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Connecticut operates a state-run health insurance exchange — Access Health CT — with three participating insurers. Average premiums increased by almost 13% for 2023, but subsidies also grew to offset most of that rate increase.
Access Health CT expanded its Navigator program in the fall of 2022, and has seven Navigator organizations available around the state to assist consumers with the enrollment process.
Outside of the yearly open enrollment period, a qualifying event is required to enroll or make changes to coverage. But there are some people who can enroll anytime, including Native Americans and people who are eligible for Medicaid/CHIP (HUSKY Health) or the Covered Connecticut program.
The open enrollment period for individual/family coverage runs from November 1 through January 15 in Connecticut. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
But people who are eligible for Covered Connecticut can enroll anytime, and enrollment in HUSKY Health (Connecticut’s Medicaid/CHIP) is also open year-round. Native Americans can also enroll year-round in any state’s exchange.
For 2023 coverage (as was the case for 2022), three insurers are offering plans through the exchange in Connecticut:
2015 — 2016: UnitedHealthcare joined the exchange in Connecticut for 2015, bringing the total number of participating insurers to four: ConnectiCare, Anthem, Healthy CT, and UnitedHealthcare. All four continued to offer plans in 2016, although ConnectiCare gained market share in 2016—covering about 53 percent of the exchange’s enrollees—while the other insurers’ market share shrank that year.
2017: Insurer participation dropped to just two carriers—Anthem and ConnectiCare Benefits—as of 2017. Those two insurers have continued to offer plans ever since.
2022: ConnectiCare Insurance Company joined the exchange, after previously offering plans outside the exchange. There are a total of three participating insurers, with Anthem and ConnectiCare Benefits continuing to offer plans. This continues to be the case for 2023 as well.
UnitedHealthcare exited Access Health CT at the end of 2016, as was the case in most of the states where they had offered plans. But they only had 1,477 enrollees in the individual market through Access Health CT, and just 124 people covered under small group plans through the Access Health CT SHOP exchange. Their market share was dramatically smaller than the other three carriers that offered plans in 2016.
But HealthyCT also exited Connecticut’s market at the end of 2016, and their exit had a more significant impact. HealthyCT had escaped the initial wave of CO-OP failures in the fall of 2015, but when it was determined that they would owe $13.4 million in risk adjustment payments in 2016, it became evident that they could not remain solvent.
HealthyCT lost $28 million in 2014, and although the rate of losses slowed in the first half of 2015, they still lost $9.5 million by mid-2015. In order to be successful, start-up health insurance carriers must experience enrollment growth, but with premiums that are high enough to cover claims and administrative expenses. Admittedly, that’s a tough target to hit. In 2014, HealthyCT had projected 25,000 enrollees but they had less than a third of that amount — just 7,966 members — at the end of 2014. That year, HealthyCT’s rates were among the highest on Access Health CT, hampering their enrollment goals.
But the CO-OP lowered premiums for 2015 to among the lowest offered through Access Health CT. As a result, their membership grew considerably. They had 31,212 members in mid-2015, and enrollment had increased to 36,000 by early November. Their 2016 rates were not as competitive as they were in 2015, but their rate increase was still modest, at 7.2 percent.
Unlike many other CO-OPs, HealthyCT wasn’t counting on the risk corridors payout that they were owed for 2014. So when CMS announced in October 2015 that carriers would get just 12.6 percent of what they were owed, the blow wasn’t as significant for HealthyCT as it was for some of the other CO-OPs. Unlike most CO-OPs, HealthyCT also sold coverage in the large group market, which meant they had a stronger off-exchange presence than carriers that just sell individual and small group plans. HealthyCT also built its own provider network, instead of having to pay to rent a network from another carrier, as was the norm for many CO-OPs.
But ultimately, the risk adjustment program proved to be the final nail in the coffin for HealthyCT. In the summer of 2016, the CO-OP owed $13.4 million to HHS under the risk adjustment program, and could not pay it and remain solvent. The carrier stopped issuing policies in mid-2016, and all exchange enrollees with HealthyCT plans had to select coverage from another carrier during the open enrollment period for 2017 coverage.
HealthyCT had 13,000 individual market members, and 11,299 of them had coverage through Access Health CT. Their coverage continued through the end of 2016, but they needed to select 2017 coverage from another insurer during open enrollment.
Three insurers filed plans for 2023 on-exchange coverage in Connecticut. The Connecticut Insurance Department reviewed the rates in the summer of 2022, and is generally the case in Connecticut, the regulators finalized smaller rate increases than the insurers had proposed (rate details available here):
The rates the insurers had proposed amounted to an overall increase of more than 20%, but the final approved average rate increase ended up being 12.9%. The Connecticut Insurance Department tends to approve rate increases that are smaller than the insurers propose, and the rates for 2023 were no exception.
The CT Insurance Department also noted that premium subsidies had grown for 2023, offsetting most of the average rate increases for most enrollees who receive subsidies.
For perspective, here’s a look at how premiums have changed in Connecticut’s individual market in prior years:
The 3.65 percent average increase applies across the full individual market in Connecticut, which includes some ConnectiCare plans that are only sold outside the exchange.
Throughout 2017, Access Health CT’s then-CEO, Jim Wadleigh, expressed concern about the possibility that the exchange’s insurers might not return for 2018. In April 2017, Wadleigh said that he was “worried that [Access Health CT] could be seen as the first marketplace not to have carriers in 2018” and he reiterated that concern in August. This did not come to pass, as both ConnectiCare and Anthem continued to offer plans in the exchange in 2018, albeit with average rate increases of about 29%, and sharply higher premiums for silver plans.
For the entire individual market in Connecticut, the average rate increase was 24.8 percent for 2017. That’s higher than either of the average rate hikes for the exchange plans, because some carriers that only offer off-exchange plans had higher average rate increases. Five carriers — Aetna, Anthem, Cigna, ConnectiCare, and Golden Rule — offered plans outside the exchange for 2017.
As was the case in most states, enrollment in private plans (QHPs) through Connecticut’s exchange grew significantly in 2015. Since then, Access Health CT’s enrollment has hovered between about 110,000 and 116,000 people. It dropped a bit in 2020 and 2021, but rebounded in 2022 (as expected, given the American Rescue Plan’s subsidy enhancements that made coverage much more affordable during the open enrollment period for 2022 coverage). Here’s a summary of how many people have enrolled in QHPs each year during open enrollment:
There was an overall decline in enrollment across states that use HealthCare.gov in 2017, although states that run their own exchanges (which includes Connecticut) saw an average increase in enrollment. Declining enrollment was linked to a variety of factors, including higher prices and insurer exits from the exchange (both of which were an issue in Connecticut). But Connecticut also had no insurers paying broker commissions for on-exchange enrollments in 2017, which may have hindered enrollment by reducing the number of people available to assist with the process.
But Access Health CT’s enrollment increased in 2018, despite a shorter enrollment period and GOP efforts to repeal the ACA throughout 2017. Open enrollment for 2018 plans in states that use HealthCare.gov ended on December 15, 2017. And Access Health CT explained in June 2017 that the state’s insurers wanted all enrollees to have full-year plans for 2018, indicating that they were unlikely to extend open enrollment into January. But they ultimately granted a one-week extension that allowed people a little additional time to sign up, while maintaining full-year coverage for all enrollees.
In addition to the extra week at the end of open enrollment, Access Health CT significantly increased access to in-person enrollment assistance during the fall 2017 open enrollment period. The exchange previously had two in-person enrollment assistance centers (in New Haven and New Britain), but spread their in-person assistance centers out across the state as of the start of open enrollment in November 2017, offering in-person assistance in Bridgeport, Danbury, East Hartford, Hartford, Milford, New Britain, New Haven, Norwich, Stamford, and Waterbury.
In 2021, Connecticut lawmakers included funding for a new health coverage program in the state’s budget legislation. Covered Connecticut became available to parents with modest incomes as of July 2021, and eligibility was greatly expanded in July 2022, allowing up to 40,000 people access to the Covered Connecticut program.
As of July 2022, Covered Connecticut is available to adults under the age of 65 who aren’t eligible for Medicaid and whose household income doesn’t exceed 175% of the poverty level (here are the income limits for 2022).
Under the Covered Connecticut program, eligible enrollees must select a silver plan through Access Health CT and accept all of the federal subsidies available to them. Covered Connecticut then pays any remaining premiums and cost-sharing, resulting in a plan that has a $0 premium and $0 cost-sharing.
Enrollees who are eligible for Covered Connecticut are already eligible for substantial federal premium subsidies and strong cost-sharing reductions. But the Covered Connecticut program will pick up the tab for any additional premium, as well as deductible, copays, and coinsurance that would normally be the consumer’s responsibility.
Covered Connecticut was initially only available to parents with household income between 160% and 175% of the poverty level, and at least one dependent child under the age of 19.
(In Connecticut, Medicaid is available to parents with dependent children if the household income is below 160% of the poverty level — that’s 155% plus a built-in 5% income disregard that applies to MAGI-based Medicaid eligibility determination. So the Covered Connecticut program would pick up where Medicaid (Husky Health) ends. That’s still the case for parents, but the program is now also available to people who don’t have dependent children.)
Connecticut HB5210, which was signed into law in May 2018, mandates the ACA’s essential health benefits for individual and small group plans sold in the state, regardless of whether any future changes are made at the federal level.
The legislation also expands coverage for contraceptives by requiring coverage for all FDA-approved contraceptive measures, rather than just the FDA-approved contraceptives for women, which is what federal regulations require.
There’s an exception in the legislation for HSA-qualified high deductible plans (HDHPs), since plans that cover male contraception before the deductible are not considered HSA-qualified under IRS rules (the IRS granted a transitional period, through 2019, when they did not enforce this, since several states have recently mandated pre-deductible male contraceptive coverage).
In the 2018 legislative session, Connecticut lawmakers considered legislation to implement an individual mandate (H.B.5039 and H.B.5379) and to seek federal funding for a reinsurance program (H.B.5114, which would also have implemented an individual mandate), but none of those bills passed. Reinsurance was considered again in 2019 (SB136) and 2020 (SB328), but did not advance out of committee.
It should be noted that as long as the American Rescue Plan’s subsidy enhancements are in effect (through at least 2025), reinsurance is not as important as it used to be. That’s because the subsidy enhancements eliminated the “subsidy cliff,” meaning that there’s no set income cap for subsidy eligibility, and fewer people have to pay full price for their coverage (full-price enrollees are primarily the ones who are helped by reinsurance programs, since the programs bring down the cost of full-price coverage, but not the after-subsidy price of subsidized coverage).
Although reinsurance is successfully in use in 17 states as a means of reducing individual market premiums and stabilizing the market, the biggest question mark for lawmakers tends to revolve around funding. The states that have implemented reinsurance programs thus far have all used 1332 waivers in order to capture federal pass-through funding, and the bills that have been introduced in Connecticut would have directed the state to use a 1332 waiver to obtain federal funding.
(Reinsurance results in lower premiums, and the lower premiums result in smaller premium subsidies. A 1332 waiver allows the state to use the savings generated by the smaller premium subsidies, instead of having the federal government keep it.)
But states also have to contribute some funding of their own; the most common approaches are to allocate money from the state’s general fund, or to impose an assessment on insurers and/or medical providers in the state. In late 2019, lawmakers in Connecticut met to discuss options for reinsurance funding. They were working towards a bipartisan agreement so that legislation could be settled during the 2020 session, but the 2020 session was upended due to the novel coronavirus pandemic.
During the 2019 legislative session, lawmakers in Connecticut had also considered the creation of a public-option health plan that would have competed with private plans in the state’s individual and small group markets. That legislation was strongly opposed by the private insurance industry and did not pass.
The public option was not being considered by the lawmakers who worked on options for 2020 health care reform legislation, and neither was an individual mandate. Of the individual mandate bills that were previously considered in Connecticut, HB5039 was the more straightforward, with an individual mandate penalty resembling the ACA’s penalty, but slightly smaller: Only adults would have been subject to the penalty, and it would have been 2 percent of household income or $500 per uninsured adult (as opposed to the ACA’s 2.5 percent of household income or $695 per uninsured adult).
H.B.5379 incorporated ideas proposed by Yale economist, Fiona Scott Morton. It would have been a much more radical individual mandate, with penalties of up to $10,000 (applicable to households earning just over $100,000 a year) for people who chose to remain uninsured. H.B.5379 would have capped the penalty at the lesser of 9.66 percent of income or $10,000, and would have directed the penalty into a healthcare savings account, administered by the exchange, from which the household could then withdraw money to pay for health care.
Under the ACA, various life changes are considered qualifying events, and they trigger special enrollment periods, either in the exchange or in the entire individual market (all of these qualifying events are explained in detail in our guide to special enrollment periods). The qualifying events are similar to those that already existed for the employer-sponsored market, but there are some qualifying events that are specific to the individual market (prior to 2014, qualifying events weren’t necessary in the individual market, since people could apply year-round — but insurers could reject applicants based on medical history, and that’s no longer allowed).
The birth of a baby is considered a qualifying event under federal rules, but a pregnancy is not. HHS considered the possibility of changing this a few years ago, but clarified in 2015 that they had decided against making pregnancy a qualifying event.
But DC and five states — including Connecticut — do consider pregnancy to be a qualifying life event. Pregnancy became a qualifying event in Connecticut starting in 2019, under the terms of SB206. The legislation passed with very strong support in the House and unanimous support in the Senate during the 2018 session. Governor Malloy did not sign it, but it became law automatically, without his signature, since he also did not veto it. (Malloy had previously expressed concerns about a pregnancy-related special enrollment period, and opted to let the bill become law without his signature.)
Connecticut’s new law creates a special enrollment period that lasts for 30 days from the time a pregnancy is confirmed by a licensed healthcare provider. The special enrollment period only applies to ACA-compliant individual market plans, and is only available to someone who does not already have minimum essential coverage. So it does not allow a pregnant woman to switch from, say, a bronze plan to a gold plan when she finds out she’s pregnant.
The text of the legislation states that the special enrollment period applies to “pregnant individuals not more than thirty days after the commencement of the pregnancy, as certified by any licensed health care provider acting within the scope of such health care provider’s practice.” This is a bit ambiguous, and there was extensive debate in the Connecticut House in terms of whether that meant that the 30-day window would start when the pregnancy began (many women don’t realize they’re pregnant until more than 30 days after the pregnancy commences), or when the pregnancy is confirmed by a medical provider. But Senator Kevin Kelly (R-Stratford), who was a co-sponsor of the bill and is the Senate Republican chair of the Insurance and Real Estate Committee, confirmed that the special enrollment period would start when the pregnancy is confirmed by a medical provider, and would last for 30 days.
Although two carriers offered plans through Access Health CT in 2017, neither of those carriers paid broker commissions for exchange plans in 2017 (both continued to pay commissions for off-exchange plans).
Connecticut regulators had previously stepped in to prevent carriers from cutting broker commissions for 2016, noting that the commissions were included in the filed rates. But for 2017, neither exchange carrier included broker commissions in their rate filings for on-exchange plans.
About 40 percent of Access Health CT’s enrollments were done with the help of brokers for 2016, but most brokers were unable—or understandably unwilling—to work for free in 2017 (brokers do not receive any compensation other than the commissions paid by insurers, unless they’re paid as in-house, salaried staff for another entity). The exchange maintained an in-house staff of 21 salaried brokers and they worked to assist enrollees for 2017. But by January 2017, Access Health CT could tell that the lack of broker support was hurting their enrollment and customer service efforts.
As a result, in late January 2017, the Access Health CT board of directors voted to require insurers to pay broker commissions for on-exchange plans, although they didn’t stipulate that the commissions had to be the same as off-exchange commissions (video of the board meeting is here; the discussion about broker commissions begins around the 8:30 mark, and the vote is around the 31-minute mark).
The board voted to require commissions for all on-exchange plans, and also to require commission parity between on and off-exchange plans. But Anthem filed rates for 2018 that included $5 per member per month commissions on-exchange, and $15 per member per month commissions off-exchange (this was included in the rate filing that was approved in September). This still effectively incentivizes brokers to enroll people off-exchange, but the customer service situation for Access Health CT should be better than it was during enrollment for 2017 coverage. ConnectiCare’s rate filing indicated a slight increase in administrative costs (which includes commissions), from 13 percent of premiums in 2017 to 13.9 percent of premiums in 2018. But that includes all administrative costs, which obviously encompasses much more than commissions.
Outside of open enrollment, coverage is only available for purchase – on or off-exchange – if the applicant has a qualifying event (Native Americans can enroll year-round without a qualifying event, as can anyone eligible for Medicaid -HUSKY – or CHIP).
This has been the case since 2014, but Access Health CT did not require proof of eligibility for special enrollment periods in 2014 and 2015. As a result, people who enrolled outside of open enrollment tended to use more healthcare services and were more likely to subsequently drop their coverage than people who enrolled during open enrollment. Starting in 2016, Access Health CT said they would require proof of a qualifying event in order to grant a special enrollment period. They further tightened up the requirements in 2017.
Healthcare.gov had the same lax enforcement of special enrollment period eligibility in 2014 and 2015, but they also tightened up the process of verifying qualifying events in 2016, in an effort to reduce the possibility of adverse selection taking place outside of open enrollment. Since the summer of 2017, the HealthCare.gov is requiring most people who apply outside of open enrollment to provide proof of their qualifying events before their application can be processed.
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. Connecticut’s Fairfield County made the Kaiser Family Foundation list of the top 10 most expensive health insurance markets in 2014. 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 (although perhaps counter-intuitively, premium analyses from 2014, 2015, and 2015 found that state-run exchanges that used a clearinghouse model – as opposed to an active purchaser model – had lower overall average premiums).
Access Health CT has been one of the nation’s most successful marketplaces. Connecticut subsequently 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. And Access Health CT’s former CEO, Kevin Counihan, took over as the CEO of the federal exchange, HealthCare.gov, from 2014 through the start of 2017.
In addition to launching its own health insurance exchange, Connecticut also opted to expand Medicaid under the ACA, using federal funds to increase income eligibility for the program to 138% of the poverty level.
Access Health CT was the first exchange to actively reach out to people who are newly-naturalized citizens, letting them know about their coverage options and the special enrollment period that applies for people who gain citizenship.
Access Health CT began sending representatives to the naturalization ceremonies in US District Courts in New Haven, Bridgeport, and Hartford, so they can be on hand to provide information to the newly-naturalized citizens. Roughly 15,000 people become citizens in Connecticut each year.
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
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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