Frequently asked questions about short-term health insurance in Connecticut
There are no short-term plans for sale in Connecticut, due to the state’s strict rules.
As of October 2, 2018, the Trump administration relaxed the rules in terms of the allowable duration of short-term health insurance plans. But states can continue to impose more strict restrictions, and Connecticut does. As a result of the state’s regulations — including enhanced rules that took effect in 2019, requiring short-term plans to cover essential health benefits — there were no insurers offering short-term plans as of 2019. That continues to be the case in 2020.
Before the new federal rules took effect, Connecticut’s Insurance Commissioner, Katharine Wade, noted that “Connecticut already has the necessary statutory consumer protections in place to prohibit ‘junk plans.’
After the Trump administration’s new regulations for short-term plans were finalized, the Connecticut Insurance Department issued an information statement (Bulletin HC-121) to clarify the rules for short-term health insurance in Connecticut, which remained in effect after the federal rules were relaxed.
Although there are no short-term medical plans for sale in Connecticut, the state does have laws in place to govern these plans in the event that an insurer chose to offer them.
Short-term health insurance in Connecticut cannot have a plan duration in excess of six months, and cannot be renewable.
Connecticut’s general statute 38a-476 requires health insurance plans to cover pre-existing conditions, unless the plan is “a short-term health insurance policy issued on a nonrenewable basis for six months or less.”
Short-term coverage virtually always excludes pre-existing conditions, so short-term plan duration is effectively limited to six months in duration. And it’s noteworthy that Connecticut’s law only allows them to exclude pre-existing conditions for which the patient received medical treatment/advice during the 24 months prior to the policy effective date.
As of January 1, 2019, short-term health insurance in Connecticut was required to cover essential health benefits (EHBs). In most states, short-term plans do not include coverage for all of the essential health benefits — maternity, prescription drug, and mental health coverage are most likely to be lacking.
So it was not surprising that as of 2019, Connecticut joined the list of states where there are no longer any short-term plans for sale. Avoiding coverage for some of the essential health benefits is one of the ways that short-term plans keep their costs down, and a state-level requirement to cover essential health benefits makes the market unattractive to short-term insurers.
Connecticut’s determination that short-term plans must cover EHBs was issued in a regulatory bulletin in 2018, but legislators considered a bill in 2019 that would have codified this requirement into state law. SB34 did not advance out of committee, but the state’s existing regulation is still in place.
Since short-term health plans are currently not available in Connecticut, you’ll want to check to see if you’re eligible to enroll in an ACA-compliant major medical plan (Obamacare) through the Connecticut insurance exchange/marketplace (you can also enroll directly through a health insurance company, but no financial assistance is available if you go that route).
Open enrollment for these plans runs from November 1 to December 15. Connecticut runs its own marketplace, so they have the option to extend open enrollment. They generally do so, but usually not until the last minute (ie, unlike most other states with state-run marketplaces, Connecticut generally does not issue open enrollment extensions well in advance).
If you want to enroll outside of the open enrollment period, you’ll need a qualifying life event in order to trigger a special enrollment period. A wide range of events will grant you a special enrollment period, including pregnancy (this is a Connecticut-specific rule; pregnancy is not a qualifying event in most other states). The Connecticut marketplace (AccessHealthCT) has a web page with extensive information about the qualifying events that will trigger a special enrollment period in Connecticut.
ACA-compliant major medical policies are purchased on a month-to-month basis, without a requirement that you continue your coverage for the full year. So you can enroll in a plan even if you only need coverage for a few months before another policy takes effect. For example, if you’re newly employed and you know that you’ll soon be covered by an employer-sponsored health insurance plan, or if you’ll soon be age 65 and enrolled in Medicare, you can still enroll in an ACA-compliant plan during open enrollment or a special enrollment period. You can then terminate the coverage when your Medicare or employer-sponsored policy begins.
Based on your income you may also qualify for health coverage in Connecticut under expanded Medicaid coverage. When the Affordable Care Act was enacted in 2010, Medicaid expansion was a cornerstone of lawmakers’ efforts to expand realistic access to healthcare to as many people as possible. Adults up to age 64 are eligible for Medicaid in Connecticut with a household income up to 138 percent of the poverty level.
In Connecticut, eligibility for Medicaid or CHIP extends to higher income levels for children and pregnant women, so these coverage options may also be available to you, depending on your household income and circumstances. Enrollment in Medicaid and CHIP continues year-round, without having to experience a qualifying event.
People who are not eligible for Medicaid, CHIP, or a premium subsidy may find that the full-cost monthly premiums for an ACA-compliant plan are simply too costly, especially if their income is just a little too high for subsidy eligibility (400 percent of the poverty level for adults). But contributions to pre-tax retirement accounts and health savings accounts will lower the modified adjusted gross income number that the IRS uses to determine subsidy eligibility, so some households can become subsidy-eligible by saving some additional money in a tax-advantaged account.
If that still doesn’t work, there may be other non-ACA-compliant options available, including health care sharing ministry plans and direct primary care plans (DPC plans do not have as much flexibility in Connecticut as they do in many other states, but are still available). These types of coverage are relatively affordable in terms of monthly fees, but this can rapidly be offset by uncovered medical bills in the event of a serious illness or injury, as these types of coverage have significant limitations. They are not adequate as a long-term healthcare coverage solution, and should only be used as a last resort when the alternative is going without healthcare coverage altogether.