% of FPL (about $46,000) and below will be eligible.
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● Individuals with dependents can also receive help based on their families combined MAGI. The maximum MAGI for a family of four would be $94,200. This is their 400% of FPL amount.
● A single person who makes $40,000 would have to pay, as their share of the premium, an amount equal to 9.5% of their annual MAGI or $316.66 a month. The share for a family of four whose MAGI is $94,200 would be $745.75 each month. The monthly share for a person 22 and one who is 62 will be the same if each has the same income.
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● The amount, which I call premium support, a person can receive is calculated for example by subtracting the above Single individual’s $316 share from their age based premium. If their premium was $600 it would be $284. The amount a person receives is technically an Advance Premium Tax Credit (APTC) and as a tax credit it will be reported to the IRS. Thus, a person will be responsible to reconcile this credit as part of their annual 1040 income tax report.
● The premium support or APTC amount is not based on any plan a person may select but only on the eligible person’s monthly premium for the second lowest cost Silver plan.
● The federal level Health and Human Services will send the premium support an individual is eligible for to the person’s medical insurance company each month. This amount will vary based on a person’s age and the number of individuals they cover.
● The health insurance company, the person selects, will invoice them at home each month and they will pay their share on an after tax basis.
Initial plans for the application process was for a person to go to Access Health CT, enter personal and financial information, and while this was being done the system would:
● Interact with federal agencies, such as Homeland Security (citizenship), Social Security, and the IRS through a federal level data hub.
● Come back in real time and indicate, while on line, if they are eligible for help and the amount they would have to pay each month. e.g. the above $316.
● Move them to the next step to review medical insurance plans from the four companies participating in the Individual plan part of Access Health CT. Eligible individuals will be able to select a plan, other than the second lowest cost Silver plan, which has more coverage by paying the additional premium.
● Then move them to the medical insurance company they selected to complete their enrollment.
As of today we do not know how much of the fully automated enrollment process will be available initially.
Want to take a look at whether you would be eligible for a premium discount and what your share might be? Go to AccessHealthCT.com. There is a link to a savings calculator on the home page.
