Also, as of July 1, some Connecticut residents that meet specific eligibility requirements can pay $0 for their health insurance coverage through Access Health CT, thanks to the new Covered Connecticut Program created by the state.

To qualify for the Covered Connecticut Program, you must:

• Have a household annual income that is greater than 160%, and up to
  and including 175% of the federal poverty level.
•  Have at least one dependent child in the household under age 19; children age 18 must be a full-time student in secondary school.
• Be eligible for advance premium tax credits (APTCs) and cost-sharing
  reductions (CSRs).
• Use 100% of APTCs and CSRs available to them, along with the expanded American Rescue Plan Act (ARPA) financial assistance.
• Be enrolled in an eligible Silver Level Plan.

Those that qualify for the program can enroll through Dec. 31, or the end of the open enrollment period. To enroll in the Covered Connecticut Program, call the Access Health CT Call Center at 1-855-805-4325.

“The American Rescue Plan Act has made health insurance coverage significantly more affordable and this special enrollment period provides access to this help for many more people,” said James Michel, chief executive officer at Access Health CT.

According to Access Health CT, people at nearly every income level can expect reduced fees, with an average yearly savings of nearly $1,400 per household. Those who qualified for or received unemployment insurance benefits at any point during 2021 are eligible for coverage at nearly $0. Connecticut households with annual incomes greater than $51,040 can plan on saving an average of $6,200 a year.

Previously enrolled Access Health CT customers who meet the requirements for cost reduction will see benefits automatically applied to their health insurance plans. Access Health CT will notify ineligible customers.

Health insurance savings will expire on Jan. 1, 2023, unless Congress elects to extend the federal subsidies.

Since its start on May 1, the program has saved more than $4.5 million for 33,000 Connecticut residents and counting, according to Access Health CT.

To enroll, go to AccessHealthCT.com’s live chat, call 1-855-805-4325, Monday through Friday from 8 a.m. to 5 p.m., or Saturday, Aug. 14, and Sunday, Aug. 15, from 9 a.m. to 3 p.m. In-person help is available at Project Access New Haven, located at 63 York St., New Haven, and the Community Renewal Team located at 330 Market St., Hartford.

The newly-approved federal American Rescue Plan is making health insurance more affordable by eliminating or vastly reducing monthly premium costs for people with low to moderate incomes. Even people with higher incomes who are enrolled in health insurance through Access Health, the state’s insurance exchange, may see their monthly premium costs reduced.

The special enrollment period at Access Health CT runs from May 1 to Aug. 15.

James Michel, chief executive officer at Access Health CT, said that there are about 200,000 people in the state without any health insurance, and others who are under-insured because they couldn’t afford the coverage cost.

“The American Rescue Plan will assist many people since financial help will be significantly greater for almost everyone at every income level,” Michel said.

The new federal subsidies for insurance will last for two years, but there is an effort to make them permanent.

To shop for health insurance, go to Access Health CT.  You can get assistance via a live chat or by calling 1-855-805-4325, Monday-Friday, 8 a.m. to 5 p.m.

On Saturday (May 1), there are special call-in hours from 9 a.m. to 3 p.m.  AHCT’s Navigators are available by appointment only with safety protocols in place to assist with enrollment at Project Access New Haven, 63 York St., and Community Renewal Team, 330 Market St., Hartford.

Thanks to the ACA, the law known as Obamacare, a provision allows young adults to remain on their parents’ health insurance policies until age 26. Dinh, of South Windsor, is covered on her mother’s policy.

“If I lost coverage under my parents, I would not know what to do,” Dinh said. “Chances are I would have to handle medical expenses out of pocket, which would definitely cause a financial strain and make me hesitant to go to the doctor’s unless it is a dire emergency.”

“I am also worried about COVID because the risks are too high under current circumstances to be uninsured,” said Dinh. She’s one of  2.3 million young adults who gained coverage through their parents’ plans under the ACA, according to a Kaiser Family Foundation analysis.

Vyanne Dinh, 21, is a senior at New York University, has health insurance through her mother’s plan.

Striking down Obamacare would have a large-scale impact on the country’s health care system and the lives of millions of people who have gained health insurance coverage through the exchanges and the expansion of Medicaid.  One of the most-popular provisions – protecting people with pre-existing medical conditions – would be eliminated along with coverage for many essential benefits.

The stakes for keeping Obamacare in place are even higher now with the addition of Justice Amy Coney Barrett to the high court, a conservative who could provide the vote needed to overturn it.

“The effects of the Affordable Care Act impacted many parts of the health care system,” said Tiffany Donelson, president and CEO of the Connecticut Health Foundation. “It’s going to be extremely difficult to just patch up a new law if this were overturned. It took years for the Obama administration to work on this. This is one of the things that [people] need to realize. We all gained from the Affordable Care Act.”

Roughly 300,000 people in Connecticut have insurance, in one way or another, thanks to the ACA, Donelson said.

“Our uninsured rates are going to skyrocket, undoubtedly, in our state, if we overturn the ACA at the federal level.” 

— Tiffany Donelson

Everyone benefits when all people can access insurance, said Angela Mattie, professor of management and medical sciences at Quinnipiac University’s Frank H. Netter M.D. School of Medicine.

What’s at stake at the Nov. 10 hearing before the Supreme Court “is extremely significant to our entire population. It’s even more tragic that it’s all under the umbrella of a pandemic,” Mattie said.

Medicaid Expansion

“[Many] people don’t realize that the Affordable Care Act also provided for the expansion of Medicaid,” said Mattie.

In 2010, Connecticut became the first state to expand Medicaid, and Mattie said providing coverage to the most vulnerable populations is more cost-effective than letting them go uninsured in the long run.

“We know that when people don’t have medical coverage, they delay care and end up sicker. And they end up eventually seeking care, because it’s life-threatening, and they end up in a health care facility without any form of payment and we, as a society, end up paying for that,” Mattie said.

As of June 2019, there were 276,885 people in Connecticut who enrolled in Medicaid since 2010, according to the Kaiser Family Foundation. Of those, 243,618 were newly eligible specifically due to the expansion, according to state-level data. Nationwide, about 12 million people in 33 states and in Washington, D.C. became eligible for Medicaid under the expansion, through June 2019.

“Community-based organizations, the ones working with people day in and day out, are extremely concerned,” said Donelson, including federally qualified health centers that serve many on Medicaid. “This is really coming to a head, that there is a good chance the ACA could be overturned, and there is no confidence that there’s a replacement.”

Health Insurance Exchange

Connecticut is one of 15 states that has its own fully run health insurance exchange, Access Health Connecticut (AHCT), which is preparing to launch its eighth open enrollment on Nov. 1.

There are 103,955 Connecticut residents enrolled in plans through AHCT, according to the Kaiser Family Foundation. Of those, 72,767 (70%) receive the Advance Premium Tax Credit, which lets individuals lower their monthly insurance premiums; and 35,304 (34%) receive a cost-sharing reduction that lowers deductibles, copayments and coinsurance.

Enrollment in qualified health plans through Access Health CT is up about 5% from a year ago; enrollment in Medicaid through the exchange is up about 10%, according to Marketing Director Andrea Ravitz.

“This is where we work harder to raise awareness,” she said. “Our mission continues to be to reduce the number of uninsured in Connecticut.”

Nationwide, 10.7 million people were enrolled in insurance through an ACA-created marketplace as of February 2020, according to Kaiser Family Foundation.

Medicare Part D

The ACA closed the coverage gap, known as the donut hole, in Medicare Part D. Prior to the legislation, seniors’ prescription drug coverage dropped off once they hit a certain yearly dollar amount, then kicked back in later.

Without the protection offered by the ACA, seniors could see prescription costs skyrocket, Mattie said.

“When you have to start paying out of pocket and you’re on a fixed income – and these drugs are expensive – you have to start making decisions.”

— Angela Mattie

Some seniors may forego prescriptions, in order to afford rent or food, which can lead to health issues, she added.

Preventive Care

Nationwide, about 150 million people are enrolled in employer insurance plans or individual market insurance plans that must provide free preventive care services, such as annual wellness exams, cancer screenings, and vaccinations under the ACA, according to Kaiser Family Foundation.

“Payment for these types of services will go away” if it’s overturned, said Mattie. “If you decrease the amount of screening, you increase the amount of morbidity and mortality.”

“When people are connected to primary care, overall, they are healthier, because they are getting the consistent care that they need,” said Donelson.

For those who don’t have a qualifying event for special enrollment—such as getting married, giving birth or adopting a child—open enrollment for 2021 health insurance plans begins Nov. 1 and runs through Dec. 15.

Consumers can begin “window shopping” and comparing plans on Oct. 26 but can’t enroll or re-enroll in coverage until Nov. 1. Open enrollment is for coverage that begins Jan. 1.

As job cuts continue to mount in the state amid the COVID-19 pandemic, anyone who loses employer-backed insurance coverage qualifies for special enrollment and has 60 days from the time of their job loss to enroll in a plan offered through the marketplace.

“If 2020 has taught us anything, it’s that having and keeping and using health insurance is incredibly important,” said Andrea Ravitz, AHCT’s marketing director. AHCT is closely monitoring reports of layoffs and contacting affected workers as quickly as possible, she said.

“A lot of individuals don’t know that we even exist,” Ravitz said. She said many workers have long held insurance policies through their employers and haven’t needed to secure coverage on their own until now.

To reach a licensed broker to discuss health insurance options call 855-805-4325.

This will be the eighth open enrollment for AHCT, which is the insurance marketplace created by the Affordable Care Act.

For 2021, the exchange will again offer plans from Anthem and ConnectiCare. Earlier this fall, the state Insurance Department reduced the rate increases each company sought. The average rate increase for Anthem plans will be 1.9%, while ConnectiCare customers will see an average rate decrease of 0.1%.

But consumers should not choose plans based solely on premium price tags, Ravitz said.

“Even if you’re experiencing a decrease in your rate, it doesn’t mean that you’re in the right plan,” she said. The “Compare Plans” tool at accesshealthct.com lets consumers view plans while considering their specific doctors, prescription drugs costs and medical habits, giving them a clearer picture of how much each plan will cost them out of pocket.

Currently, nearly 100,000 people are enrolled in qualified health plans through AHCT, up about 5% from a year ago, and about 700,000 are enrolled in Medicaid plans through the exchange, up roughly 10% from a year ago, according to Ravitz.

In the early days of the pandemic, the state and AHCT announced in March a new special enrollment period during which anyone uninsured could enroll in coverage. That period ran from March 19 through April 2 for coverage that began April 1. Around that time—between March 19 and April 17—5,629 people enrolled in qualified health plans and 26,773 individuals enrolled in Medicaid or Children’s Health Insurance Plan (CHIP), according to AHCT.

More than 90% of people who purchased plans through the exchange qualify for financial help or price reductions, she said.

As usual, AHCT will offer consumers multiple ways to connect with licensed brokers who can help them understand plan options: online at accesshealthct.com, by phone at 855-805-4325 and in person.

Six enrollment centers will be open for in-person appointments. Reservations will be required at the sites, which will follow strict COVID safety guidelines, and walk-ins will not be allowed.  Individuals who schedule appointments will be contacted by AHCT before their appointment to ensure they have all necessary documents and information they will need to complete their enrollment at their meeting, Ravitz said.

Enrollment centers will be located at Project Access, 63 York St., New Haven; and Community Renewal Team, 330 Market St., Hartford. Others will be in Bridgeport, Stamford, New Britain and Groton.

AHCT also will hold multiple virtual enrollment fairs this year. During those events, if enrollees want, customer service representatives will walk them through the enrollment process through a screen-sharing feature that allows the AHCT representative and consumer to view forms simultaneously.

While most people must wait until Nov. 1 to enroll in plans, enrollment in Medicaid HUSKY and CHIP is open year-round to eligible individuals and families.

For information on health insurance, you can sign up for a healthy chat scheduled for the following days: Nov. 12, 6-7 p.m. in Spanish only; Nov. 18, 3-4 p.m. or Nov. 19, 6-7 p.m.

Access Health CT’s two insurance carriers, Anthem and ConnectiCare, will be accepting new enrollments beginning now through April 17, according to spokeswoman Kathleen Tallarita.

“No Connecticut resident should worry that testing or treatment will compromise their financial security,” said Gov. Ned Lamont, in an earlier announcement.

“We are experience a moment in history that requires flexibility and innovative ways to access health care,” said Access Health CT CEO James Michel.

The coverage obtained through the extended enrollment period will begin May 1, according to Tallarita.

Only uninsured Connecticut residents who are present in the U.S. and are not incarcerated are eligible to sign up. To do so, call 855-365-2428. Enrollment will be by phone only, Tallarita said.

More information about the special enrollment period is available at Learn.AccessHealthCT.com.

Tallarita noted that individuals who experience a “qualifying life event” such as losing health insurance due to job change/loss, a move to Connecticut, getting married, and having/adopting a child, can always enroll online, in-person or over the phone and all help is free.

Officials at the state’s health insurance exchange are boosting marketing and outreach efforts at a time when many consumers may be confused, said Andrea Ravitz, AHCT’s director of marketing and sales.

Grace Montesi, an outreach team worker for Access Health CT, discusses open enrollment at festival, sponsored by Junta For Progressive Action, at the Peabody Museum, New Haven.

Despite efforts by President Donald Trump and Republicans in Congress to repeal the Affordable Care Act (ACA), which created AHCT, the legislation and the marketplace still stand.

“The constant mixed messages are confusing people,” Ravitz said. “There are certain things that are affecting the federal platform that are not affecting Connecticut at all. There’s a lot of confusion.”

Planned online outages for the federal healthcare.gov website, for instance, will not impact accesshealthct.com, she said, and AHCT’s outreach efforts will not be impeded by federal budget cuts.

One major change from previous years: those renewing plans or enrolling in new ones will have to do so by Dec. 22, and all plans will be effective Jan. 1. In prior years, consumers had until Jan. 31 to enroll and could have start dates later than Jan. 1.

This year, the marketplace has two insurance carriers, ConnectiCare and Anthem. Plans under both carriers will be more expensive than last year, after state regulators approved average increases of 27.7 percent in ConnectiCare’s rates and 31.7 percent for Anthem’s plans.

Amid the changes, ACHT, now in its fifth year, is working to assist consumers. Officials expect about 111,000 people to enroll in plans during open enrollment, roughly the same as last year, Ravitz said.

There will be 10 enrollment centers, up from two last year, where consumers can get free, in-person help. They will be in Bridgeport, Danbury, East Hartford, Harford, Milford, New Haven, New Britain, Norwich, Stamford and Waterbury.

Hundreds of brokers also will be available statewide to offer guidance, Ravitz said. While AHCT enrollment specialists can enroll people in plans, only brokers can recommend certain plans over others, she noted.

AHCT will hold enrollments fairs at various locations statewide every Saturday between Nov. 1 and Dec. 22. Also, the exchange’s online and mobile sites have been upgraded to provide simpler cost estimates and health care provider information.

Grassroots efforts also are under way to connect consumers with resources.

Together We Rise CT, a group of volunteers around the Lower Connecticut River Valley region, is working with Community Health Center in Middletown to spread awareness about open enrollment. The group also will have counselors from the health center at several events to help people enroll, and will offer individuals rides to the center to enroll.

Indivisible, an anti-Trump movement, has Connecticut factions that are doing community outreach and education as well.

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act, sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment people without coverage can shop for insurance plans and those with coverage can renew or change their plans. This year, the marketplace has two insurance carriers, ConnectiCare and Anthem.

The largest premium increases are in mid-level, “silver tiered” plans, which are the most popular on the insurance exchange. Of the 96,000 enrollees in Access Health, more than 60,000 purchased a silver plan.

The 7,700 customers who enrolled in 2017 plans using AHCT and received no financial assistance are enrolled in silver plans and may see higher costs, according to Ravitz. Financial help remains available to consumers who need it, she said.

After open enrollment ends on Dec. 22, consumers can sign up for 2018 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid Husky and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

Paying The Price For No Insurance

As in previous years, people who don’t have health insurance will face fines in 2018 but they are not increasing over 2017. Most people without coverage in 2018 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2017 returns in early 2018, and will be asked on their returns whether they had insurance coverage in 2017.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

Consumers faced the same fines for lacking coverage in 2016, but those fines were higher than the previous year. In 2015, consumers with no coverage paid 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay will see it deducted from future tax refunds.

For addresses of Access Health CT’s enrollment centers click here.

Insurance plans typically use complicated language that is difficult to understand, according to the Health Disparities Institute, UConn Health. As a result, some patients have trouble accessing care, experience delays in care, encounter administrative hassles and face other hurdles, the study found.

The institute conducted a statewide poll last year among 516 adults who enrolled in qualified health plans through Access Health CT (AHCT), the state health insurance exchange created under the Affordable Care Act. Many struggled to understand basic insurance terms like “premium,” “deductible” and “co-pay.”

More needs to be done to educate all health insurance consumers, regardless of where they buy their policies, said Lisa Freeman, executive director of the nonprofit Connecticut Center for Patient Safety.

“If people are going to access something, they have to understand what they’re accessing,” she said, and that goes beyond merely jargon. “It’s so much more than just words on a page; you have to understand the relationship between the different pieces. It’s really hard to put your arms around it, particularly if you’re somebody who’s new to health insurance.”

Insurers acknowledge that health plans are complex and are taking steps to make plans easier to understand.

The study found that people with more education had an easier time than less-educated respondents, according to researchers. But among people with the same education level, the study uncovered “significant differences” by race, ethnicity and language preference. Black and Hispanic consumers had more trouble understanding their plans than whites, according to the institute.

Researchers said the Connecticut findings likely mirror national trends. The study marks the first time health insurance literacy has been examined among Connecticut consumers enrolled in private insurance plans, according to Health Disparities Institute Director Dr. Judith Fifield.

Among the findings: 20 percent of respondents did not understand the use of the word “premium” as it pertains to insurance; 66 percent didn’t understand the word “formulary”; only 33 percent could calculate their out-of-pocket cost of a hospital bill when their plans included a deductible and a co-pay; and 40 percent realized in-network hospitals may have out-of-network doctors.

Access Health staff makes a concerted effort to help consumers understand health plans, but it can be challenging, said Andrea Ravitz, director of marketing and sales for the exchange. Staff strives to break plan complexities down to a fifth- to eighth-grade reading level, she said, and is trained to ask consumers whether they understand what has been explained to them.

“Health insurance by itself is extremely complex,” she said, adding many enrollees through AHCT have no prior experience with insurance. “There is a huge expectation from insurance companies, and really the industry as a whole, that people know what they’re talking about, and that’s a huge misconception. It’s almost impossible to explain it in simple terms, but we can try.”

AHCT staff encourages consumers to question doctors, hospitals, insurance companies and others whenever they come across a term they don’t know, she said. For some, she added, language barriers present additional obstacles.

Anthem, which sells policies on the exchange, has made several changes, said spokeswoman Sarah Yeager. Among them: The company has identified a list of jargon words that will never be used in member communications; and it sends new members a series of “welcome” emails to help familiarize them with their plans.

“We are currently in the midst of a significant shift in how we communicate with our members, which we believe will improve member understanding about and access to the benefits they have and the care they choose to receive,” she said.

ConnectiCare, which also offers insurance on the exchange, also is trying to eliminate confusion by using various media and messages to reach members, according to a company statement. Consumers can participate in educational seminars at the ConnectiCare Center in Manchester during open enrollment, and can make appointments year-round to speak to someone in person at the company’s centers in Bridgeport, Newington or Manchester.

“ConnectiCare understands that navigating the healthcare landscape can be confusing and complicated,” a company statement said.

To combat the problem, the Health Disparities Institute recommends a collaborative, statewide effort to simplify insurance plans and their language. The group also calls for the use of trained, in-person health insurance “navigators,” or coaches, who can help patients better understand their plans.

“Health insurance literacy is a health care disparity that we actually have the power to do something about, and we can continue to measure our progress,” Fifield said in a statement. “The first big step is stepping up our patient education to increase health insurance literacy, and also to implement more consumer-friendly health insurance plans.”

Freeman said greater transparency around health care plans and their associated costs would also help. Too many consumers are confused, she said, and “it’s keeping people from accessing care.”

Now in its fourth year, the state’s health insurance marketplace looks different than it has in the past. Most notably, it has only two insurance carriers, ConnectiCare and Anthem, instead of four.

State insurance regulators approved a 17.4 percent increase in ConnectiCare’s rates for exchange plans and approved a 22.4 percent rate hike for Anthem’s plans.

With the high-profile departure of UnitedHealthcare from the exchange and health insurance co-op HealthyCT going out of business, consumers will no longer be able to enroll in those plans.

Open enrollment begins Nov. 1.

That means consumers currently enrolled in UnitedHealthcare and HealthyCT plans must find alternative options by Dec. 31. The exchange currently has about 9,500 people enrolled in HealthyCT and 1,800 in UnitedHealthcare plans, according to AHCT officials.

AHCT officials expect the exchange to enroll 125,000 consumers in plans during the upcoming open enrollment period that runs Nov. 1 to Jan. 31, up from 116,000 last year, said Andrea Ravitz, marketing director.

Of those currently in plans bought on the exchange, 60 percent are enrolled in either ConnectiCare or Anthem, which should soften the blow of other carriers leaving, she said.

Still, she said, “We want to make sure that people understand that if they chose [UnitedHealthcare or HealthyCT] in the past, those companies are no longer a choice.”

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2017, consumers can shop on the marketplace for plans offered by ConnectiCare and Anthem. Open enrollment runs Nov. 1 through Jan. 31, but individuals must enroll in plans by Dec. 15 if they want coverage to begin Jan. 1.

After open enrollment ends Jan. 31, consumers can sign up for 2017 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

AHCT call centers are being operated by a new vendor, Faneuil Inc., which Ravitz said should result in better customer service. The vendor was chosen following an open-bid process that included prior client recommendations, among other things. AHCT hired Faneuil in September.

Also new this year, Faneuil is hiring about 20 insurance brokers to help consumers by phone and in person at enrollment centers. In previous years, insurance carriers had incentivized brokers to enroll consumers in exchange plans by paying them a commission—about $16 per member per month—but the carriers are no longer paying those commissions, Ravitz said, so AHCT has devised a short-term plan to give consumers access to brokers.

Photo Provided By ConnectiCare.

ConnectiCare opened a health insurance store in Manchester.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

Paying The Price For No Insurance

As in previous years, people who don’t have health insurance will face fines in 2017 but they are not increasing over 2016. Most people without coverage in 2017 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2017 returns in early 2018, and will be asked on their returns whether they had insurance coverage in 2017.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

Consumers faced the same fines for lacking coverage in 2016, but those fines were higher than the previous year. In 2015, consumers with no coverage paid 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay will see it deducted from future tax refunds.

For more information on the Affordable Care Act click here.

Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years.

The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Consumers, particularly those who are uninsured, may have noticed AHCT’s increased marketing efforts.

AHCT has increased its public awareness campaign, she said, including identifying 640 “community influencers” at more than 330 locations across the state to help spread the word. Those people include politicians, teachers, nurses, faith-based leaders and others within various communities that have a large uninsured population, she said.

The organization also reached about 270,000 people during the summer, when representatives attended dozens of community events statewide as part of a campaign to boost awareness, Ravitz said.

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment, which runs from Sunday through Jan. 31, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2016, consumers can shop on the marketplace for plans offered by Anthem, ConnectiCare, HealthyCT and United Healthcare. Coverage begins as early as Jan. 1, but those who want coverage to start on that date must enroll by Dec. 15.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Sunday to enroll in plans, enrollment is open year-round to people who have experienced a qualifying life event, such as the birth of a child, a death in the household, a marriage, or a loss of coverage.

Also, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

The number of insured Connecticut residents is on the rise, according to U.S. Census Bureau figures and AHCT.

AHCT officials said earlier this month that an analysis by the marketplace found 3.8 percent of Connecticut residents are uninsured this year, down from 4 percent last year.

Census figures paint a slightly different picture, but still show steady improvement in the state. The Census estimates 7 percent of Connecticut residents lacked health insurance in 2014, down from nearly 10 percent in 2013, according to data released in September.

Paying The Price For No Insurance

Those who don’t have health insurance will face heftier fines in 2016. Most people without coverage in 2016 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2016 returns in early 2017, and will be asked on their returns whether they had insurance coverage in 2016.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

In 2015, consumers with no coverage will pay 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay the fine will see it deducted from future tax refunds.

Update And Compare Plans for 2016

People enrolled in the health insurance marketplace can re-enroll or choose a new plan for 2016.

Consumers should update their income and household information for 2016 and review all new insurances plans and pricing.

Even those who plan to keep their current plans should update their household information; it’s the only way to ensure any tax credits they may be eligible for in 2016 are accurate. Consumers can update household information as soon as Sunday.

Plans and prices change each year and those who don’t research 2016 options may spend more than they need, get an outdated premium tax credit or be enrolled in a plan for which they are no longer eligible. Some may mistakenly get a higher tax credit than they qualify for, meaning they will have to pay back some or all of it when they file federal taxes.

“Go check your options,” Ravitz said. “There could be some extra savings.”

Rules Changing For Businesses

Under the federal law, employers with 50 or more full-time-equivalent employees must offer their full-time, eligible workers “minimal essential coverage” that is affordable, or face penalties.

Starting in 2016, however, “how you count those employees is different,” said Ken Comeau, senior vice president of the Connecticut Business & Industry Association. The change could result in businesses having to offer coverage to more workers.

Currently, businesses must provide insurance coverage to full-time workers if they have 50 full-time-equivalent employees, which historically has referred to those who work full time. But beginning Jan. 1, businesses must calculate their full-time-equivalents by taking into account all full-time workers and prorating hours worked by part-time employees, Comeau said.

The change will impact businesses that have few full-time employees but many part-timers, such as restaurants, he said. Full-timers work 30 hours a week or more; part-timers work fewer than 30 hours.

Additionally, through this year, businesses with 50 to 100 full-time-equivalent employees that haven’t offered the required coverage haven’t been penalized. But as of Jan. 1, that “transitional relief” disappears and businesses not complying with the law may face penalties, Comeau said.

Sources: Healthcare.gov, Access Health CT, Connecticut Business & Industry Association

Connecticut is one of 15 states included in the study, which analyzed the 2014 and 2015 health plans of companies that provide coverage under the ACA in state marketplaces. It found violations in all 15 states and concluded that they are likely occurring nationwide.

According to the report, Connecticut women have been denied coverage for the following: breastfeeding counseling and education after two months following delivery, infertility treatments after the age of 40, sterilization procedures, emergency birth control, and maintenance care for such things as lupus, HIV, and hormones after breast cancer treatment. Coverage was also denied for transgender transitions.

Some of the violations found in Connecticut have been corrected. The companies that participate in the state health marketplace, Access Health CT, are: Anthem Health Plans, ConnectiCare Benefits Inc., HealthyCT and UnitedHealth Group.

Karen Davenport, the law center’s director of health policy, said it takes all violations “seriously,” but added Connecticut didn’t have “really shocking problems” such as a Colorado insurer’s one-year waiting period for organ transplants, and a Tennessee insurer’s refusal to pay for labor and delivery costs for policyholders’ dependents.

The state’s Insurance Department informed insurers that coverage of breastfeeding counseling is required “during pregnancy and/or the postpartum period.”

The severity of a violation “depends on the woman and her circumstances,” Davenport said. “Where women aren’t able to get the services that the law guarantees them, depending on where you sit, any one of them could be egregious,” she said.

Some of the Connecticut violations were corrected in insurance plans after the state issued bulletins clarifying that transgender transitions, sterilization for women, and contraception should be fully covered without a co-pay or deductible.

The remaining problems with Connecticut plans mainly concern the duration for which breastfeeding counseling is covered and a lack of coverage for infertility treatments for women age 40 and older.

On breastfeeding counseling, the state’s Insurance Department informed insurers to provide coverage for an undefined postpartum period, according to spokeswoman Donna Tommelleo. The department used a federal guideline that stipulates coverage is required “during pregnancy and/or the postpartum period,” Tommelleo said.

But when asked for clarification, the U.S. Department of Health and Human Services (HHS) responded that health plans must cover breastfeeding counseling “for the duration of breastfeeding.”

The Insurance Department is now reviewing the infertility coverage issue and “collecting additional data,” Tommelleo said. All four companies in the state’s insurance marketplace limit infertility coverage to women younger than 40. But the law center report states, “many women over 40 still have reproductive capacity.”

Davenport, of the law center, explained that because Connecticut mandates coverage of infertility services in its benchmark plan for Essential Health Benefits, it must be covered under the ACA. “If Connecticut chose a benchmark plan that did not cover infertility, such as a plan offered under the Federal Employees Health Benefit Program, infertility would not be part of Connecticut’s Essential Health Benefits,” she said.

The state must also adhere to an ACA prohibition against age discrimination, Davenport said.

Meanwhile, the report praises the state’s Insurance Department for clarifying coverage requirements for contraception and transgender-related care. It calls the state’s birth control bulletin “an important step toward ensuring that issuers clearly understand the requirements of the law and are not inappropriately charging women cost-sharing.”

Susan Lloyd Yolen, vice president of public policy and advocacy for Planned Parenthood of Southern New England, said her organization joined the law center in approaching the Insurance Department, which was “eager to correct inconsistencies and violations.”

In May, the HHS informed insurers that all forms of contraception identified by the FDA should be fully covered. This followed a letter from 39 U.S. senators, including Connecticut Democrats Richard Blumenthal and Chris Murphy, who complained about inconsistent contraception coverage.

“We take reports of non-compliance very seriously,” said Katie Hill, an HHS spokesperson.

After the state told insurers that failure to provide transgender transition coverage violates state discrimination law, all insurers in the state’s marketplace included it in their 2015 plans. None covered it in their 2014 plans, according to the law center report.

HealthyCT’s Chief Executive Officer Ken Lalime said when his company “became aware that policies were out of compliance, we immediately rectified the situation.” Its plan now includes coverage for lactation education through the duration of breastfeeding, and full coverage of female sterilization services and routine maternity care.

“As a brand new insurance company, HealthyCT had to write an entire Certificate of Coverage from scratch under new laws at the state and federal level,” he said, adding that “it’s unfortunate” that the law center didn’t acknowledge his company’s amended plan when it published its report.

ConnectiCare said it has been covering sterilization services for women without co-pays or deductibles since 2012 and disputed the law center’s contention that it hasn’t.

An Anthem spokesperson, Sarah Yeager, said in an email, “Our products are approved by the Connecticut Insurance Department.”

United, cited for the age limit in its infertility coverage, didn’t respond to a request for comment.

Davenport said the center does not know how many women were affected by the violations. The state Insurance Department does not know how many Connecticut women have coverage under ACA, said Tommelleo. The report states that nearly 6.3 million women nationally bought insurance during the 2015 open enrollment period.