Access Health CT on solid financial ground
Although many other state-run exchanges are struggling to become financially self-sustaining now that federal funds are drying up, Access Health CT is on solid financial footing. The exchange board approved an $81.6 million budget proposal for the upcoming fiscal year, but more than half of that amount will be reimbursed by the state Department of Social Services, as it’s money that’s spent to enroll people in the Medicaid program.
The new budget reduces spending by nearly 25 percent, and Access Health CT’s CEO Jim Wadleigh noted that Connecticut is “the best positioned state in the country” in terms of having an exchange that’s on track to be financially self-sufficient.
The exchange will still need to raise their assessment rate slightly, from 1.35 percent of premiums to at least 1.5 percent (this is still quite low compared with other states). At the end of May, the board will consider the possibility of raising the assessment to 1.5 percent in 2016 and then to 1.65 percent the following year, versus simply raising it to 1.65 percent starting in 2016. Either way, the impact should be minimal for most policy-holders: Despite the fact that the assessments will likely be passed on in the form of higher premiums, the CFO noted that on a premium of $700/month, increasing the assessment from 1.35 percent to 1.5 percent would only increase the monthly price by about a dollar.
Single-digit requested average rate increase
On May 7, the Connecticut Insurance Department released the 2016 rate filings that carriers in the state have submitted for the coming year. UnitedHealthcare’s rate request for their off-exchange plans is a whopping 33 percent, but that’s an outlier, and it’s only for off-exchange coverage. For the four carriers that offer plans on Access Health CT, the weighted average requested rate increase is 7.7 percent. And it’s important to keep in mind that these are just the requested rate changes – last year, the final approved rate increases were far lower than the requested rate increases, so a lot could change between now and when the rates are finalized.
And in good news on the rate front, ConnectiCare has stated that the average age of their enrollees declined from 2014 to 2015, and they expect that trend to continue in 2016 (enrolling “young invincibles” has been a primary goal for all of the exchanges, as they tend to be relatively healthy). In addition, carriers in the exchange have said that although there was an influx of previously uninsured enrollees in 2014 who had “pent-up” healthcare needs, that’s no longer as much of a concern heading into 2016.
Last year, when carriers were setting rates for 2015, they had almost no claims data for new enrollees, since the first open enrollment period had just ended when rates for 2015 were due. This year, carriers are setting rates for 2016 based on a year of claims data for people who have enrolled under the new ACA rules that make coverage guaranteed-issue – and the average requested rate increase for 2016 is lower than it was for 2015.
ConnectiCare’s average requested rate hike was just 2 percent for 2016, the smallest increase of any of Connecticut’s carriers. HealthyCT requested a rate increase of 13.96 percent, the highest among the exchange carriers. But it’s important to note that HealthyCT had some of the lowest prices on Access Health CT for 2015. Their rates were relatively high in 2014, and dropped for 2015. It appears they may increase again for 2016, but that’s a relatively common cycle for carriers, especially those that position themselves to be among the lowest priced plans available.
Open enrollment begins on November 1, for coverage effective January 1, 2016. The final rates will be available after the Insurance Department completes the rate review process, and will be effective for plans purchased starting November 1. It will be important to once again shop around during open enrollment. That’s particularly true for those who receive premium subsidies, as it’s possible that the benchmark plans could be changing for 2016, resulting in subsidy fluctuations for people who let their plans auto-renew.
More than 204,000 Connecticut residents newly enrolled in health coverage during the 2015 open enrollment period. Between Nov. 15 and Feb. 15, 41,864 people enrolled in qualified health plans (QHPs) and 162,494 individuals enrolled in Medicaid through the state-run marketplace.
Access Health CT greatly exceeded its goal of enrolling an additional 70,000 people in health coverage for 2015. According to a CT Mirror article, Access Health CT enrolled 256,666 residents in health coverage in 2014. Of that number, about 139,000 were previously uninsured, and about 80 percent enrolled in Medicaid.
The 2015 enrollment total continued to grow with Access Health CT’s special enrollment period (SEP) for individuals who were previously unaware of the tax penalty for being uninsured. The requirement for insurance went into effect in 2014, but many people only learned about the penalty when they filled out their 2014 tax forms. The penalty-related SEP ran from April 1 through April 30, and Access Health CT announced that 1,429 people enrolled in private plans through the exchange during the SEP.
SEPs are also available to individuals who experience a qualifying life event, such as getting married or losing a job. A SEP is the only way to obtain coverage – on or off the exchange – for the rest of 2015. Without a qualifying event, enrollment won’t be available again until November 1, for coverage effective January 1, 2016.
If you qualify for Medicaid (HUSKY), you can enroll anytime throughout the year.
2015 health plans and premiums
Four health insurers are offering individual and family plans through Access Health CT for 2015. Anthem, Connecticare and HealthyCT are returning from 2014, and UnitedHealthCare joined the exchange for 2015.
Regulators in Connecticut pushed back on the 2015 rates proposed by insurers. Connecticare and Anthem both requested increases of more than 10, which regulators reduced to 3.1 percent or less. HealthyCT received approval to reduce its rates an average of 8.5 percent.
According to the Commonwealth Fund, 2015 rates on Access Health CT decreased 1 percent on average for individual coverage and 2 percent on average for family coverage.
Penalties going up for those not insured
The penalty for not having health insurance is higher in 2015 than it was last year. The fee is the greater of 1) two percent of yearly household income or 2) up to $975 for families ($325 per adult and $162.50 per child under 18). The fee will be assessed when you file your 2015 taxes in 2016.
Learn more about the penalty and who is excluded.
History of Connecticut’s exchange
Connecticut was one of the early adopters in implementing a health insurance marketplace. Gov. Malloy signed legislation in 2011 to create the Connecticut Health Insurance Exchange, which was rebranded as Access Health CT in February 2013. The U.S. Department of Health and Human Services (HHS) approved Connecticut’s blueprint for a state-run exchange in December 2012.
Access Health CT describes itself as an active purchaser, but did not negotiate 2014 rates with health plans. Prompted by concerns over high premiums, Connecticut legislators revisited the issue during the 2014 session. SB-11 would have allowed Access Health CT to negotiate with insurers for plans sold in 2016. However, the bill did not pass. Connecticut’s Fairfield County made the Kaiser Family Foundation list of the top 10 most expensive health insurance markets in 2014.
Access Health CT has been one of the nation’s most successful marketplaces. Signs of that success include:
- Connecticut’s uninsured rate dropped by 50 percent: from 7.9 percent in 2012 to 4 percent in 2014.
- Connecticut launched a consulting business through which other states can license Access Health CT’s technology or pay Access Health CT to manage various marketplace functions. According to an article in the CT Mirror, nine states have expressed interest.
- Access Health CT’s former CEO, Kevin Counihan, was tapped to take over as the CEO of the federal exchange, HealthCare.gov. Jim Wadleigh took over the CEO role. Wadleigh previously served as the exchange’s chief information officer.
Connecticut health insurance exchange links
Access Health CT
State Exchange Profile: Connecticut
The Henry J. Kaiser Family Foundation overview of Connecticut’s progress toward creating a state health insurance exchange.
Connecticut Health Reform Central
Information about exchange planning and development