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120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special Enrollment Period (SEP) for eligible individuals who lose HUSKY Health
coverage on or after April 1, 2023. Under this SEP, eligible applicants will have up to 120 days
to enroll in new health and/or dental insurance coverage after their loss of HUSKY Health
coverage. An applicant's coverage effective date will be the first day of the month following plan
selection.
More Information:
•
Medicaid Unwinding
•
Special Enrollment Periods
•
Verification Documents | What is the main topic of this document? | 120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special E |
120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special Enrollment Period (SEP) for eligible individuals who lose HUSKY Health
coverage on or after April 1, 2023. Under this SEP, eligible applicants will have up to 120 days
to enroll in new health and/or dental insurance coverage after their loss of HUSKY Health
coverage. An applicant's coverage effective date will be the first day of the month following plan
selection.
More Information:
•
Medicaid Unwinding
•
Special Enrollment Periods
•
Verification Documents | Who is mentioned in the document? | 120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special E |
120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special Enrollment Period (SEP) for eligible individuals who lose HUSKY Health
coverage on or after April 1, 2023. Under this SEP, eligible applicants will have up to 120 days
to enroll in new health and/or dental insurance coverage after their loss of HUSKY Health
coverage. An applicant's coverage effective date will be the first day of the month following plan
selection.
More Information:
•
Medicaid Unwinding
•
Special Enrollment Periods
•
Verification Documents | What are the key takeaways from this text? | 120-day Special Enrollment Period
Written by Yessenia Milan | Last published at: October 25, 2023
Residents affected by the Medicaid Unwinding: AHCT will offer a 120-day ‘Medicaid
Unwind’ Special E |
About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and earlier, individuals without coverage during those years may be subject
to a penalty. This penalty is also known as the “Individual Responsibility Payment.”
If you did not have healthcare coverage in 2018, the Internal Revenue Service (IRS) may charge a
penalty when you file your federal tax return. The State of Connecticut does not charge a penalty for
not having healthcare coverage.
The IRS reviews the number of months out of the tax year that you didn’t have coverage, and
charges a penalty based on those months if they exceeded three months total.
The penalty amount can vary. The IRS calculates the total amount for the year that you owe for
months you were not covered. You will pay 1/12th of the total amount for the year for each month you
and/or members of your tax household were not covered.
The easiest way to avoid a penalty is to get coverage. Many types of coverage count to help you
avoid a penalty from the IRS. These include plans offered through your employer, plans available
through Access Health CT and other individual market plans, HUSKY (Medicaid), Medicare, the
Children’s Health Insurance Plan (CHIP or HUSKY B), VA Care or Tricare. | What is the main topic of this document? | About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and |
About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and earlier, individuals without coverage during those years may be subject
to a penalty. This penalty is also known as the “Individual Responsibility Payment.”
If you did not have healthcare coverage in 2018, the Internal Revenue Service (IRS) may charge a
penalty when you file your federal tax return. The State of Connecticut does not charge a penalty for
not having healthcare coverage.
The IRS reviews the number of months out of the tax year that you didn’t have coverage, and
charges a penalty based on those months if they exceeded three months total.
The penalty amount can vary. The IRS calculates the total amount for the year that you owe for
months you were not covered. You will pay 1/12th of the total amount for the year for each month you
and/or members of your tax household were not covered.
The easiest way to avoid a penalty is to get coverage. Many types of coverage count to help you
avoid a penalty from the IRS. These include plans offered through your employer, plans available
through Access Health CT and other individual market plans, HUSKY (Medicaid), Medicare, the
Children’s Health Insurance Plan (CHIP or HUSKY B), VA Care or Tricare. | Who is mentioned in the document? | About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and |
About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and earlier, individuals without coverage during those years may be subject
to a penalty. This penalty is also known as the “Individual Responsibility Payment.”
If you did not have healthcare coverage in 2018, the Internal Revenue Service (IRS) may charge a
penalty when you file your federal tax return. The State of Connecticut does not charge a penalty for
not having healthcare coverage.
The IRS reviews the number of months out of the tax year that you didn’t have coverage, and
charges a penalty based on those months if they exceeded three months total.
The penalty amount can vary. The IRS calculates the total amount for the year that you owe for
months you were not covered. You will pay 1/12th of the total amount for the year for each month you
and/or members of your tax household were not covered.
The easiest way to avoid a penalty is to get coverage. Many types of coverage count to help you
avoid a penalty from the IRS. These include plans offered through your employer, plans available
through Access Health CT and other individual market plans, HUSKY (Medicaid), Medicare, the
Children’s Health Insurance Plan (CHIP or HUSKY B), VA Care or Tricare. | What are the key takeaways from this text? | About the IRS Tax Penalty
Written by Yessenia Milan | Last published at: November 25, 2024
For Tax Year 2020, the penalty or fee for not having health insurance coverage is $0.
For Tax Years 2018 and |
¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
aquellos a quienes se les otorgó una exención por dificultades o asequibilidad de Access
Health CT. No puede obtener ayuda financiera para pagar los planes Catastróficos.
Estos planes tienen primas mensuales bajas y brindan el nivel más bajo de cobertura, pero
tienen gastos de bolsillo más altos que otros tipos de planes.
Cuando complete una solicitud de cobertura, verá los planes catastróficos enumerados como
una opción solo si califica para ellos. Si no califica, no los verá como una opción para
seleccionar. Solo Access Health CT puede otorgar una exención por dificultades o
asequibilidad para comprar un plan catastrófico. Haga clic aquí para descargar la solicitud y las
instrucciones sobre cómo completar el formulario.
¿Este plan es para ti?
Puede ser una buena opción para las personas que desean protegerse de los peores
escenarios, como enfermarse o lesionarse gravemente, pero usted pagará la mayoría de los
gastos médicos de rutina. Estos planes tienen primas mensuales bajas, pero también tienen
deducibles altos (su deducible es el monto que paga por los servicios de atención médica
cubiertos antes que su plan de seguro comience a pagar). Su deducible no se aplicará a sus
primeras 3 visitas de atención primaria, pero debe alcanzar el deducible del plan para todos los
demás servicios cubiertos antes que el plan brinde cobertura. Después de gastar el monto
del deducible, su compañía de seguros paga todos los servicios cubiertos,
sin copago ni coseguro. Si califica para créditos fiscales para la prima en función de los
ingresos de su hogar, no se pueden aplicar a un plan Catastrófico. Es posible que desee
considerar un plan Bronce o Plata, que puede ser mejor valor. Asegúrese de comparar.
Para obtener más información sobre los tipos de planes que puede obtener a través de Access
Health CT, haga clic aquí. | What is the main topic of this document? | ¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
|
¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
aquellos a quienes se les otorgó una exención por dificultades o asequibilidad de Access
Health CT. No puede obtener ayuda financiera para pagar los planes Catastróficos.
Estos planes tienen primas mensuales bajas y brindan el nivel más bajo de cobertura, pero
tienen gastos de bolsillo más altos que otros tipos de planes.
Cuando complete una solicitud de cobertura, verá los planes catastróficos enumerados como
una opción solo si califica para ellos. Si no califica, no los verá como una opción para
seleccionar. Solo Access Health CT puede otorgar una exención por dificultades o
asequibilidad para comprar un plan catastrófico. Haga clic aquí para descargar la solicitud y las
instrucciones sobre cómo completar el formulario.
¿Este plan es para ti?
Puede ser una buena opción para las personas que desean protegerse de los peores
escenarios, como enfermarse o lesionarse gravemente, pero usted pagará la mayoría de los
gastos médicos de rutina. Estos planes tienen primas mensuales bajas, pero también tienen
deducibles altos (su deducible es el monto que paga por los servicios de atención médica
cubiertos antes que su plan de seguro comience a pagar). Su deducible no se aplicará a sus
primeras 3 visitas de atención primaria, pero debe alcanzar el deducible del plan para todos los
demás servicios cubiertos antes que el plan brinde cobertura. Después de gastar el monto
del deducible, su compañía de seguros paga todos los servicios cubiertos,
sin copago ni coseguro. Si califica para créditos fiscales para la prima en función de los
ingresos de su hogar, no se pueden aplicar a un plan Catastrófico. Es posible que desee
considerar un plan Bronce o Plata, que puede ser mejor valor. Asegúrese de comparar.
Para obtener más información sobre los tipos de planes que puede obtener a través de Access
Health CT, haga clic aquí. | Who is mentioned in the document? | ¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
|
¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
aquellos a quienes se les otorgó una exención por dificultades o asequibilidad de Access
Health CT. No puede obtener ayuda financiera para pagar los planes Catastróficos.
Estos planes tienen primas mensuales bajas y brindan el nivel más bajo de cobertura, pero
tienen gastos de bolsillo más altos que otros tipos de planes.
Cuando complete una solicitud de cobertura, verá los planes catastróficos enumerados como
una opción solo si califica para ellos. Si no califica, no los verá como una opción para
seleccionar. Solo Access Health CT puede otorgar una exención por dificultades o
asequibilidad para comprar un plan catastrófico. Haga clic aquí para descargar la solicitud y las
instrucciones sobre cómo completar el formulario.
¿Este plan es para ti?
Puede ser una buena opción para las personas que desean protegerse de los peores
escenarios, como enfermarse o lesionarse gravemente, pero usted pagará la mayoría de los
gastos médicos de rutina. Estos planes tienen primas mensuales bajas, pero también tienen
deducibles altos (su deducible es el monto que paga por los servicios de atención médica
cubiertos antes que su plan de seguro comience a pagar). Su deducible no se aplicará a sus
primeras 3 visitas de atención primaria, pero debe alcanzar el deducible del plan para todos los
demás servicios cubiertos antes que el plan brinde cobertura. Después de gastar el monto
del deducible, su compañía de seguros paga todos los servicios cubiertos,
sin copago ni coseguro. Si califica para créditos fiscales para la prima en función de los
ingresos de su hogar, no se pueden aplicar a un plan Catastrófico. Es posible que desee
considerar un plan Bronce o Plata, que puede ser mejor valor. Asegúrese de comparar.
Para obtener más información sobre los tipos de planes que puede obtener a través de Access
Health CT, haga clic aquí. | What are the key takeaways from this text? | ¿Access Health CT ofrece un plan catastrófico?
Written by Yessenia Milan | Last published at: April 26, 2023
Los planes catastróficos solo están disponibles para personas menores de 30 años o para
|
Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amount to reduce your monthly premium OR take less
by using the scale in the disclaimer below. The sliding scale appears in the disclaimer below.
You Should Know:
Those who take less APTC may be eligible to receive the remaining tax credit as a refund based on
the actual Modified Adjusted Gross Income (MAGI) reported on their federal Income tax return.
If you actual annual income could be higher than what you listed in your application, you can select
to receive a smaller APTC amount. To select a smaller APTC amount, move the slider to the left (see
example below).
The IRS ultimately decides who receives repayment of tax credits and how much they receive.
Access Health CT cannot guarantee payment of any remaining APTC when you file your federal tax
return.
For additional information about the tax provisions of the Affordable Care Act (ACA), click here. | What is the main topic of this document? | Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amoun |
Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amount to reduce your monthly premium OR take less
by using the scale in the disclaimer below. The sliding scale appears in the disclaimer below.
You Should Know:
Those who take less APTC may be eligible to receive the remaining tax credit as a refund based on
the actual Modified Adjusted Gross Income (MAGI) reported on their federal Income tax return.
If you actual annual income could be higher than what you listed in your application, you can select
to receive a smaller APTC amount. To select a smaller APTC amount, move the slider to the left (see
example below).
The IRS ultimately decides who receives repayment of tax credits and how much they receive.
Access Health CT cannot guarantee payment of any remaining APTC when you file your federal tax
return.
For additional information about the tax provisions of the Affordable Care Act (ACA), click here. | Who is mentioned in the document? | Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amoun |
Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amount to reduce your monthly premium OR take less
by using the scale in the disclaimer below. The sliding scale appears in the disclaimer below.
You Should Know:
Those who take less APTC may be eligible to receive the remaining tax credit as a refund based on
the actual Modified Adjusted Gross Income (MAGI) reported on their federal Income tax return.
If you actual annual income could be higher than what you listed in your application, you can select
to receive a smaller APTC amount. To select a smaller APTC amount, move the slider to the left (see
example below).
The IRS ultimately decides who receives repayment of tax credits and how much they receive.
Access Health CT cannot guarantee payment of any remaining APTC when you file your federal tax
return.
For additional information about the tax provisions of the Affordable Care Act (ACA), click here. | What are the key takeaways from this text? | Advance Premium Tax Credit Disclaimer
If you enroll in a Qualified Health Plan (QHP) and you are eligible for advance payments of the Premium
Tax Credit (APTC) you can choose to use the full amoun |
• Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insurance company directly with questions or to learn
more about resources available to you
• Always pay your premiums on time to avoid coverage delays
or lapses
After You Enroll
After you enroll in healthcare coverage through Access Health CT, you’ll receive additional materials from us
and from your insurance company (materials may vary depending on the plan you choose). To stay organized,
check off each item below as you receive it from us.
Questions about your coverage?
Access Health CT does not have access to that information.
Anthem:
1-855-738-6644
Anthem.com
Get the most from your healthcare coverage
Start by choosing a primary care doctor from your insurance company’s provider directory, and
schedule your annual checkup. Make sure you:
When
From
What
about 3 days after enrolling
Access Health CT and your insurance
company will each mail you a separate letter.
Your insurance company will send you a bill
is due and how to pay it.
about 5–10 days after enrolling
about 1–2 weeks after you
available any day, 24/7
Your insurance company’s website:
Anthem.com
ConnectiCare.com
HuskyHealthCT.org
First Bill
Pharmacy and
Doctor Directories
ID Card
You may be asked to provide proof of your income (such as a recent pay stub), identity
(such as a driver’s license or passport), and immigration status (such as visa documents)
Important note:
Learn more about managing your account after enrollment at AccessHealthCT.com/manage-your-account
AccessHealthCT.com | Follow us on:
Your insurance company; they can help you
find in-network pharmacies, primary care
physicians, specialists, and hospitals to
help save money.
ConnectiCare Benefits, Inc. &
ConnectiCare Insurance Company, Inc.:
1-800-251-7722
ConnectiCare.com
Department of Social Services,
Husky Health Member Services:
1-800-859-9889
HuskyHealthCT.org
Confirmation Letter | What is the main topic of this document? | • Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insu |
• Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insurance company directly with questions or to learn
more about resources available to you
• Always pay your premiums on time to avoid coverage delays
or lapses
After You Enroll
After you enroll in healthcare coverage through Access Health CT, you’ll receive additional materials from us
and from your insurance company (materials may vary depending on the plan you choose). To stay organized,
check off each item below as you receive it from us.
Questions about your coverage?
Access Health CT does not have access to that information.
Anthem:
1-855-738-6644
Anthem.com
Get the most from your healthcare coverage
Start by choosing a primary care doctor from your insurance company’s provider directory, and
schedule your annual checkup. Make sure you:
When
From
What
about 3 days after enrolling
Access Health CT and your insurance
company will each mail you a separate letter.
Your insurance company will send you a bill
is due and how to pay it.
about 5–10 days after enrolling
about 1–2 weeks after you
available any day, 24/7
Your insurance company’s website:
Anthem.com
ConnectiCare.com
HuskyHealthCT.org
First Bill
Pharmacy and
Doctor Directories
ID Card
You may be asked to provide proof of your income (such as a recent pay stub), identity
(such as a driver’s license or passport), and immigration status (such as visa documents)
Important note:
Learn more about managing your account after enrollment at AccessHealthCT.com/manage-your-account
AccessHealthCT.com | Follow us on:
Your insurance company; they can help you
find in-network pharmacies, primary care
physicians, specialists, and hospitals to
help save money.
ConnectiCare Benefits, Inc. &
ConnectiCare Insurance Company, Inc.:
1-800-251-7722
ConnectiCare.com
Department of Social Services,
Husky Health Member Services:
1-800-859-9889
HuskyHealthCT.org
Confirmation Letter | Who is mentioned in the document? | • Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insu |
• Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insurance company directly with questions or to learn
more about resources available to you
• Always pay your premiums on time to avoid coverage delays
or lapses
After You Enroll
After you enroll in healthcare coverage through Access Health CT, you’ll receive additional materials from us
and from your insurance company (materials may vary depending on the plan you choose). To stay organized,
check off each item below as you receive it from us.
Questions about your coverage?
Access Health CT does not have access to that information.
Anthem:
1-855-738-6644
Anthem.com
Get the most from your healthcare coverage
Start by choosing a primary care doctor from your insurance company’s provider directory, and
schedule your annual checkup. Make sure you:
When
From
What
about 3 days after enrolling
Access Health CT and your insurance
company will each mail you a separate letter.
Your insurance company will send you a bill
is due and how to pay it.
about 5–10 days after enrolling
about 1–2 weeks after you
available any day, 24/7
Your insurance company’s website:
Anthem.com
ConnectiCare.com
HuskyHealthCT.org
First Bill
Pharmacy and
Doctor Directories
ID Card
You may be asked to provide proof of your income (such as a recent pay stub), identity
(such as a driver’s license or passport), and immigration status (such as visa documents)
Important note:
Learn more about managing your account after enrollment at AccessHealthCT.com/manage-your-account
AccessHealthCT.com | Follow us on:
Your insurance company; they can help you
find in-network pharmacies, primary care
physicians, specialists, and hospitals to
help save money.
ConnectiCare Benefits, Inc. &
ConnectiCare Insurance Company, Inc.:
1-800-251-7722
ConnectiCare.com
Department of Social Services,
Husky Health Member Services:
1-800-859-9889
HuskyHealthCT.org
Confirmation Letter | What are the key takeaways from this text? | • Take advantage of key in-network preventive care visits, which
are covered 100% and can help you stay healthy
• Use in-netw
• Save money with generic drugs and mail-order programs
• Call your insu |
Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados por el empleador,
de los cuales los empleados son reembolsados libres de impuestos para los gastos médicos
calificados hasta un monto fijo en dólares por año. Los montos no utilizadas pueden ser
renovados para ser utilizadose en años posteriores. El empleador financia y es propietario de la
cuenta.
Affordable Care Act (ACA)
(also known as the Patient Protection and Affordable Care Act or Obamacare) and is the
landmark health reform legislation signed into law in March 2010. Key provisions are intended to
extend coverage to millions of uninsured Americans, implement measures that will lower health
care costs and improve system efficiency, and eliminate industry practices that include rescission
and denial of coverage due to pre-existing conditions.
Agent
An agent is a state-licensed individual or entity representing one or more insurance companies.
An agent solicits and facilitates the sale of insurance contracts or policies and provides services
to the policyholder on behalf of the insurer.
Agente
Un agente es una persona o entidad con licencia estatal que representa a una o más compañías
de seguros. Un agente solicita y facilita la venta de contratos o pólizas de seguro y brinda
servicios al titular de la póliza en nombre del asegurador.
Agente de seguros
Un agente de seguros es un representante legal autorizado del titular de la póliza, que negocia
con una compañía de seguros en nombre de un cliente. La compañía de seguros le paga una
comisión.
Annual Limit
A limit on the benefits your health plan will pay in a year. Limits are sometimes placed on
particular services, such as prescriptions or physical therapy treatments. They can also be placed
on the dollar amount or on the number of visits. After an annual limit is reached, you must pay all
related health care costs for the rest of the year.
año calendario
1 de enero - 31 de diciembre
APTC
also known as Advanced Premium Tax Credits. The credit amount will be paid directly to the
insurance company from the federal government. The individual pays the difference between the
credit and the plan's premium.
Authorized Representative
An authorized representative is a person who has been designated in the Exchange to act on
someone else’s behalf.
Beneficios esenciales de salud
Todos los planes de salud calificados (QHP en inglés) que se ofrecen a través de Access Health
CT brindan el mismo conjunto de 10 beneficios esenciales de salud. Los beneficios pueden
costar más o menos en diferentes planes en diferentes niveles, puede estar seguro de que todos
los planes brindarán: 1. Servicios preventivos y de bienestar y manejo de enfermedades crónicas
2. Servicios pediátricos 3. Servicios ambulatorios para pacientes (atención ambulatoria que
recibe sin hospitalización) 4. Cobertura de la sala de emergencias 5. Hospitalización (como
cirugía) 6. Atención de maternidad y del recién nacido (atención antes y después del nacimiento
de su bebé) 7. Servicios de salud mental y abuso de sustancias, incluido el tratamiento de salud
conductual (incluye asesoramiento y psicoterapia) 8. Cobertura de medicamentos prescritos 9.
Servicios y dispositivos de rehabilitación y habilitación (servicios y dispositivos para ayudar a las
personas con lesiones, discapacidades o afecciones crónicas a obtener o recuperar habilidades
mentales y físicas) 10. Cobertura de servicios de laboratorio
Broker
A broker is a licensed legal representative of the policyholder, who negotiates with an insurance
company on behalf of a customer but is paid a commission by the insurance company.
Calendar Year
January 1 - December 31
Catastrophic Plans
Catastrophic plans are available to people younger than 30 years old or to those who have been
granted a hardship or affordability exemption. You are not eligible to get financial help to pay for
catastrophic plans. These plans have low monthly premiums and provide the lowest level of
coverage. Catastrophic plans offer protection when healthcare costs near or reach annual-of-
pocket cost maximums.
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for
administering Medicare, Medicaid, State Children's Health Insurance, Health Insurance Portability
and Accountability Act, Clinical Laboratory Improvement Amendments, and several other health-
related programs. CMS also establishes standards for healthcare providers that must be complied
with in order for providers to meet certain certification requirements.
Centro de Servicios de Medicare y Medicaid (CMS en inglés)
El Centro de Servicios de Medicare y Medicaid (CMS) es la agencia federal responsable de
administrar Medicare, Medicaid, el seguro médico para niños (CHIP en inglés), la Ley de
Responsabilidad y Portabilidad del Seguro de Salud, las Enmiendas para mejorar los
Laboratorios Clínicos y varios otros programas relacionados con la salud. El Centro de Servicios
de Medicare y Medicaid también establece estándares para los proveedores de atención médica,
los cuales deben cumplirse para que los proveedores cumplan con ciertos requisitos de
certificación.
Children’s Health Insurance Program (CHIP)
CHIP is an insurance program funded by state and Federal government that provides health
insurance to children in low-income households. In Connecticut, this program is referred to as
HUSKY B.
Claim
A claim is a request for payment that you or your health care provider submits to your health
insurer when you get items or services.
Cobertura acreditable
La cobertura acreditable es cualquiera de los siguientes planes: plan de salud grupal, plan de
salud individual, plan de salud para estudiantes, Medicare, Medicaid, CHAMPUS y TRICARE,
Programa de Beneficios de Salud para Empleados Federales, Servicio de Salud para Indígenas,
Cuerpo de Paz, plan de salud pública (como los de el gobierno de los EE. UU., un gobierno
estatal, o un país extranjero) o el Programa de seguro médico para niños (CHIP en inglés).
Cobertura de dependientes
La cobertura de dependientes se refiere a la cobertura de seguro para los miembros de la familia
del titular de la póliza, como un cónyuge, hijo o pareja.
Cobertura dento de la red
su compañía de seguros ha contratado a hospitales, proveedores y proveedores para brindar
servicios a un costo menor. Puede averiguar si un proveedor está dentro de la red utilizando el
directorio de proveedores en línea o comunicándose con su compañía de seguros.
Cobertura esencial minima
La Cobertura Esencial Mínima (MEC en inglés) es el tipo de cobertura que una persona debe
tener para cumplir con el requisito de responsabilidad individual, según la Ley de Cuidado de
Salud a Bajo Costo. Esto incluye pólizas de mercado individuales, cobertura a través de su
trabajo, Medicare, Medicaid, Programa de seguro médico para niños, TRICARE y algunas otras
coberturas.
Co-Insurance
The percentage of costs you pay for a covered healthcare services after you have paid your
deductible.
Copago
Un copago es una cantidad fija (por ejemplo, $15) que paga por un servicio de atención médica
cubierto, generalmente cuando recibe el servicio. El monto en dólares puede variar según el tipo
de servicio.
Co-Payment
A co-payment is a fixed amount (for example $15) that you pay for a covered healthcare service,
usually when you receive the service. The dollar amount can vary by the type of service.
Coseguro
El porcentaje de los costos que paga por los servicios de atención médica cubiertos después de
haber pagado su deducible.
Cost-Sharing Reduction
Cost-Sharing Reduction (CSR) lowers the amount you pay out-of-pocket for deductibles, co-
insurance and co-payments when you get medical services. If you qualify for CSR, you must
enroll in a Silver level plan to get these lower costs.
Creditable Coverage
Creditable coverage is any of the following plans: group health plan, individual health plan,
student health plan, Medicare, Medicaid, CHAMPUS and TRICARE, Federal Employees Health
Benefits Program, Indian Health Service, Peace Corps, public health plan (such as those from the
US Government, or a state government, or a foreign country), or Children’s Health Insurance
Program (CHIP)
Creditos fiscales anticipados para la prima
también conocido como créditos fiscales anticipados para la prima. El monto del crédito se
pagará directamente del gobierno federal a la compañía de seguros. El individuo paga la
diferencia entre el crédito y la prima del plan.
Cuenta de ahorro para la salud
Las cuentas de ahorro para la salud (HSA en inglés) le permiten apartar dinero antes de
impuestos para pagar los gastos médicos calificados si tiene un plan de seguro de salud con
deducible alto.
deducible
El deducible es el monto que paga por los servicios de atención médica cubiertos antes que su
plan de seguro comience a pagar. Puede que no se aplique a todos los servicios.
Deductible
The deductible is the amount you pay for covered healthcare services before your insurance plan
starts to pay. It may not apply to all services.
Dependent Coverage
Dependent coverage refers to insurance coverage for family members of the policyholder, such
as a spouse, child, or partner.
Dependent(s)
A dependent is a spouse, child or family member of the household obtaining health coverage
under the primary applicant's insurance plan
Dependiente(s)
Un dependiente es un cónyuge, hijo o miembro de la familia del hogar que obtiene cobertura
médica bajo el plan de seguro del solicitante principal.
Especialista
médico que se enfoca en un área específica de la medicina o en un grupo de pacientes para
diagnosticar, manejar, prevenir o tratar ciertos tipos de síntomas y afecciones.
essential health benefits
All qualified health plans (QHP) offered through Access Health CT provide the same set
of 10 Essential Health Benefits. While the benefits may cost more or less in different plans at
different levels, you can be assured that all plans will provide: 1. Preventive and wellness
services and chronic disease management 2. Pediatric services 3. Ambulatory patient services
(outpatient care you get without being admitted to a hospital) 4. Emergency room coverage 5.
Hospitalization (such as surgery) 6. Maternity and newborn care (care before and after your baby
is born) 7. Mental health and substance abuse services, including behavioral health treatment
(includes counseling and psychotherapy) 8. Prescription drug coverage 9. Rehabilitation and
Habilitation services and devices (services and devices to help people with injuries, disabilities, or
chronic conditions gain or recover mental and physical skills) 10. Laboratory service coverage
evento de vida calificado
Un evento de vida calificado (QLE en inglés) es un cambio en su vida, como perder la cobertura
de salud, casarse, tener un bebé, o mudarse a Connecticut, que puede hacerlo elegible para un
período de inscripción especial, lo que le permite inscribirse en un seguro de salud fuera del
período abierto anual de inscripción.
Federal Poverty Level
The Federal Poverty Level (FPL) is a measure of income issued every year by the Department of
Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility
for certain programs and benefits, including savings on Marketplace health insurance, and
Medicaid and CHIP coverage.
Fuera de la red
Proveedores o servicios con los que su plan de seguro médico no tiene contrato. Es posible que
termine pagando una mayor parte del costo de esta atención. Asegúrese de verificar si sus
proveedores están dentro de la red. Puede averiguar si un proveedor está dentro de la red
utilizando el directorio de proveedores en línea o comunicándose con su compañía de seguros.
Gastos de bolsillo
Los gastos de bolsillo son gastos de atención médica que no son reembolsados por su compañía
de seguros. Estos costos incluyen deducibles, coseguros y copagos por servicios cubiertos, más
todos los costos por servicios que no están cubiertos.
Health Reimbursement Account (HRA)
Health Reimbursement Accounts are employer-funded group health plans from which employees
are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.
Unused amounts may be rolled over to be used in subsequent years. The employer funds and
owns the account.
Health Savings Account (HSA)
Health Savings Accounts (HSA) allow you to set aside money on a pre-tax basis to pay for
qualified medical expenses if you have a high deductible health insurance plan.
High Deductible Health Plans (HDHP)
A High Deductible Health Plan (HDHP) is plan that requires higher deductibles than other plans.
These can be combined with a health savings account or a health reimbursement arrangement to
allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.
Hogar (hogar fiscal)
Para la mayoría de las personas, un hogar está formado por el declarante de impuestos, su
cónyuge, si tiene uno, y sus dependientes fiscales, incluidos aquellos que no necesitan
cobertura. El Mercado cuenta los ingresos estimados de todos los miembros del hogar, incluso
aquellos que no solicitan cobertura. Cuando calcule sus ingresos para recibir ayuda financiera,
debe contar los ingresos de todas las personas de su hogar fiscal.
Household (Tax Household)
For most people, a household consists of the tax filer, their spouse if they have one, and their tax
dependents, including those who don’t need coverage. The Marketplace counts estimated income
of all household members, even those who are not applying for coverage. When you estimate
your income to receive financial help you should count income for everyone in your tax
household.
In-Network Coverage
Your insurance company has contracted with hospitals, providers and suppliers to provide
services at a lower cost. You can find out if a provider is in-network using the online provider
directory or by contacting your insurance company.
Ley de Cuidado de Salud a Bajo Precio
(también conocida como la Ley de Protección al Paciente y Cuidado de Salud a bajo precio u
Obamacare) es una legislación histórica de reforma de salud promulgada en marzo de 2010. Las
disposiciones clave están destinadas a extender la cobertura a millones de estadounidenses sin
seguro, implementar medidas que reduzcan los costos de atención médica, mejorar la eficiencia
del sistema, y eliminar las prácticas de la industria que incluyen la rescisión y denegación de
cobertura debido a condiciones preexistentes.
Limite Annual
Un límite en los beneficios que pagará su plan de salud en un año. A veces, se imponen límites a
servicios particulares, como prescripciones o tratamientos de fisioterapia. También se pueden
colocar en el monto en dólares o en el número de visitas. Una vez que se alcanza un límite
anual, debe pagar todos los costos de atención médica relacionados durante el resto del año.
Máximo de gastos de bolsillo
El máximo de gastos de bolsillo (MOOP en inglés), también conocido como límites de gastos de
bolsillo, es lo máximo que pagará durante un período de póliza (generalmente un año) antes de
que su plan de salud comience a pagar el 100% de la cantidad permitida. Este límite nunca
incluye su prima, los cargos facturados por el saldo o los servicios que su plan no cubre. Algunos
planes de salud no cuentan todos sus copagos, deducibles, pagos de coseguro, pagos fuera de
la red u otros gastos para este límite. Para el Programa de salud HUSKY (Medicaid / Programa
de seguro médico para niños), el límite sí incluye las primas.
Maximum-Out-of-Pocket (MOOP)
The Maximum-Out-Of-Pocket (MOOP) also known as out-of-pocket limits, is the most you will pay
during a policy period (usually a year) before your health plan begins to pay 100% of the allowed
amount. This limit never includes your premium, balance-billed charges or services your plan
does not cover. Some health plans do not count all of your co-payments, deductibles, co-
insurance payments, out-of-network payments or other expenses toward this limit. For HUSKY
Health Program (Medicaid/Children’s Health Insurance Program), the limit does include
premiums.
Medicaid
Medicaid is state-administered health insurance program for low-income families and children,
pregnant women, the elderly, people with disabilities, and in some states, other adults. The
federal government provides a portion of the funding for Medicaid and sets guidelines for the
program. States also have choices in how they design their program, so Medicaid varies state by
state.
Medicaid (español)
Medicaid es un programa de seguro médico administrado por el estado para familias y niños de
hogares de bajos ingresos, mujeres embarazadas, ancianos, personas con discapacidades y, en
algunos estados, otros adultos. El gobierno federal proporciona una parte de los fondos
para Medicaid y establece las pautas para el programa. Los estados también tienen opciones
sobre cómo diseñar su programa, por lo que Medicaid varía de un estado a otro.
Medicare
Medicare is a federal health insurance program for people who are age 65 or older and for certain
younger people with disabilities. Medicare offers broad coverage – Part A covers hospital
insurance; Part B is medical insurance and Part D covers prescription drugs. Part C can
supplement Part A, B and sometimes D.
Medicare (español)
Medicare es un programa de seguro médico federal para personas de 65 años o más y para
ciertas personas más jóvenes con discapacidades. Medicare ofrece una amplia cobertura: la
Parte A cubre el seguro hospitalario; La Parte B es un seguro médico y la Parte D cubre los
medicamentos recetados. La Parte C puede complementar la Parte A, B y, a veces, la D.
Médico de atención primaria (PCP en inglés)
Un médico que brinda, coordina o ayuda a un paciente a acceder a una variedad de servicios de
atención médica.
Minimum Essential Coverage (MEC)
Minimum Essential Coverage (MEC) is the type of coverage an individual needs to have to meet
the individual responsibility requirement under the Affordable Care Act. This includes individual
market policies, job-based coverage, Medicare, Medicaid, Children’s Health Insurance Program,
TRICARE, and certain other coverage.
Modified Adjusted Gross Income (MAGI)
Modified Adjusted Gross Income (MAGI) is defined by the Internal Revenue Service (IRS).
Calculations include determination of MAGI with respect to federal poverty level and other
considerations such as pregnancy, children, children’s age, and whether the applicant is a
caretaker for other dependents.
nivel federal de pobreza
El Nivel Federal de Pobreza (FPL en inglés) es una medida de ingresos emitida cada año por el
Departamento de Salud y Servicios Humanos (HHS en inglés). Los niveles federales de pobreza
se utilizan para determinar su elegibilidad para ciertos programas y beneficios, incluyendo los
ahorros en el seguro médico del Mercado y la cobertura de Medicaid y CHIP.
Open Enrollment Period
The period of time, from November 1 – January 15, when you can enroll or renew in qualified
health plans (QHP) through Access Health CT. Open Enrollment Periods can differ between
states and coverage types.
Out-of-Network
Providers or services with which your health insurance plan has not contracted. You may end up
paying more of the cost for this care. Be sure to check if your providers are in-network. You can
find out if a provider is in-network using the online provider directory or by contacting your
insurance company.
Out-of-Pocket Costs
Out-of-pocket costs are expenses for medical care that are not reimbursed
by your insurance company. These costs include deductibles, co-insurance, and co-payments for
covered services plus all costs for services that are not covered.
periodo abierto de inscripción
Es un período de tiempo, del 1 de noviembre al 15 de enero, en el que puede inscribirse o
renovar en planes de salud calificados (QHP en inglés) a través de Access Health CT. Los
períodos abierto de inscripción pueden diferir entre los estados y los tipos de cobertura.
Periodo de Inscripción Especial
Un Período de Inscripción Especial (SEP en inglés) es un período de tiempo especial durante el
año en el que puede inscribirse en cobertura de salud a través de Access Health CT. Para
obtener un Período de Inscripción Especial, debe demostrar que tiene un Evento de Vida
Calificado y tendrá 60 días, a partir de la fecha de ese evento, para comenzar su proceso de
solicitud.
plan catastrófico
Los planes catastróficos están disponibles para personas menores de 30 años o para aquellos a
quienes se les haya otorgado una exención por dificultades económicas. Los planes catastróficos
no son elegibles para ayuda financiera. Estos planes tienen primas mensuales bajas y brindan el
nivel más bajo de cobertura. Los planes catastróficos ofrecen protección cuando los costos de
atención médica se acercan o alcanzan los costos máximos anuales de bolsillo.
Plan de Organización de Proveedores Preferidos
Un plan de Organización de Proveedores Preferidos (PPO en inglés) contrata a proveedores de
salud, como hospitales y médicos, para crear una red de proveedores participantes. Paga menos
si utiliza proveedores que pertenecen a la red del plan. Por lo general, puede utilizar médicos,
hospitales y proveedores fuera de la red por un costo adicional.
Plan de punto de servicio
Un plan de punto de servicio (POS en inglés) ofrece servicios con descuento si utiliza médicos,
hospitales y otros proveedores de atención médica que pertenecen a la red del plan. Los planes
de punto de servicio pueden requerir que obtenga una remisión de su médico de atención
primaria para ver a un especialista.
Plan de Salud Calificado
Un plan de salud calificado (QHP en inglés) por Access Health CT, proporciona beneficios
esenciales de salud, sigue los límites establecidos sobre costos compartidos (como deducibles,
copagos y montos máximos de gastos de bolsillo) y cumple con otros requisitos.
Plan de salud con un deducible alto
Un plan de salud con deducible alto (HDHP en inglés) es un plan que requiere deducibles más
altos que otros planes. Estos pueden combinarse con una cuenta de ahorros para la salud (HSA
en inglés) o un acuerdo de reembolso de la salud (HRA en inglés) para permitirle pagar los
gastos médicos calificados de su bolsillo antes de impuestos.
Plan Network
A plan network includes specific doctors, hospitals, pharmacies, and other health care providers
who have contracted with the health insurance company.
Point-of-Service (POS) Plan
A Point-of-Service Plan (POS) type offers discounted services if you use doctors, hospitals, and
other healthcare providers that belong to the plan’s network. POS plans may require you to get a
referral from your primary care doctor in order to see a specialist.
Preferred Provider Organization (PPO) Plan
A Preferred Provider Organization plan (PPO) contracts with medical providers, such as hospitals
and doctors, to create a network of participating providers. You pay less if you use providers that
belong to the plan’s network. You can usually use doctors, hospitals, and providers outside of the
network for an additional cost.
Premium
The amount you pay for your health insurance plan to the insurance company every month.
Preventive Services
These services include annual check-ups, immunizations, patient counseling, and screenings.
Preventive services are an Essential Health Benefit and covered under plans offered through
Access Health CT.
Prima
La cantidad que paga por su plan de seguro médico a la compañía de seguros cada mes.
Primary Care Physician (PCP)
A doctor who provides, coordinates or helps a patient access a range of health care services.
Programa de seguro médico para niños (CHIP en inglés)
CHIP es un programa de seguro financiado por el gobierno estatal y federal, que brinda seguro
de salud a niños en hogares de bajos ingresos. En Connecticut, este programa se conoce como
HUSKY B.
Qualified Health Plan (QHP)
An insurance plan that is certified by Access Health CT, provides Essential Health Benefits,
follows established limits on cost -sharing (like deductibles, co-payments, and out-of-pocket
maximum amounts), and meets other requirements.
Qualifying Life Event (QLE)
A Qualifying Life Event (QLE) is a change in your life — like losing health coverage, getting
married, having a baby or moving to Connecticut— that can make you eligible for a Special
Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment
Period.
Reclamo
Un reclamo es una solicitud de pago que usted o su proveedor de atención médica presentan a
su aseguradora de salud cuando recibe artículos o servicios.
Red de un plan
La red de un plan incluye médicos, hospitales, farmacias y otros proveedores de atención médica
específicos que tienen contrato con la compañía de seguro médico.
Red escalonada
Una red escalonada divide a los hospitales y médicos en grupos, según la información sobre la
calidad de su atención y los costos de sus servicios. Lo que paga se basa en el nivel del
proveedor.
Reducción de Costos Compartidos (CSR en inglés)
Reducción de Costos Compartidos (CSR) reduce la cantidad que paga de su bolsillo por
deducibles, coseguros y copagos cuando recibe servicios médicos. Si califica para Reducción de
Costos Compartidos, debe inscribirse en un plan de nivel Plata para obtener estos bajos costos.
Representante Autorizado
Un representante autorizado es una persona que ha sido designada en la solicitud para actuar
en nombre de otra persona.
Servicios Preventivos
Estos servicios incluyen chequeos anuales, vacunas, asesoramiento para pacientes y exámenes
de detección. Los servicios preventivos son un beneficio esencial salud y están cubiertos por los
planes que se ofrecen a través de Access Health CT.
Special Enrollment Period (SEP)
A Special Enrollment Period (SEP) is a special window of time during the year when you can
enroll in health insurance through Access Health CT. To get a Special Enrollment Period, you
must prove that you have a Qualifying Life Event – and you will have 60 days from the date of
that event begin your application process.
Specialist
A doctor who focuses on a specific area of medicine or a group of patients to diagnose, manage,
prevent or treat certain types of symptoms and conditions.
Tiered Network
A tiered network divides hospitals and doctors into groups, based on information about the quality
of their care and the costs of their services. What you pay is based on the tier of the provider. | What is the main topic of this document? | Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados |
Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados por el empleador,
de los cuales los empleados son reembolsados libres de impuestos para los gastos médicos
calificados hasta un monto fijo en dólares por año. Los montos no utilizadas pueden ser
renovados para ser utilizadose en años posteriores. El empleador financia y es propietario de la
cuenta.
Affordable Care Act (ACA)
(also known as the Patient Protection and Affordable Care Act or Obamacare) and is the
landmark health reform legislation signed into law in March 2010. Key provisions are intended to
extend coverage to millions of uninsured Americans, implement measures that will lower health
care costs and improve system efficiency, and eliminate industry practices that include rescission
and denial of coverage due to pre-existing conditions.
Agent
An agent is a state-licensed individual or entity representing one or more insurance companies.
An agent solicits and facilitates the sale of insurance contracts or policies and provides services
to the policyholder on behalf of the insurer.
Agente
Un agente es una persona o entidad con licencia estatal que representa a una o más compañías
de seguros. Un agente solicita y facilita la venta de contratos o pólizas de seguro y brinda
servicios al titular de la póliza en nombre del asegurador.
Agente de seguros
Un agente de seguros es un representante legal autorizado del titular de la póliza, que negocia
con una compañía de seguros en nombre de un cliente. La compañía de seguros le paga una
comisión.
Annual Limit
A limit on the benefits your health plan will pay in a year. Limits are sometimes placed on
particular services, such as prescriptions or physical therapy treatments. They can also be placed
on the dollar amount or on the number of visits. After an annual limit is reached, you must pay all
related health care costs for the rest of the year.
año calendario
1 de enero - 31 de diciembre
APTC
also known as Advanced Premium Tax Credits. The credit amount will be paid directly to the
insurance company from the federal government. The individual pays the difference between the
credit and the plan's premium.
Authorized Representative
An authorized representative is a person who has been designated in the Exchange to act on
someone else’s behalf.
Beneficios esenciales de salud
Todos los planes de salud calificados (QHP en inglés) que se ofrecen a través de Access Health
CT brindan el mismo conjunto de 10 beneficios esenciales de salud. Los beneficios pueden
costar más o menos en diferentes planes en diferentes niveles, puede estar seguro de que todos
los planes brindarán: 1. Servicios preventivos y de bienestar y manejo de enfermedades crónicas
2. Servicios pediátricos 3. Servicios ambulatorios para pacientes (atención ambulatoria que
recibe sin hospitalización) 4. Cobertura de la sala de emergencias 5. Hospitalización (como
cirugía) 6. Atención de maternidad y del recién nacido (atención antes y después del nacimiento
de su bebé) 7. Servicios de salud mental y abuso de sustancias, incluido el tratamiento de salud
conductual (incluye asesoramiento y psicoterapia) 8. Cobertura de medicamentos prescritos 9.
Servicios y dispositivos de rehabilitación y habilitación (servicios y dispositivos para ayudar a las
personas con lesiones, discapacidades o afecciones crónicas a obtener o recuperar habilidades
mentales y físicas) 10. Cobertura de servicios de laboratorio
Broker
A broker is a licensed legal representative of the policyholder, who negotiates with an insurance
company on behalf of a customer but is paid a commission by the insurance company.
Calendar Year
January 1 - December 31
Catastrophic Plans
Catastrophic plans are available to people younger than 30 years old or to those who have been
granted a hardship or affordability exemption. You are not eligible to get financial help to pay for
catastrophic plans. These plans have low monthly premiums and provide the lowest level of
coverage. Catastrophic plans offer protection when healthcare costs near or reach annual-of-
pocket cost maximums.
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for
administering Medicare, Medicaid, State Children's Health Insurance, Health Insurance Portability
and Accountability Act, Clinical Laboratory Improvement Amendments, and several other health-
related programs. CMS also establishes standards for healthcare providers that must be complied
with in order for providers to meet certain certification requirements.
Centro de Servicios de Medicare y Medicaid (CMS en inglés)
El Centro de Servicios de Medicare y Medicaid (CMS) es la agencia federal responsable de
administrar Medicare, Medicaid, el seguro médico para niños (CHIP en inglés), la Ley de
Responsabilidad y Portabilidad del Seguro de Salud, las Enmiendas para mejorar los
Laboratorios Clínicos y varios otros programas relacionados con la salud. El Centro de Servicios
de Medicare y Medicaid también establece estándares para los proveedores de atención médica,
los cuales deben cumplirse para que los proveedores cumplan con ciertos requisitos de
certificación.
Children’s Health Insurance Program (CHIP)
CHIP is an insurance program funded by state and Federal government that provides health
insurance to children in low-income households. In Connecticut, this program is referred to as
HUSKY B.
Claim
A claim is a request for payment that you or your health care provider submits to your health
insurer when you get items or services.
Cobertura acreditable
La cobertura acreditable es cualquiera de los siguientes planes: plan de salud grupal, plan de
salud individual, plan de salud para estudiantes, Medicare, Medicaid, CHAMPUS y TRICARE,
Programa de Beneficios de Salud para Empleados Federales, Servicio de Salud para Indígenas,
Cuerpo de Paz, plan de salud pública (como los de el gobierno de los EE. UU., un gobierno
estatal, o un país extranjero) o el Programa de seguro médico para niños (CHIP en inglés).
Cobertura de dependientes
La cobertura de dependientes se refiere a la cobertura de seguro para los miembros de la familia
del titular de la póliza, como un cónyuge, hijo o pareja.
Cobertura dento de la red
su compañía de seguros ha contratado a hospitales, proveedores y proveedores para brindar
servicios a un costo menor. Puede averiguar si un proveedor está dentro de la red utilizando el
directorio de proveedores en línea o comunicándose con su compañía de seguros.
Cobertura esencial minima
La Cobertura Esencial Mínima (MEC en inglés) es el tipo de cobertura que una persona debe
tener para cumplir con el requisito de responsabilidad individual, según la Ley de Cuidado de
Salud a Bajo Costo. Esto incluye pólizas de mercado individuales, cobertura a través de su
trabajo, Medicare, Medicaid, Programa de seguro médico para niños, TRICARE y algunas otras
coberturas.
Co-Insurance
The percentage of costs you pay for a covered healthcare services after you have paid your
deductible.
Copago
Un copago es una cantidad fija (por ejemplo, $15) que paga por un servicio de atención médica
cubierto, generalmente cuando recibe el servicio. El monto en dólares puede variar según el tipo
de servicio.
Co-Payment
A co-payment is a fixed amount (for example $15) that you pay for a covered healthcare service,
usually when you receive the service. The dollar amount can vary by the type of service.
Coseguro
El porcentaje de los costos que paga por los servicios de atención médica cubiertos después de
haber pagado su deducible.
Cost-Sharing Reduction
Cost-Sharing Reduction (CSR) lowers the amount you pay out-of-pocket for deductibles, co-
insurance and co-payments when you get medical services. If you qualify for CSR, you must
enroll in a Silver level plan to get these lower costs.
Creditable Coverage
Creditable coverage is any of the following plans: group health plan, individual health plan,
student health plan, Medicare, Medicaid, CHAMPUS and TRICARE, Federal Employees Health
Benefits Program, Indian Health Service, Peace Corps, public health plan (such as those from the
US Government, or a state government, or a foreign country), or Children’s Health Insurance
Program (CHIP)
Creditos fiscales anticipados para la prima
también conocido como créditos fiscales anticipados para la prima. El monto del crédito se
pagará directamente del gobierno federal a la compañía de seguros. El individuo paga la
diferencia entre el crédito y la prima del plan.
Cuenta de ahorro para la salud
Las cuentas de ahorro para la salud (HSA en inglés) le permiten apartar dinero antes de
impuestos para pagar los gastos médicos calificados si tiene un plan de seguro de salud con
deducible alto.
deducible
El deducible es el monto que paga por los servicios de atención médica cubiertos antes que su
plan de seguro comience a pagar. Puede que no se aplique a todos los servicios.
Deductible
The deductible is the amount you pay for covered healthcare services before your insurance plan
starts to pay. It may not apply to all services.
Dependent Coverage
Dependent coverage refers to insurance coverage for family members of the policyholder, such
as a spouse, child, or partner.
Dependent(s)
A dependent is a spouse, child or family member of the household obtaining health coverage
under the primary applicant's insurance plan
Dependiente(s)
Un dependiente es un cónyuge, hijo o miembro de la familia del hogar que obtiene cobertura
médica bajo el plan de seguro del solicitante principal.
Especialista
médico que se enfoca en un área específica de la medicina o en un grupo de pacientes para
diagnosticar, manejar, prevenir o tratar ciertos tipos de síntomas y afecciones.
essential health benefits
All qualified health plans (QHP) offered through Access Health CT provide the same set
of 10 Essential Health Benefits. While the benefits may cost more or less in different plans at
different levels, you can be assured that all plans will provide: 1. Preventive and wellness
services and chronic disease management 2. Pediatric services 3. Ambulatory patient services
(outpatient care you get without being admitted to a hospital) 4. Emergency room coverage 5.
Hospitalization (such as surgery) 6. Maternity and newborn care (care before and after your baby
is born) 7. Mental health and substance abuse services, including behavioral health treatment
(includes counseling and psychotherapy) 8. Prescription drug coverage 9. Rehabilitation and
Habilitation services and devices (services and devices to help people with injuries, disabilities, or
chronic conditions gain or recover mental and physical skills) 10. Laboratory service coverage
evento de vida calificado
Un evento de vida calificado (QLE en inglés) es un cambio en su vida, como perder la cobertura
de salud, casarse, tener un bebé, o mudarse a Connecticut, que puede hacerlo elegible para un
período de inscripción especial, lo que le permite inscribirse en un seguro de salud fuera del
período abierto anual de inscripción.
Federal Poverty Level
The Federal Poverty Level (FPL) is a measure of income issued every year by the Department of
Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility
for certain programs and benefits, including savings on Marketplace health insurance, and
Medicaid and CHIP coverage.
Fuera de la red
Proveedores o servicios con los que su plan de seguro médico no tiene contrato. Es posible que
termine pagando una mayor parte del costo de esta atención. Asegúrese de verificar si sus
proveedores están dentro de la red. Puede averiguar si un proveedor está dentro de la red
utilizando el directorio de proveedores en línea o comunicándose con su compañía de seguros.
Gastos de bolsillo
Los gastos de bolsillo son gastos de atención médica que no son reembolsados por su compañía
de seguros. Estos costos incluyen deducibles, coseguros y copagos por servicios cubiertos, más
todos los costos por servicios que no están cubiertos.
Health Reimbursement Account (HRA)
Health Reimbursement Accounts are employer-funded group health plans from which employees
are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.
Unused amounts may be rolled over to be used in subsequent years. The employer funds and
owns the account.
Health Savings Account (HSA)
Health Savings Accounts (HSA) allow you to set aside money on a pre-tax basis to pay for
qualified medical expenses if you have a high deductible health insurance plan.
High Deductible Health Plans (HDHP)
A High Deductible Health Plan (HDHP) is plan that requires higher deductibles than other plans.
These can be combined with a health savings account or a health reimbursement arrangement to
allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.
Hogar (hogar fiscal)
Para la mayoría de las personas, un hogar está formado por el declarante de impuestos, su
cónyuge, si tiene uno, y sus dependientes fiscales, incluidos aquellos que no necesitan
cobertura. El Mercado cuenta los ingresos estimados de todos los miembros del hogar, incluso
aquellos que no solicitan cobertura. Cuando calcule sus ingresos para recibir ayuda financiera,
debe contar los ingresos de todas las personas de su hogar fiscal.
Household (Tax Household)
For most people, a household consists of the tax filer, their spouse if they have one, and their tax
dependents, including those who don’t need coverage. The Marketplace counts estimated income
of all household members, even those who are not applying for coverage. When you estimate
your income to receive financial help you should count income for everyone in your tax
household.
In-Network Coverage
Your insurance company has contracted with hospitals, providers and suppliers to provide
services at a lower cost. You can find out if a provider is in-network using the online provider
directory or by contacting your insurance company.
Ley de Cuidado de Salud a Bajo Precio
(también conocida como la Ley de Protección al Paciente y Cuidado de Salud a bajo precio u
Obamacare) es una legislación histórica de reforma de salud promulgada en marzo de 2010. Las
disposiciones clave están destinadas a extender la cobertura a millones de estadounidenses sin
seguro, implementar medidas que reduzcan los costos de atención médica, mejorar la eficiencia
del sistema, y eliminar las prácticas de la industria que incluyen la rescisión y denegación de
cobertura debido a condiciones preexistentes.
Limite Annual
Un límite en los beneficios que pagará su plan de salud en un año. A veces, se imponen límites a
servicios particulares, como prescripciones o tratamientos de fisioterapia. También se pueden
colocar en el monto en dólares o en el número de visitas. Una vez que se alcanza un límite
anual, debe pagar todos los costos de atención médica relacionados durante el resto del año.
Máximo de gastos de bolsillo
El máximo de gastos de bolsillo (MOOP en inglés), también conocido como límites de gastos de
bolsillo, es lo máximo que pagará durante un período de póliza (generalmente un año) antes de
que su plan de salud comience a pagar el 100% de la cantidad permitida. Este límite nunca
incluye su prima, los cargos facturados por el saldo o los servicios que su plan no cubre. Algunos
planes de salud no cuentan todos sus copagos, deducibles, pagos de coseguro, pagos fuera de
la red u otros gastos para este límite. Para el Programa de salud HUSKY (Medicaid / Programa
de seguro médico para niños), el límite sí incluye las primas.
Maximum-Out-of-Pocket (MOOP)
The Maximum-Out-Of-Pocket (MOOP) also known as out-of-pocket limits, is the most you will pay
during a policy period (usually a year) before your health plan begins to pay 100% of the allowed
amount. This limit never includes your premium, balance-billed charges or services your plan
does not cover. Some health plans do not count all of your co-payments, deductibles, co-
insurance payments, out-of-network payments or other expenses toward this limit. For HUSKY
Health Program (Medicaid/Children’s Health Insurance Program), the limit does include
premiums.
Medicaid
Medicaid is state-administered health insurance program for low-income families and children,
pregnant women, the elderly, people with disabilities, and in some states, other adults. The
federal government provides a portion of the funding for Medicaid and sets guidelines for the
program. States also have choices in how they design their program, so Medicaid varies state by
state.
Medicaid (español)
Medicaid es un programa de seguro médico administrado por el estado para familias y niños de
hogares de bajos ingresos, mujeres embarazadas, ancianos, personas con discapacidades y, en
algunos estados, otros adultos. El gobierno federal proporciona una parte de los fondos
para Medicaid y establece las pautas para el programa. Los estados también tienen opciones
sobre cómo diseñar su programa, por lo que Medicaid varía de un estado a otro.
Medicare
Medicare is a federal health insurance program for people who are age 65 or older and for certain
younger people with disabilities. Medicare offers broad coverage – Part A covers hospital
insurance; Part B is medical insurance and Part D covers prescription drugs. Part C can
supplement Part A, B and sometimes D.
Medicare (español)
Medicare es un programa de seguro médico federal para personas de 65 años o más y para
ciertas personas más jóvenes con discapacidades. Medicare ofrece una amplia cobertura: la
Parte A cubre el seguro hospitalario; La Parte B es un seguro médico y la Parte D cubre los
medicamentos recetados. La Parte C puede complementar la Parte A, B y, a veces, la D.
Médico de atención primaria (PCP en inglés)
Un médico que brinda, coordina o ayuda a un paciente a acceder a una variedad de servicios de
atención médica.
Minimum Essential Coverage (MEC)
Minimum Essential Coverage (MEC) is the type of coverage an individual needs to have to meet
the individual responsibility requirement under the Affordable Care Act. This includes individual
market policies, job-based coverage, Medicare, Medicaid, Children’s Health Insurance Program,
TRICARE, and certain other coverage.
Modified Adjusted Gross Income (MAGI)
Modified Adjusted Gross Income (MAGI) is defined by the Internal Revenue Service (IRS).
Calculations include determination of MAGI with respect to federal poverty level and other
considerations such as pregnancy, children, children’s age, and whether the applicant is a
caretaker for other dependents.
nivel federal de pobreza
El Nivel Federal de Pobreza (FPL en inglés) es una medida de ingresos emitida cada año por el
Departamento de Salud y Servicios Humanos (HHS en inglés). Los niveles federales de pobreza
se utilizan para determinar su elegibilidad para ciertos programas y beneficios, incluyendo los
ahorros en el seguro médico del Mercado y la cobertura de Medicaid y CHIP.
Open Enrollment Period
The period of time, from November 1 – January 15, when you can enroll or renew in qualified
health plans (QHP) through Access Health CT. Open Enrollment Periods can differ between
states and coverage types.
Out-of-Network
Providers or services with which your health insurance plan has not contracted. You may end up
paying more of the cost for this care. Be sure to check if your providers are in-network. You can
find out if a provider is in-network using the online provider directory or by contacting your
insurance company.
Out-of-Pocket Costs
Out-of-pocket costs are expenses for medical care that are not reimbursed
by your insurance company. These costs include deductibles, co-insurance, and co-payments for
covered services plus all costs for services that are not covered.
periodo abierto de inscripción
Es un período de tiempo, del 1 de noviembre al 15 de enero, en el que puede inscribirse o
renovar en planes de salud calificados (QHP en inglés) a través de Access Health CT. Los
períodos abierto de inscripción pueden diferir entre los estados y los tipos de cobertura.
Periodo de Inscripción Especial
Un Período de Inscripción Especial (SEP en inglés) es un período de tiempo especial durante el
año en el que puede inscribirse en cobertura de salud a través de Access Health CT. Para
obtener un Período de Inscripción Especial, debe demostrar que tiene un Evento de Vida
Calificado y tendrá 60 días, a partir de la fecha de ese evento, para comenzar su proceso de
solicitud.
plan catastrófico
Los planes catastróficos están disponibles para personas menores de 30 años o para aquellos a
quienes se les haya otorgado una exención por dificultades económicas. Los planes catastróficos
no son elegibles para ayuda financiera. Estos planes tienen primas mensuales bajas y brindan el
nivel más bajo de cobertura. Los planes catastróficos ofrecen protección cuando los costos de
atención médica se acercan o alcanzan los costos máximos anuales de bolsillo.
Plan de Organización de Proveedores Preferidos
Un plan de Organización de Proveedores Preferidos (PPO en inglés) contrata a proveedores de
salud, como hospitales y médicos, para crear una red de proveedores participantes. Paga menos
si utiliza proveedores que pertenecen a la red del plan. Por lo general, puede utilizar médicos,
hospitales y proveedores fuera de la red por un costo adicional.
Plan de punto de servicio
Un plan de punto de servicio (POS en inglés) ofrece servicios con descuento si utiliza médicos,
hospitales y otros proveedores de atención médica que pertenecen a la red del plan. Los planes
de punto de servicio pueden requerir que obtenga una remisión de su médico de atención
primaria para ver a un especialista.
Plan de Salud Calificado
Un plan de salud calificado (QHP en inglés) por Access Health CT, proporciona beneficios
esenciales de salud, sigue los límites establecidos sobre costos compartidos (como deducibles,
copagos y montos máximos de gastos de bolsillo) y cumple con otros requisitos.
Plan de salud con un deducible alto
Un plan de salud con deducible alto (HDHP en inglés) es un plan que requiere deducibles más
altos que otros planes. Estos pueden combinarse con una cuenta de ahorros para la salud (HSA
en inglés) o un acuerdo de reembolso de la salud (HRA en inglés) para permitirle pagar los
gastos médicos calificados de su bolsillo antes de impuestos.
Plan Network
A plan network includes specific doctors, hospitals, pharmacies, and other health care providers
who have contracted with the health insurance company.
Point-of-Service (POS) Plan
A Point-of-Service Plan (POS) type offers discounted services if you use doctors, hospitals, and
other healthcare providers that belong to the plan’s network. POS plans may require you to get a
referral from your primary care doctor in order to see a specialist.
Preferred Provider Organization (PPO) Plan
A Preferred Provider Organization plan (PPO) contracts with medical providers, such as hospitals
and doctors, to create a network of participating providers. You pay less if you use providers that
belong to the plan’s network. You can usually use doctors, hospitals, and providers outside of the
network for an additional cost.
Premium
The amount you pay for your health insurance plan to the insurance company every month.
Preventive Services
These services include annual check-ups, immunizations, patient counseling, and screenings.
Preventive services are an Essential Health Benefit and covered under plans offered through
Access Health CT.
Prima
La cantidad que paga por su plan de seguro médico a la compañía de seguros cada mes.
Primary Care Physician (PCP)
A doctor who provides, coordinates or helps a patient access a range of health care services.
Programa de seguro médico para niños (CHIP en inglés)
CHIP es un programa de seguro financiado por el gobierno estatal y federal, que brinda seguro
de salud a niños en hogares de bajos ingresos. En Connecticut, este programa se conoce como
HUSKY B.
Qualified Health Plan (QHP)
An insurance plan that is certified by Access Health CT, provides Essential Health Benefits,
follows established limits on cost -sharing (like deductibles, co-payments, and out-of-pocket
maximum amounts), and meets other requirements.
Qualifying Life Event (QLE)
A Qualifying Life Event (QLE) is a change in your life — like losing health coverage, getting
married, having a baby or moving to Connecticut— that can make you eligible for a Special
Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment
Period.
Reclamo
Un reclamo es una solicitud de pago que usted o su proveedor de atención médica presentan a
su aseguradora de salud cuando recibe artículos o servicios.
Red de un plan
La red de un plan incluye médicos, hospitales, farmacias y otros proveedores de atención médica
específicos que tienen contrato con la compañía de seguro médico.
Red escalonada
Una red escalonada divide a los hospitales y médicos en grupos, según la información sobre la
calidad de su atención y los costos de sus servicios. Lo que paga se basa en el nivel del
proveedor.
Reducción de Costos Compartidos (CSR en inglés)
Reducción de Costos Compartidos (CSR) reduce la cantidad que paga de su bolsillo por
deducibles, coseguros y copagos cuando recibe servicios médicos. Si califica para Reducción de
Costos Compartidos, debe inscribirse en un plan de nivel Plata para obtener estos bajos costos.
Representante Autorizado
Un representante autorizado es una persona que ha sido designada en la solicitud para actuar
en nombre de otra persona.
Servicios Preventivos
Estos servicios incluyen chequeos anuales, vacunas, asesoramiento para pacientes y exámenes
de detección. Los servicios preventivos son un beneficio esencial salud y están cubiertos por los
planes que se ofrecen a través de Access Health CT.
Special Enrollment Period (SEP)
A Special Enrollment Period (SEP) is a special window of time during the year when you can
enroll in health insurance through Access Health CT. To get a Special Enrollment Period, you
must prove that you have a Qualifying Life Event – and you will have 60 days from the date of
that event begin your application process.
Specialist
A doctor who focuses on a specific area of medicine or a group of patients to diagnose, manage,
prevent or treat certain types of symptoms and conditions.
Tiered Network
A tiered network divides hospitals and doctors into groups, based on information about the quality
of their care and the costs of their services. What you pay is based on the tier of the provider. | Who is mentioned in the document? | Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados |
Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados por el empleador,
de los cuales los empleados son reembolsados libres de impuestos para los gastos médicos
calificados hasta un monto fijo en dólares por año. Los montos no utilizadas pueden ser
renovados para ser utilizadose en años posteriores. El empleador financia y es propietario de la
cuenta.
Affordable Care Act (ACA)
(also known as the Patient Protection and Affordable Care Act or Obamacare) and is the
landmark health reform legislation signed into law in March 2010. Key provisions are intended to
extend coverage to millions of uninsured Americans, implement measures that will lower health
care costs and improve system efficiency, and eliminate industry practices that include rescission
and denial of coverage due to pre-existing conditions.
Agent
An agent is a state-licensed individual or entity representing one or more insurance companies.
An agent solicits and facilitates the sale of insurance contracts or policies and provides services
to the policyholder on behalf of the insurer.
Agente
Un agente es una persona o entidad con licencia estatal que representa a una o más compañías
de seguros. Un agente solicita y facilita la venta de contratos o pólizas de seguro y brinda
servicios al titular de la póliza en nombre del asegurador.
Agente de seguros
Un agente de seguros es un representante legal autorizado del titular de la póliza, que negocia
con una compañía de seguros en nombre de un cliente. La compañía de seguros le paga una
comisión.
Annual Limit
A limit on the benefits your health plan will pay in a year. Limits are sometimes placed on
particular services, such as prescriptions or physical therapy treatments. They can also be placed
on the dollar amount or on the number of visits. After an annual limit is reached, you must pay all
related health care costs for the rest of the year.
año calendario
1 de enero - 31 de diciembre
APTC
also known as Advanced Premium Tax Credits. The credit amount will be paid directly to the
insurance company from the federal government. The individual pays the difference between the
credit and the plan's premium.
Authorized Representative
An authorized representative is a person who has been designated in the Exchange to act on
someone else’s behalf.
Beneficios esenciales de salud
Todos los planes de salud calificados (QHP en inglés) que se ofrecen a través de Access Health
CT brindan el mismo conjunto de 10 beneficios esenciales de salud. Los beneficios pueden
costar más o menos en diferentes planes en diferentes niveles, puede estar seguro de que todos
los planes brindarán: 1. Servicios preventivos y de bienestar y manejo de enfermedades crónicas
2. Servicios pediátricos 3. Servicios ambulatorios para pacientes (atención ambulatoria que
recibe sin hospitalización) 4. Cobertura de la sala de emergencias 5. Hospitalización (como
cirugía) 6. Atención de maternidad y del recién nacido (atención antes y después del nacimiento
de su bebé) 7. Servicios de salud mental y abuso de sustancias, incluido el tratamiento de salud
conductual (incluye asesoramiento y psicoterapia) 8. Cobertura de medicamentos prescritos 9.
Servicios y dispositivos de rehabilitación y habilitación (servicios y dispositivos para ayudar a las
personas con lesiones, discapacidades o afecciones crónicas a obtener o recuperar habilidades
mentales y físicas) 10. Cobertura de servicios de laboratorio
Broker
A broker is a licensed legal representative of the policyholder, who negotiates with an insurance
company on behalf of a customer but is paid a commission by the insurance company.
Calendar Year
January 1 - December 31
Catastrophic Plans
Catastrophic plans are available to people younger than 30 years old or to those who have been
granted a hardship or affordability exemption. You are not eligible to get financial help to pay for
catastrophic plans. These plans have low monthly premiums and provide the lowest level of
coverage. Catastrophic plans offer protection when healthcare costs near or reach annual-of-
pocket cost maximums.
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for
administering Medicare, Medicaid, State Children's Health Insurance, Health Insurance Portability
and Accountability Act, Clinical Laboratory Improvement Amendments, and several other health-
related programs. CMS also establishes standards for healthcare providers that must be complied
with in order for providers to meet certain certification requirements.
Centro de Servicios de Medicare y Medicaid (CMS en inglés)
El Centro de Servicios de Medicare y Medicaid (CMS) es la agencia federal responsable de
administrar Medicare, Medicaid, el seguro médico para niños (CHIP en inglés), la Ley de
Responsabilidad y Portabilidad del Seguro de Salud, las Enmiendas para mejorar los
Laboratorios Clínicos y varios otros programas relacionados con la salud. El Centro de Servicios
de Medicare y Medicaid también establece estándares para los proveedores de atención médica,
los cuales deben cumplirse para que los proveedores cumplan con ciertos requisitos de
certificación.
Children’s Health Insurance Program (CHIP)
CHIP is an insurance program funded by state and Federal government that provides health
insurance to children in low-income households. In Connecticut, this program is referred to as
HUSKY B.
Claim
A claim is a request for payment that you or your health care provider submits to your health
insurer when you get items or services.
Cobertura acreditable
La cobertura acreditable es cualquiera de los siguientes planes: plan de salud grupal, plan de
salud individual, plan de salud para estudiantes, Medicare, Medicaid, CHAMPUS y TRICARE,
Programa de Beneficios de Salud para Empleados Federales, Servicio de Salud para Indígenas,
Cuerpo de Paz, plan de salud pública (como los de el gobierno de los EE. UU., un gobierno
estatal, o un país extranjero) o el Programa de seguro médico para niños (CHIP en inglés).
Cobertura de dependientes
La cobertura de dependientes se refiere a la cobertura de seguro para los miembros de la familia
del titular de la póliza, como un cónyuge, hijo o pareja.
Cobertura dento de la red
su compañía de seguros ha contratado a hospitales, proveedores y proveedores para brindar
servicios a un costo menor. Puede averiguar si un proveedor está dentro de la red utilizando el
directorio de proveedores en línea o comunicándose con su compañía de seguros.
Cobertura esencial minima
La Cobertura Esencial Mínima (MEC en inglés) es el tipo de cobertura que una persona debe
tener para cumplir con el requisito de responsabilidad individual, según la Ley de Cuidado de
Salud a Bajo Costo. Esto incluye pólizas de mercado individuales, cobertura a través de su
trabajo, Medicare, Medicaid, Programa de seguro médico para niños, TRICARE y algunas otras
coberturas.
Co-Insurance
The percentage of costs you pay for a covered healthcare services after you have paid your
deductible.
Copago
Un copago es una cantidad fija (por ejemplo, $15) que paga por un servicio de atención médica
cubierto, generalmente cuando recibe el servicio. El monto en dólares puede variar según el tipo
de servicio.
Co-Payment
A co-payment is a fixed amount (for example $15) that you pay for a covered healthcare service,
usually when you receive the service. The dollar amount can vary by the type of service.
Coseguro
El porcentaje de los costos que paga por los servicios de atención médica cubiertos después de
haber pagado su deducible.
Cost-Sharing Reduction
Cost-Sharing Reduction (CSR) lowers the amount you pay out-of-pocket for deductibles, co-
insurance and co-payments when you get medical services. If you qualify for CSR, you must
enroll in a Silver level plan to get these lower costs.
Creditable Coverage
Creditable coverage is any of the following plans: group health plan, individual health plan,
student health plan, Medicare, Medicaid, CHAMPUS and TRICARE, Federal Employees Health
Benefits Program, Indian Health Service, Peace Corps, public health plan (such as those from the
US Government, or a state government, or a foreign country), or Children’s Health Insurance
Program (CHIP)
Creditos fiscales anticipados para la prima
también conocido como créditos fiscales anticipados para la prima. El monto del crédito se
pagará directamente del gobierno federal a la compañía de seguros. El individuo paga la
diferencia entre el crédito y la prima del plan.
Cuenta de ahorro para la salud
Las cuentas de ahorro para la salud (HSA en inglés) le permiten apartar dinero antes de
impuestos para pagar los gastos médicos calificados si tiene un plan de seguro de salud con
deducible alto.
deducible
El deducible es el monto que paga por los servicios de atención médica cubiertos antes que su
plan de seguro comience a pagar. Puede que no se aplique a todos los servicios.
Deductible
The deductible is the amount you pay for covered healthcare services before your insurance plan
starts to pay. It may not apply to all services.
Dependent Coverage
Dependent coverage refers to insurance coverage for family members of the policyholder, such
as a spouse, child, or partner.
Dependent(s)
A dependent is a spouse, child or family member of the household obtaining health coverage
under the primary applicant's insurance plan
Dependiente(s)
Un dependiente es un cónyuge, hijo o miembro de la familia del hogar que obtiene cobertura
médica bajo el plan de seguro del solicitante principal.
Especialista
médico que se enfoca en un área específica de la medicina o en un grupo de pacientes para
diagnosticar, manejar, prevenir o tratar ciertos tipos de síntomas y afecciones.
essential health benefits
All qualified health plans (QHP) offered through Access Health CT provide the same set
of 10 Essential Health Benefits. While the benefits may cost more or less in different plans at
different levels, you can be assured that all plans will provide: 1. Preventive and wellness
services and chronic disease management 2. Pediatric services 3. Ambulatory patient services
(outpatient care you get without being admitted to a hospital) 4. Emergency room coverage 5.
Hospitalization (such as surgery) 6. Maternity and newborn care (care before and after your baby
is born) 7. Mental health and substance abuse services, including behavioral health treatment
(includes counseling and psychotherapy) 8. Prescription drug coverage 9. Rehabilitation and
Habilitation services and devices (services and devices to help people with injuries, disabilities, or
chronic conditions gain or recover mental and physical skills) 10. Laboratory service coverage
evento de vida calificado
Un evento de vida calificado (QLE en inglés) es un cambio en su vida, como perder la cobertura
de salud, casarse, tener un bebé, o mudarse a Connecticut, que puede hacerlo elegible para un
período de inscripción especial, lo que le permite inscribirse en un seguro de salud fuera del
período abierto anual de inscripción.
Federal Poverty Level
The Federal Poverty Level (FPL) is a measure of income issued every year by the Department of
Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility
for certain programs and benefits, including savings on Marketplace health insurance, and
Medicaid and CHIP coverage.
Fuera de la red
Proveedores o servicios con los que su plan de seguro médico no tiene contrato. Es posible que
termine pagando una mayor parte del costo de esta atención. Asegúrese de verificar si sus
proveedores están dentro de la red. Puede averiguar si un proveedor está dentro de la red
utilizando el directorio de proveedores en línea o comunicándose con su compañía de seguros.
Gastos de bolsillo
Los gastos de bolsillo son gastos de atención médica que no son reembolsados por su compañía
de seguros. Estos costos incluyen deducibles, coseguros y copagos por servicios cubiertos, más
todos los costos por servicios que no están cubiertos.
Health Reimbursement Account (HRA)
Health Reimbursement Accounts are employer-funded group health plans from which employees
are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.
Unused amounts may be rolled over to be used in subsequent years. The employer funds and
owns the account.
Health Savings Account (HSA)
Health Savings Accounts (HSA) allow you to set aside money on a pre-tax basis to pay for
qualified medical expenses if you have a high deductible health insurance plan.
High Deductible Health Plans (HDHP)
A High Deductible Health Plan (HDHP) is plan that requires higher deductibles than other plans.
These can be combined with a health savings account or a health reimbursement arrangement to
allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.
Hogar (hogar fiscal)
Para la mayoría de las personas, un hogar está formado por el declarante de impuestos, su
cónyuge, si tiene uno, y sus dependientes fiscales, incluidos aquellos que no necesitan
cobertura. El Mercado cuenta los ingresos estimados de todos los miembros del hogar, incluso
aquellos que no solicitan cobertura. Cuando calcule sus ingresos para recibir ayuda financiera,
debe contar los ingresos de todas las personas de su hogar fiscal.
Household (Tax Household)
For most people, a household consists of the tax filer, their spouse if they have one, and their tax
dependents, including those who don’t need coverage. The Marketplace counts estimated income
of all household members, even those who are not applying for coverage. When you estimate
your income to receive financial help you should count income for everyone in your tax
household.
In-Network Coverage
Your insurance company has contracted with hospitals, providers and suppliers to provide
services at a lower cost. You can find out if a provider is in-network using the online provider
directory or by contacting your insurance company.
Ley de Cuidado de Salud a Bajo Precio
(también conocida como la Ley de Protección al Paciente y Cuidado de Salud a bajo precio u
Obamacare) es una legislación histórica de reforma de salud promulgada en marzo de 2010. Las
disposiciones clave están destinadas a extender la cobertura a millones de estadounidenses sin
seguro, implementar medidas que reduzcan los costos de atención médica, mejorar la eficiencia
del sistema, y eliminar las prácticas de la industria que incluyen la rescisión y denegación de
cobertura debido a condiciones preexistentes.
Limite Annual
Un límite en los beneficios que pagará su plan de salud en un año. A veces, se imponen límites a
servicios particulares, como prescripciones o tratamientos de fisioterapia. También se pueden
colocar en el monto en dólares o en el número de visitas. Una vez que se alcanza un límite
anual, debe pagar todos los costos de atención médica relacionados durante el resto del año.
Máximo de gastos de bolsillo
El máximo de gastos de bolsillo (MOOP en inglés), también conocido como límites de gastos de
bolsillo, es lo máximo que pagará durante un período de póliza (generalmente un año) antes de
que su plan de salud comience a pagar el 100% de la cantidad permitida. Este límite nunca
incluye su prima, los cargos facturados por el saldo o los servicios que su plan no cubre. Algunos
planes de salud no cuentan todos sus copagos, deducibles, pagos de coseguro, pagos fuera de
la red u otros gastos para este límite. Para el Programa de salud HUSKY (Medicaid / Programa
de seguro médico para niños), el límite sí incluye las primas.
Maximum-Out-of-Pocket (MOOP)
The Maximum-Out-Of-Pocket (MOOP) also known as out-of-pocket limits, is the most you will pay
during a policy period (usually a year) before your health plan begins to pay 100% of the allowed
amount. This limit never includes your premium, balance-billed charges or services your plan
does not cover. Some health plans do not count all of your co-payments, deductibles, co-
insurance payments, out-of-network payments or other expenses toward this limit. For HUSKY
Health Program (Medicaid/Children’s Health Insurance Program), the limit does include
premiums.
Medicaid
Medicaid is state-administered health insurance program for low-income families and children,
pregnant women, the elderly, people with disabilities, and in some states, other adults. The
federal government provides a portion of the funding for Medicaid and sets guidelines for the
program. States also have choices in how they design their program, so Medicaid varies state by
state.
Medicaid (español)
Medicaid es un programa de seguro médico administrado por el estado para familias y niños de
hogares de bajos ingresos, mujeres embarazadas, ancianos, personas con discapacidades y, en
algunos estados, otros adultos. El gobierno federal proporciona una parte de los fondos
para Medicaid y establece las pautas para el programa. Los estados también tienen opciones
sobre cómo diseñar su programa, por lo que Medicaid varía de un estado a otro.
Medicare
Medicare is a federal health insurance program for people who are age 65 or older and for certain
younger people with disabilities. Medicare offers broad coverage – Part A covers hospital
insurance; Part B is medical insurance and Part D covers prescription drugs. Part C can
supplement Part A, B and sometimes D.
Medicare (español)
Medicare es un programa de seguro médico federal para personas de 65 años o más y para
ciertas personas más jóvenes con discapacidades. Medicare ofrece una amplia cobertura: la
Parte A cubre el seguro hospitalario; La Parte B es un seguro médico y la Parte D cubre los
medicamentos recetados. La Parte C puede complementar la Parte A, B y, a veces, la D.
Médico de atención primaria (PCP en inglés)
Un médico que brinda, coordina o ayuda a un paciente a acceder a una variedad de servicios de
atención médica.
Minimum Essential Coverage (MEC)
Minimum Essential Coverage (MEC) is the type of coverage an individual needs to have to meet
the individual responsibility requirement under the Affordable Care Act. This includes individual
market policies, job-based coverage, Medicare, Medicaid, Children’s Health Insurance Program,
TRICARE, and certain other coverage.
Modified Adjusted Gross Income (MAGI)
Modified Adjusted Gross Income (MAGI) is defined by the Internal Revenue Service (IRS).
Calculations include determination of MAGI with respect to federal poverty level and other
considerations such as pregnancy, children, children’s age, and whether the applicant is a
caretaker for other dependents.
nivel federal de pobreza
El Nivel Federal de Pobreza (FPL en inglés) es una medida de ingresos emitida cada año por el
Departamento de Salud y Servicios Humanos (HHS en inglés). Los niveles federales de pobreza
se utilizan para determinar su elegibilidad para ciertos programas y beneficios, incluyendo los
ahorros en el seguro médico del Mercado y la cobertura de Medicaid y CHIP.
Open Enrollment Period
The period of time, from November 1 – January 15, when you can enroll or renew in qualified
health plans (QHP) through Access Health CT. Open Enrollment Periods can differ between
states and coverage types.
Out-of-Network
Providers or services with which your health insurance plan has not contracted. You may end up
paying more of the cost for this care. Be sure to check if your providers are in-network. You can
find out if a provider is in-network using the online provider directory or by contacting your
insurance company.
Out-of-Pocket Costs
Out-of-pocket costs are expenses for medical care that are not reimbursed
by your insurance company. These costs include deductibles, co-insurance, and co-payments for
covered services plus all costs for services that are not covered.
periodo abierto de inscripción
Es un período de tiempo, del 1 de noviembre al 15 de enero, en el que puede inscribirse o
renovar en planes de salud calificados (QHP en inglés) a través de Access Health CT. Los
períodos abierto de inscripción pueden diferir entre los estados y los tipos de cobertura.
Periodo de Inscripción Especial
Un Período de Inscripción Especial (SEP en inglés) es un período de tiempo especial durante el
año en el que puede inscribirse en cobertura de salud a través de Access Health CT. Para
obtener un Período de Inscripción Especial, debe demostrar que tiene un Evento de Vida
Calificado y tendrá 60 días, a partir de la fecha de ese evento, para comenzar su proceso de
solicitud.
plan catastrófico
Los planes catastróficos están disponibles para personas menores de 30 años o para aquellos a
quienes se les haya otorgado una exención por dificultades económicas. Los planes catastróficos
no son elegibles para ayuda financiera. Estos planes tienen primas mensuales bajas y brindan el
nivel más bajo de cobertura. Los planes catastróficos ofrecen protección cuando los costos de
atención médica se acercan o alcanzan los costos máximos anuales de bolsillo.
Plan de Organización de Proveedores Preferidos
Un plan de Organización de Proveedores Preferidos (PPO en inglés) contrata a proveedores de
salud, como hospitales y médicos, para crear una red de proveedores participantes. Paga menos
si utiliza proveedores que pertenecen a la red del plan. Por lo general, puede utilizar médicos,
hospitales y proveedores fuera de la red por un costo adicional.
Plan de punto de servicio
Un plan de punto de servicio (POS en inglés) ofrece servicios con descuento si utiliza médicos,
hospitales y otros proveedores de atención médica que pertenecen a la red del plan. Los planes
de punto de servicio pueden requerir que obtenga una remisión de su médico de atención
primaria para ver a un especialista.
Plan de Salud Calificado
Un plan de salud calificado (QHP en inglés) por Access Health CT, proporciona beneficios
esenciales de salud, sigue los límites establecidos sobre costos compartidos (como deducibles,
copagos y montos máximos de gastos de bolsillo) y cumple con otros requisitos.
Plan de salud con un deducible alto
Un plan de salud con deducible alto (HDHP en inglés) es un plan que requiere deducibles más
altos que otros planes. Estos pueden combinarse con una cuenta de ahorros para la salud (HSA
en inglés) o un acuerdo de reembolso de la salud (HRA en inglés) para permitirle pagar los
gastos médicos calificados de su bolsillo antes de impuestos.
Plan Network
A plan network includes specific doctors, hospitals, pharmacies, and other health care providers
who have contracted with the health insurance company.
Point-of-Service (POS) Plan
A Point-of-Service Plan (POS) type offers discounted services if you use doctors, hospitals, and
other healthcare providers that belong to the plan’s network. POS plans may require you to get a
referral from your primary care doctor in order to see a specialist.
Preferred Provider Organization (PPO) Plan
A Preferred Provider Organization plan (PPO) contracts with medical providers, such as hospitals
and doctors, to create a network of participating providers. You pay less if you use providers that
belong to the plan’s network. You can usually use doctors, hospitals, and providers outside of the
network for an additional cost.
Premium
The amount you pay for your health insurance plan to the insurance company every month.
Preventive Services
These services include annual check-ups, immunizations, patient counseling, and screenings.
Preventive services are an Essential Health Benefit and covered under plans offered through
Access Health CT.
Prima
La cantidad que paga por su plan de seguro médico a la compañía de seguros cada mes.
Primary Care Physician (PCP)
A doctor who provides, coordinates or helps a patient access a range of health care services.
Programa de seguro médico para niños (CHIP en inglés)
CHIP es un programa de seguro financiado por el gobierno estatal y federal, que brinda seguro
de salud a niños en hogares de bajos ingresos. En Connecticut, este programa se conoce como
HUSKY B.
Qualified Health Plan (QHP)
An insurance plan that is certified by Access Health CT, provides Essential Health Benefits,
follows established limits on cost -sharing (like deductibles, co-payments, and out-of-pocket
maximum amounts), and meets other requirements.
Qualifying Life Event (QLE)
A Qualifying Life Event (QLE) is a change in your life — like losing health coverage, getting
married, having a baby or moving to Connecticut— that can make you eligible for a Special
Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment
Period.
Reclamo
Un reclamo es una solicitud de pago que usted o su proveedor de atención médica presentan a
su aseguradora de salud cuando recibe artículos o servicios.
Red de un plan
La red de un plan incluye médicos, hospitales, farmacias y otros proveedores de atención médica
específicos que tienen contrato con la compañía de seguro médico.
Red escalonada
Una red escalonada divide a los hospitales y médicos en grupos, según la información sobre la
calidad de su atención y los costos de sus servicios. Lo que paga se basa en el nivel del
proveedor.
Reducción de Costos Compartidos (CSR en inglés)
Reducción de Costos Compartidos (CSR) reduce la cantidad que paga de su bolsillo por
deducibles, coseguros y copagos cuando recibe servicios médicos. Si califica para Reducción de
Costos Compartidos, debe inscribirse en un plan de nivel Plata para obtener estos bajos costos.
Representante Autorizado
Un representante autorizado es una persona que ha sido designada en la solicitud para actuar
en nombre de otra persona.
Servicios Preventivos
Estos servicios incluyen chequeos anuales, vacunas, asesoramiento para pacientes y exámenes
de detección. Los servicios preventivos son un beneficio esencial salud y están cubiertos por los
planes que se ofrecen a través de Access Health CT.
Special Enrollment Period (SEP)
A Special Enrollment Period (SEP) is a special window of time during the year when you can
enroll in health insurance through Access Health CT. To get a Special Enrollment Period, you
must prove that you have a Qualifying Life Event – and you will have 60 days from the date of
that event begin your application process.
Specialist
A doctor who focuses on a specific area of medicine or a group of patients to diagnose, manage,
prevent or treat certain types of symptoms and conditions.
Tiered Network
A tiered network divides hospitals and doctors into groups, based on information about the quality
of their care and the costs of their services. What you pay is based on the tier of the provider. | What are the key takeaways from this text? | Access Health CT Glossary
Written by Roberto Blundo | Last published at: May 08, 2024
Glossary
acuerdo de reembolso de salud
Las cuentas de reembolso de salud son planes de salud grupales financiados |
American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
Stand-Alone Dental Plan at any time during the year and may change your health and/or dental plan
selection once a month. The coverage effective date(s) for your health and/or dental plan depend(s)
on the day you enroll. If you enroll by the 15th of the month, your coverage will start on the 1st day
of the following month (for example, if you enroll by February 15, your coverage will start on March
1). When you complete your application for health and/or dental coverage, you will not be asked to
provide documents to verify your American Indian or Alaska Native status, but you must provide the
name of your federally recognized tribe and your tribal status.
Financial Help
Based on your household's Modified Adjusted Gross Income (MAGI), you and your household
members may qualify for financial help to lower your health insurance costs.
You may qualify for a zero-cost sharing health plan if your household's income is between 100-
300% of the Federal Poverty Level (FPL). You do not owe any out-of-pocket costs for services
when you use a zero-cost sharing health plan, regardless of whether you receive care from an in-
or out-of-network provider.
You may qualify for a low-cost sharing health plan if your household's income is above 300% of
the FPL.
Your out-of-pocket costs may be waived if you receive services from an Indian Health Service
provider.
Calculating your Modified Adjusted Gross Income (MAGI)
Certain distributions and payments made to the American Indians and Alaska Natives are excluded
from MAGI for purposes of determining your household's eligibility for HUSKY Health coverage
(Medicaid and the Children's Health Insurance Program (CHIP)), the Covered CT Program, and
financial help. | What is the main topic of this document? | American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
S |
American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
Stand-Alone Dental Plan at any time during the year and may change your health and/or dental plan
selection once a month. The coverage effective date(s) for your health and/or dental plan depend(s)
on the day you enroll. If you enroll by the 15th of the month, your coverage will start on the 1st day
of the following month (for example, if you enroll by February 15, your coverage will start on March
1). When you complete your application for health and/or dental coverage, you will not be asked to
provide documents to verify your American Indian or Alaska Native status, but you must provide the
name of your federally recognized tribe and your tribal status.
Financial Help
Based on your household's Modified Adjusted Gross Income (MAGI), you and your household
members may qualify for financial help to lower your health insurance costs.
You may qualify for a zero-cost sharing health plan if your household's income is between 100-
300% of the Federal Poverty Level (FPL). You do not owe any out-of-pocket costs for services
when you use a zero-cost sharing health plan, regardless of whether you receive care from an in-
or out-of-network provider.
You may qualify for a low-cost sharing health plan if your household's income is above 300% of
the FPL.
Your out-of-pocket costs may be waived if you receive services from an Indian Health Service
provider.
Calculating your Modified Adjusted Gross Income (MAGI)
Certain distributions and payments made to the American Indians and Alaska Natives are excluded
from MAGI for purposes of determining your household's eligibility for HUSKY Health coverage
(Medicaid and the Children's Health Insurance Program (CHIP)), the Covered CT Program, and
financial help. | Who is mentioned in the document? | American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
S |
American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
Stand-Alone Dental Plan at any time during the year and may change your health and/or dental plan
selection once a month. The coverage effective date(s) for your health and/or dental plan depend(s)
on the day you enroll. If you enroll by the 15th of the month, your coverage will start on the 1st day
of the following month (for example, if you enroll by February 15, your coverage will start on March
1). When you complete your application for health and/or dental coverage, you will not be asked to
provide documents to verify your American Indian or Alaska Native status, but you must provide the
name of your federally recognized tribe and your tribal status.
Financial Help
Based on your household's Modified Adjusted Gross Income (MAGI), you and your household
members may qualify for financial help to lower your health insurance costs.
You may qualify for a zero-cost sharing health plan if your household's income is between 100-
300% of the Federal Poverty Level (FPL). You do not owe any out-of-pocket costs for services
when you use a zero-cost sharing health plan, regardless of whether you receive care from an in-
or out-of-network provider.
You may qualify for a low-cost sharing health plan if your household's income is above 300% of
the FPL.
Your out-of-pocket costs may be waived if you receive services from an Indian Health Service
provider.
Calculating your Modified Adjusted Gross Income (MAGI)
Certain distributions and payments made to the American Indians and Alaska Natives are excluded
from MAGI for purposes of determining your household's eligibility for HUSKY Health coverage
(Medicaid and the Children's Health Insurance Program (CHIP)), the Covered CT Program, and
financial help. | What are the key takeaways from this text? | American Indians and Alaska Natives
Written by Yessenia Milan | Last published at: October 25, 2024
If you are an American Indian or Alaska Native, you can enroll in a Qualified Health Plan (QHP) or
S |
American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health
insurance coverage more affordable and accessible for many Connecticut residents. These
laws changed the way we calculate financial help for customers. As a result, many more
customers now qualify for financial help to make plans more affordable. Whether you’re a first-
time shopper or an existing customer, we want to make sure you know how to take advantage
of all the financial help available. Enhanced plan subsidies are in place through Plan Year 2025,
unless they are extended beyond 2025 through federal legislation.
Real-Life example* of savings for Connecticut residents and their families due to the
ARPA and IRA:
Household
Size
Metal
Level
Coverage
Year
Income
Premium Before
Financial Help
Premium After
Financial Help
1
Silver
2022
$19,800
$ 1,289.08
$ 706.08
2023
$19,800
$ 1,340.37
$ 5.75
As a result of the ARPA and IRA:
•
More people than ever before qualify for help paying for health coverage, even those
who weren’t eligible in the past.
•
Most people currently enrolled in a plan through Access Health CT qualify for more tax
credits.
•
Your portion of health insurance premiums may be lower.
•
While the ARPA and IRA are effective, eligible individuals and households will have at
least one health plan option that costs no more than 8.5% of the annual income of their
tax household.
•
There are no changes to how someone qualifies for HUSKY Health. The ARPA added
COVID-19 vaccine and treatment coverage to more HUSKY Health Medicaid programs,
including the new COVID-19 uninsured coverage group.
To find out now if you qualify for savings on Qualified Health Plans, you can Compare
Plans or submit an application online, by phone, or with the help of an Enrollment
Specialist or Broker
We will post updates to this article as new information is available. Access Health CT customers
will hear from us directly about next steps and the impact on their household.
Complete an application at AccessHealthCT.com and we will let you know if you qualify for the
Covered Connecticut Program, a state-funded program that provides free health and dental
coverage and non-emergency medical transportation benefits to eligible Connecticut residents.
You can also call our call center for free enrollment and eligibility help at 1-855-805-4325. If you
are deaf or hearing impaired, you may use the TTY at 1-855-789-2428 or contact us at 1-855-
805-4325 with a relay operator.
We will post updates to this article as new information is available. Access Health CT
customers will hear from us directly about next steps and the impact on their household.
*All information provided in this example is for general informational purposes only, and Access
Health CT makes no representation or warranty of any kind, express or implied, regarding the
accuracy, availability, or completeness of the information provided in this example. To find out if
you qualify for financial help, you can Compare Plans or submit an application online, by phone,
or with the help of an Enrollment Specialist or Broker. | What is the main topic of this document? | American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health |
American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health
insurance coverage more affordable and accessible for many Connecticut residents. These
laws changed the way we calculate financial help for customers. As a result, many more
customers now qualify for financial help to make plans more affordable. Whether you’re a first-
time shopper or an existing customer, we want to make sure you know how to take advantage
of all the financial help available. Enhanced plan subsidies are in place through Plan Year 2025,
unless they are extended beyond 2025 through federal legislation.
Real-Life example* of savings for Connecticut residents and their families due to the
ARPA and IRA:
Household
Size
Metal
Level
Coverage
Year
Income
Premium Before
Financial Help
Premium After
Financial Help
1
Silver
2022
$19,800
$ 1,289.08
$ 706.08
2023
$19,800
$ 1,340.37
$ 5.75
As a result of the ARPA and IRA:
•
More people than ever before qualify for help paying for health coverage, even those
who weren’t eligible in the past.
•
Most people currently enrolled in a plan through Access Health CT qualify for more tax
credits.
•
Your portion of health insurance premiums may be lower.
•
While the ARPA and IRA are effective, eligible individuals and households will have at
least one health plan option that costs no more than 8.5% of the annual income of their
tax household.
•
There are no changes to how someone qualifies for HUSKY Health. The ARPA added
COVID-19 vaccine and treatment coverage to more HUSKY Health Medicaid programs,
including the new COVID-19 uninsured coverage group.
To find out now if you qualify for savings on Qualified Health Plans, you can Compare
Plans or submit an application online, by phone, or with the help of an Enrollment
Specialist or Broker
We will post updates to this article as new information is available. Access Health CT customers
will hear from us directly about next steps and the impact on their household.
Complete an application at AccessHealthCT.com and we will let you know if you qualify for the
Covered Connecticut Program, a state-funded program that provides free health and dental
coverage and non-emergency medical transportation benefits to eligible Connecticut residents.
You can also call our call center for free enrollment and eligibility help at 1-855-805-4325. If you
are deaf or hearing impaired, you may use the TTY at 1-855-789-2428 or contact us at 1-855-
805-4325 with a relay operator.
We will post updates to this article as new information is available. Access Health CT
customers will hear from us directly about next steps and the impact on their household.
*All information provided in this example is for general informational purposes only, and Access
Health CT makes no representation or warranty of any kind, express or implied, regarding the
accuracy, availability, or completeness of the information provided in this example. To find out if
you qualify for financial help, you can Compare Plans or submit an application online, by phone,
or with the help of an Enrollment Specialist or Broker. | Who is mentioned in the document? | American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health |
American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health
insurance coverage more affordable and accessible for many Connecticut residents. These
laws changed the way we calculate financial help for customers. As a result, many more
customers now qualify for financial help to make plans more affordable. Whether you’re a first-
time shopper or an existing customer, we want to make sure you know how to take advantage
of all the financial help available. Enhanced plan subsidies are in place through Plan Year 2025,
unless they are extended beyond 2025 through federal legislation.
Real-Life example* of savings for Connecticut residents and their families due to the
ARPA and IRA:
Household
Size
Metal
Level
Coverage
Year
Income
Premium Before
Financial Help
Premium After
Financial Help
1
Silver
2022
$19,800
$ 1,289.08
$ 706.08
2023
$19,800
$ 1,340.37
$ 5.75
As a result of the ARPA and IRA:
•
More people than ever before qualify for help paying for health coverage, even those
who weren’t eligible in the past.
•
Most people currently enrolled in a plan through Access Health CT qualify for more tax
credits.
•
Your portion of health insurance premiums may be lower.
•
While the ARPA and IRA are effective, eligible individuals and households will have at
least one health plan option that costs no more than 8.5% of the annual income of their
tax household.
•
There are no changes to how someone qualifies for HUSKY Health. The ARPA added
COVID-19 vaccine and treatment coverage to more HUSKY Health Medicaid programs,
including the new COVID-19 uninsured coverage group.
To find out now if you qualify for savings on Qualified Health Plans, you can Compare
Plans or submit an application online, by phone, or with the help of an Enrollment
Specialist or Broker
We will post updates to this article as new information is available. Access Health CT customers
will hear from us directly about next steps and the impact on their household.
Complete an application at AccessHealthCT.com and we will let you know if you qualify for the
Covered Connecticut Program, a state-funded program that provides free health and dental
coverage and non-emergency medical transportation benefits to eligible Connecticut residents.
You can also call our call center for free enrollment and eligibility help at 1-855-805-4325. If you
are deaf or hearing impaired, you may use the TTY at 1-855-789-2428 or contact us at 1-855-
805-4325 with a relay operator.
We will post updates to this article as new information is available. Access Health CT
customers will hear from us directly about next steps and the impact on their household.
*All information provided in this example is for general informational purposes only, and Access
Health CT makes no representation or warranty of any kind, express or implied, regarding the
accuracy, availability, or completeness of the information provided in this example. To find out if
you qualify for financial help, you can Compare Plans or submit an application online, by phone,
or with the help of an Enrollment Specialist or Broker. | What are the key takeaways from this text? | American Rescue Plan Act & Inflation Reduction
Act
Written by Yessenia Milan | Last published at: February 20, 2025
The American Rescue Plan (ARPA) and the Inflation Reduction Act (IRA) make health |
Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Plan or Medicaid.
Medicaid Only Disclaimers: You may be eligible for programs offered through the Department of Social
Services such as Medicaid (known as HUSKY A and Husky D) and the Children’s Health Insurance
Program (known as CHIP or HUSKY B). The information listed on your application will be used to decide if
you are eligible for these programs.
_____________________________________________________________________________________
I know that I must tell the program I’m enrolled in if information I listed on this application changes.
MEDICAID ONLY: I know that if Medicaid pays for a medical expense any money I get from other health
insurance or legal settlements will go to Medicaid in an amount equal to what Medicaid pays for the
expense.
MEDICAID ONLY: I know that if Medicaid pays for any of my medical expenses, any money I receive from
a lawsuit will be assigned to the State to pay for any medical expenses paid by the State related to injuries
that led to the lawsuit. If I have other insurance or a third party is liable to pay for my medical expenses,
the State may recover the cost of my medical bills directly from the insurer or third party. The State may
bill a legally liable relative to repay the State for the costs of my medical care. The State may recover
money from the estates of those people who were 55 years old or older at the time that community
medical benefits were paid and who do not have a living spouse or surviving child under age 21 or blind or
disabled. The State may recover from an inheritance or other lump sum of money I receive to repay the
State for the costs of my medical care. The State may place a lien, under certain conditions, on my home if
I permanently enter a nursing facility.
I know I’ll be asked to cooperate with the agency that collects medical support from the absent parent. If I
think that cooperating to collect medical support will harm me or my children, I can tell the agency and I
won’t have to cooperate.
I understand that AccessHealthCT.com will use data from my tax return during the renewal process to
determine yearly eligibility for help paying for health insurance for the next 5 years. I understand that if I
check this box I can change my answer later, and if I don’t check the box I can select less than 5 years.
I know that any change that I report may alter mine or my household’s eligibility status. If the change
results in me and my household becoming ineligible for help paying for health coverage, I and my
household may no longer receive help paying for coverage.
I’m signing this application under penalty of perjury. This means I’ve provided true answers to all the
questions on this form to the best of my knowledge. I know that if I’m not truthful, there may be a
penalty. | What is the main topic of this document? | Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Pla |
Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Plan or Medicaid.
Medicaid Only Disclaimers: You may be eligible for programs offered through the Department of Social
Services such as Medicaid (known as HUSKY A and Husky D) and the Children’s Health Insurance
Program (known as CHIP or HUSKY B). The information listed on your application will be used to decide if
you are eligible for these programs.
_____________________________________________________________________________________
I know that I must tell the program I’m enrolled in if information I listed on this application changes.
MEDICAID ONLY: I know that if Medicaid pays for a medical expense any money I get from other health
insurance or legal settlements will go to Medicaid in an amount equal to what Medicaid pays for the
expense.
MEDICAID ONLY: I know that if Medicaid pays for any of my medical expenses, any money I receive from
a lawsuit will be assigned to the State to pay for any medical expenses paid by the State related to injuries
that led to the lawsuit. If I have other insurance or a third party is liable to pay for my medical expenses,
the State may recover the cost of my medical bills directly from the insurer or third party. The State may
bill a legally liable relative to repay the State for the costs of my medical care. The State may recover
money from the estates of those people who were 55 years old or older at the time that community
medical benefits were paid and who do not have a living spouse or surviving child under age 21 or blind or
disabled. The State may recover from an inheritance or other lump sum of money I receive to repay the
State for the costs of my medical care. The State may place a lien, under certain conditions, on my home if
I permanently enter a nursing facility.
I know I’ll be asked to cooperate with the agency that collects medical support from the absent parent. If I
think that cooperating to collect medical support will harm me or my children, I can tell the agency and I
won’t have to cooperate.
I understand that AccessHealthCT.com will use data from my tax return during the renewal process to
determine yearly eligibility for help paying for health insurance for the next 5 years. I understand that if I
check this box I can change my answer later, and if I don’t check the box I can select less than 5 years.
I know that any change that I report may alter mine or my household’s eligibility status. If the change
results in me and my household becoming ineligible for help paying for health coverage, I and my
household may no longer receive help paying for coverage.
I’m signing this application under penalty of perjury. This means I’ve provided true answers to all the
questions on this form to the best of my knowledge. I know that if I’m not truthful, there may be a
penalty. | Who is mentioned in the document? | Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Pla |
Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Plan or Medicaid.
Medicaid Only Disclaimers: You may be eligible for programs offered through the Department of Social
Services such as Medicaid (known as HUSKY A and Husky D) and the Children’s Health Insurance
Program (known as CHIP or HUSKY B). The information listed on your application will be used to decide if
you are eligible for these programs.
_____________________________________________________________________________________
I know that I must tell the program I’m enrolled in if information I listed on this application changes.
MEDICAID ONLY: I know that if Medicaid pays for a medical expense any money I get from other health
insurance or legal settlements will go to Medicaid in an amount equal to what Medicaid pays for the
expense.
MEDICAID ONLY: I know that if Medicaid pays for any of my medical expenses, any money I receive from
a lawsuit will be assigned to the State to pay for any medical expenses paid by the State related to injuries
that led to the lawsuit. If I have other insurance or a third party is liable to pay for my medical expenses,
the State may recover the cost of my medical bills directly from the insurer or third party. The State may
bill a legally liable relative to repay the State for the costs of my medical care. The State may recover
money from the estates of those people who were 55 years old or older at the time that community
medical benefits were paid and who do not have a living spouse or surviving child under age 21 or blind or
disabled. The State may recover from an inheritance or other lump sum of money I receive to repay the
State for the costs of my medical care. The State may place a lien, under certain conditions, on my home if
I permanently enter a nursing facility.
I know I’ll be asked to cooperate with the agency that collects medical support from the absent parent. If I
think that cooperating to collect medical support will harm me or my children, I can tell the agency and I
won’t have to cooperate.
I understand that AccessHealthCT.com will use data from my tax return during the renewal process to
determine yearly eligibility for help paying for health insurance for the next 5 years. I understand that if I
check this box I can change my answer later, and if I don’t check the box I can select less than 5 years.
I know that any change that I report may alter mine or my household’s eligibility status. If the change
results in me and my household becoming ineligible for help paying for health coverage, I and my
household may no longer receive help paying for coverage.
I’m signing this application under penalty of perjury. This means I’ve provided true answers to all the
questions on this form to the best of my knowledge. I know that if I’m not truthful, there may be a
penalty. | What are the key takeaways from this text? | Application Disclaimers
You must agree to the following disclaimers to complete your application. If you do not agree to the
disclaimers, you will not be eligible to enroll in a Qualified Health Pla |
Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia en otro idioma, contamos con traductores capacitados en más de 200
idiomas que están aquí para ayudarle. Comuníquese con el centro de llamadas de Access
Health CT al 1-855-805-4325.
Si es sordo o tiene problemas de audición, puede usar el TTY al 1-855-789-2428 o
comunicarse al 1-855-805-4325 con nosotros a través de un operador de retransmisión.
Descargue una copia de nuestra lista de verificación de inscripción aquí, disponible en varios
idiomas:
Español
Inglés
Criollo haitiano
Polaco | What is the main topic of this document? | Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia e |
Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia en otro idioma, contamos con traductores capacitados en más de 200
idiomas que están aquí para ayudarle. Comuníquese con el centro de llamadas de Access
Health CT al 1-855-805-4325.
Si es sordo o tiene problemas de audición, puede usar el TTY al 1-855-789-2428 o
comunicarse al 1-855-805-4325 con nosotros a través de un operador de retransmisión.
Descargue una copia de nuestra lista de verificación de inscripción aquí, disponible en varios
idiomas:
Español
Inglés
Criollo haitiano
Polaco | Who is mentioned in the document? | Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia e |
Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia en otro idioma, contamos con traductores capacitados en más de 200
idiomas que están aquí para ayudarle. Comuníquese con el centro de llamadas de Access
Health CT al 1-855-805-4325.
Si es sordo o tiene problemas de audición, puede usar el TTY al 1-855-789-2428 o
comunicarse al 1-855-805-4325 con nosotros a través de un operador de retransmisión.
Descargue una copia de nuestra lista de verificación de inscripción aquí, disponible en varios
idiomas:
Español
Inglés
Criollo haitiano
Polaco | What are the key takeaways from this text? | Asistencia de traducción de idiomas y TTY
Written by Yessenia Milan | Last published at: January 08, 2025
¿Cómo puedo obtener ayuda con la traducción de idiomas o TTY?
Si necesita asistencia e |
Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Affordable
Care Act at no cost to the consumer. This means any plan bought through Access Health CT must
offer these contraceptive benefits as part of your health insurance coverage. You should still review
your plan benefits and costs with the insurance company you chose or are looking to choose. | What is the main topic of this document? | Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Af |
Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Affordable
Care Act at no cost to the consumer. This means any plan bought through Access Health CT must
offer these contraceptive benefits as part of your health insurance coverage. You should still review
your plan benefits and costs with the insurance company you chose or are looking to choose. | Who is mentioned in the document? | Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Af |
Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Affordable
Care Act at no cost to the consumer. This means any plan bought through Access Health CT must
offer these contraceptive benefits as part of your health insurance coverage. You should still review
your plan benefits and costs with the insurance company you chose or are looking to choose. | What are the key takeaways from this text? | Birth Control Coverage
Written by Yessenia Milan | Last published at: October 17, 2023
Yes and at no cost!
All Access Health CT health plans must cover all approved forms of birth control under the Af |
Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allow you to temporarily keep your health coverage after a
qualifying event, such as job loss. If you choose COBRA continuation coverage, you may have to
pay 100% of the monthly payments (premium), including the share the employer used to pay, and a
small administrative fee.
If you are being offered COBRA continuation coverage, there are some things you should know
before you make a final decision. Access Health CT may offer a better, less expensive choice for you
and your family.
2. COBRA Coverage vs. Coverage through Access Health CT
We recommend that you check your options with Access Health before choosing COBRA for these
reasons:
Access Health CT is the only place you can qualify for financial help to pay for health insurance.
With COBRA coverage, you may have to pay 100% of the monthly payment (premium), including
the share the employer used to pay, plus a small administrative fee.
If you decide you want to end your COBRA coverage early, you are only eligible to enroll during
the Annual – unless you have a Qualifying Life Event.
You may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), and you can
apply for and enroll in those programs any time of year.
Also consider what other options you have, like being added to a spouse or household member’s
health plan.
3. Can I apply for private health insurance through Access Health CT if I already have
COBRA?
You may be eligible to enroll in a Qualified Health Plan (QHP) during a Special Enrollment Period if
your COBRA coverage ends or your former employer stops contributing and you must pay the full
cost. If the cost does not change and you voluntarily terminate your COBRA coverage early, you will
not be eligible to enroll in a QHP until the Open Enrollment Period begins.
More Information:
Learn More About Special Enrollment Periods | What is the main topic of this document? | Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allo |
Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allow you to temporarily keep your health coverage after a
qualifying event, such as job loss. If you choose COBRA continuation coverage, you may have to
pay 100% of the monthly payments (premium), including the share the employer used to pay, and a
small administrative fee.
If you are being offered COBRA continuation coverage, there are some things you should know
before you make a final decision. Access Health CT may offer a better, less expensive choice for you
and your family.
2. COBRA Coverage vs. Coverage through Access Health CT
We recommend that you check your options with Access Health before choosing COBRA for these
reasons:
Access Health CT is the only place you can qualify for financial help to pay for health insurance.
With COBRA coverage, you may have to pay 100% of the monthly payment (premium), including
the share the employer used to pay, plus a small administrative fee.
If you decide you want to end your COBRA coverage early, you are only eligible to enroll during
the Annual – unless you have a Qualifying Life Event.
You may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), and you can
apply for and enroll in those programs any time of year.
Also consider what other options you have, like being added to a spouse or household member’s
health plan.
3. Can I apply for private health insurance through Access Health CT if I already have
COBRA?
You may be eligible to enroll in a Qualified Health Plan (QHP) during a Special Enrollment Period if
your COBRA coverage ends or your former employer stops contributing and you must pay the full
cost. If the cost does not change and you voluntarily terminate your COBRA coverage early, you will
not be eligible to enroll in a QHP until the Open Enrollment Period begins.
More Information:
Learn More About Special Enrollment Periods | Who is mentioned in the document? | Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allo |
Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allow you to temporarily keep your health coverage after a
qualifying event, such as job loss. If you choose COBRA continuation coverage, you may have to
pay 100% of the monthly payments (premium), including the share the employer used to pay, and a
small administrative fee.
If you are being offered COBRA continuation coverage, there are some things you should know
before you make a final decision. Access Health CT may offer a better, less expensive choice for you
and your family.
2. COBRA Coverage vs. Coverage through Access Health CT
We recommend that you check your options with Access Health before choosing COBRA for these
reasons:
Access Health CT is the only place you can qualify for financial help to pay for health insurance.
With COBRA coverage, you may have to pay 100% of the monthly payment (premium), including
the share the employer used to pay, plus a small administrative fee.
If you decide you want to end your COBRA coverage early, you are only eligible to enroll during
the Annual – unless you have a Qualifying Life Event.
You may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), and you can
apply for and enroll in those programs any time of year.
Also consider what other options you have, like being added to a spouse or household member’s
health plan.
3. Can I apply for private health insurance through Access Health CT if I already have
COBRA?
You may be eligible to enroll in a Qualified Health Plan (QHP) during a Special Enrollment Period if
your COBRA coverage ends or your former employer stops contributing and you must pay the full
cost. If the cost does not change and you voluntarily terminate your COBRA coverage early, you will
not be eligible to enroll in a QHP until the Open Enrollment Period begins.
More Information:
Learn More About Special Enrollment Periods | What are the key takeaways from this text? | Can I apply for a qualified health plan
through Access Health CT if I have COBRA?
Written by Yessenia Milan | Last published at: October 24, 2024
1. What is COBRA?
COBRA is a federal law that may allo |
Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accounts available to taxpayers who are
enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account aren’t
subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical
expenses and leftover funds roll over year to year if you don’t spend them, which means you don’t
lose them if they are not spent.
Some insurance companies offer High Deductible Health Plans that are compatible with a Health
Savings Account (HSA). These accounts are managed by the insurance companies and not by
Access Health CT. However, HSA compatible plans are available through the Access Health CT
Marketplace and are identified as such in the plan name. Just look for "HSA" in the plan name when
you are comparing health plans.
For more information on types of plans available through Access Health CT, click here. | What is the main topic of this document? | Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accou |
Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accounts available to taxpayers who are
enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account aren’t
subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical
expenses and leftover funds roll over year to year if you don’t spend them, which means you don’t
lose them if they are not spent.
Some insurance companies offer High Deductible Health Plans that are compatible with a Health
Savings Account (HSA). These accounts are managed by the insurance companies and not by
Access Health CT. However, HSA compatible plans are available through the Access Health CT
Marketplace and are identified as such in the plan name. Just look for "HSA" in the plan name when
you are comparing health plans.
For more information on types of plans available through Access Health CT, click here. | Who is mentioned in the document? | Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accou |
Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accounts available to taxpayers who are
enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account aren’t
subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical
expenses and leftover funds roll over year to year if you don’t spend them, which means you don’t
lose them if they are not spent.
Some insurance companies offer High Deductible Health Plans that are compatible with a Health
Savings Account (HSA). These accounts are managed by the insurance companies and not by
Access Health CT. However, HSA compatible plans are available through the Access Health CT
Marketplace and are identified as such in the plan name. Just look for "HSA" in the plan name when
you are comparing health plans.
For more information on types of plans available through Access Health CT, click here. | What are the key takeaways from this text? | Can I get a plan with a Health Savings
Account (HSA) through Access Health CT?
Written by Yessenia Milan | Last published at: February 19, 2025
Health Savings Accounts (HSAs) are medical savings accou |
Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecticut extended health coverage for most Medicaid members
enrolled on or after March 18, 2020, even if they no longer qualified, a process the federal
government calls Continuous Enrollment. The federal rules have changed; Continuous
Enrollment ends March 31, 2023 and the process of reviewing households for eligibility, referred
to as Continuous Enrollment Unwinding, will resume. You can click here for the latest updates
on this process.
What steps can I take to get ready?
1.
Update us so we can update you! Make sure your address and phone number are up to
date with Access Health CT and/or the Department of Social Services (DSS). Consider
providing your email address, opting to receive text messages or selecting paperless
delivery for important notifications.
–
HUSKY A, B and D members: Update your information online through Access
Health CT or by calling Access Health CT at 1-855-805-4325 (TTY 1-855-789-
2428 or call 1-855-805-4325 with a relay operator)
–
HUSKY C members: Update your information online at Connecticut Department of
Social Services or by calling DSS at 1-855-626-6632
2.
Look for mail or email messages from DSS, Access Health CT and HUSKY Health
3.
Follow the Department of Social Services on social media for updates CT Department of
Social Services | Facebook and https://twitter.com/ctdss
What happens to my coverage when Continuous Enrollment ends?
The Department of Social Services will contact you to complete a renewal form to see if you
qualify for coverage for the next year. Each month for the next 12 months after March 31, 2023,
a portion of HUSKY Health members will be sent a renewal notification. You should wait until
you receive your renewal notification to take action but you can update your contact information
at any time.
You will receive a renewal form 45 days before your coverage is due to end. It is important to
complete your renewal quickly and provide any documentation that may be requested. This may
help you to avoid any gaps in medical coverage.
How do I complete my renewal once I get the notice?
When you receive your renewal notification, the fastest way to complete it is to go online.
•
HUSKY A, B, and D members, visit accesshealthct.com
•
HUSKY C members, visit mydss.ct.gov
When you update or confirm your application details through Access Health CT, you will get a
final determination on whether your HUSKY Health coverage will be renewed or if you qualify for
another program. You will see that result on the final screen of the application, and you will also
receive a confirmation by mail (1-3 business days) or through your online account inbox.
What if I no longer qualify for HUSKY Health?
If you no longer qualify for HUSKY Health, you can shop for health and dental coverage through
Access Health CT. There are full coverage options available at little or no cost. Contact Access
Health CT to find out what you may qualify for:
•
Online at Access Health CT
•
Over the phone at 1-855-805-4325 (If you are deaf or hearing impaired, you may use the
TTY at 1-855-789-2428 or contact us at 1-855-805-4325 with a relay operator)
What do I need to do now?
Update your household and contact information! You can call us or follow the steps below to
make your updates online. Make sure we have the most up to date information about your
household, including your annual income and your contact information
•
If you don’t have any updates to report, wait for a notice telling you when it’s time to take
further action
•
There is no need to contact us until you receive your notice | What is the main topic of this document? | Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecti |
Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecticut extended health coverage for most Medicaid members
enrolled on or after March 18, 2020, even if they no longer qualified, a process the federal
government calls Continuous Enrollment. The federal rules have changed; Continuous
Enrollment ends March 31, 2023 and the process of reviewing households for eligibility, referred
to as Continuous Enrollment Unwinding, will resume. You can click here for the latest updates
on this process.
What steps can I take to get ready?
1.
Update us so we can update you! Make sure your address and phone number are up to
date with Access Health CT and/or the Department of Social Services (DSS). Consider
providing your email address, opting to receive text messages or selecting paperless
delivery for important notifications.
–
HUSKY A, B and D members: Update your information online through Access
Health CT or by calling Access Health CT at 1-855-805-4325 (TTY 1-855-789-
2428 or call 1-855-805-4325 with a relay operator)
–
HUSKY C members: Update your information online at Connecticut Department of
Social Services or by calling DSS at 1-855-626-6632
2.
Look for mail or email messages from DSS, Access Health CT and HUSKY Health
3.
Follow the Department of Social Services on social media for updates CT Department of
Social Services | Facebook and https://twitter.com/ctdss
What happens to my coverage when Continuous Enrollment ends?
The Department of Social Services will contact you to complete a renewal form to see if you
qualify for coverage for the next year. Each month for the next 12 months after March 31, 2023,
a portion of HUSKY Health members will be sent a renewal notification. You should wait until
you receive your renewal notification to take action but you can update your contact information
at any time.
You will receive a renewal form 45 days before your coverage is due to end. It is important to
complete your renewal quickly and provide any documentation that may be requested. This may
help you to avoid any gaps in medical coverage.
How do I complete my renewal once I get the notice?
When you receive your renewal notification, the fastest way to complete it is to go online.
•
HUSKY A, B, and D members, visit accesshealthct.com
•
HUSKY C members, visit mydss.ct.gov
When you update or confirm your application details through Access Health CT, you will get a
final determination on whether your HUSKY Health coverage will be renewed or if you qualify for
another program. You will see that result on the final screen of the application, and you will also
receive a confirmation by mail (1-3 business days) or through your online account inbox.
What if I no longer qualify for HUSKY Health?
If you no longer qualify for HUSKY Health, you can shop for health and dental coverage through
Access Health CT. There are full coverage options available at little or no cost. Contact Access
Health CT to find out what you may qualify for:
•
Online at Access Health CT
•
Over the phone at 1-855-805-4325 (If you are deaf or hearing impaired, you may use the
TTY at 1-855-789-2428 or contact us at 1-855-805-4325 with a relay operator)
What do I need to do now?
Update your household and contact information! You can call us or follow the steps below to
make your updates online. Make sure we have the most up to date information about your
household, including your annual income and your contact information
•
If you don’t have any updates to report, wait for a notice telling you when it’s time to take
further action
•
There is no need to contact us until you receive your notice | Who is mentioned in the document? | Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecti |
Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecticut extended health coverage for most Medicaid members
enrolled on or after March 18, 2020, even if they no longer qualified, a process the federal
government calls Continuous Enrollment. The federal rules have changed; Continuous
Enrollment ends March 31, 2023 and the process of reviewing households for eligibility, referred
to as Continuous Enrollment Unwinding, will resume. You can click here for the latest updates
on this process.
What steps can I take to get ready?
1.
Update us so we can update you! Make sure your address and phone number are up to
date with Access Health CT and/or the Department of Social Services (DSS). Consider
providing your email address, opting to receive text messages or selecting paperless
delivery for important notifications.
–
HUSKY A, B and D members: Update your information online through Access
Health CT or by calling Access Health CT at 1-855-805-4325 (TTY 1-855-789-
2428 or call 1-855-805-4325 with a relay operator)
–
HUSKY C members: Update your information online at Connecticut Department of
Social Services or by calling DSS at 1-855-626-6632
2.
Look for mail or email messages from DSS, Access Health CT and HUSKY Health
3.
Follow the Department of Social Services on social media for updates CT Department of
Social Services | Facebook and https://twitter.com/ctdss
What happens to my coverage when Continuous Enrollment ends?
The Department of Social Services will contact you to complete a renewal form to see if you
qualify for coverage for the next year. Each month for the next 12 months after March 31, 2023,
a portion of HUSKY Health members will be sent a renewal notification. You should wait until
you receive your renewal notification to take action but you can update your contact information
at any time.
You will receive a renewal form 45 days before your coverage is due to end. It is important to
complete your renewal quickly and provide any documentation that may be requested. This may
help you to avoid any gaps in medical coverage.
How do I complete my renewal once I get the notice?
When you receive your renewal notification, the fastest way to complete it is to go online.
•
HUSKY A, B, and D members, visit accesshealthct.com
•
HUSKY C members, visit mydss.ct.gov
When you update or confirm your application details through Access Health CT, you will get a
final determination on whether your HUSKY Health coverage will be renewed or if you qualify for
another program. You will see that result on the final screen of the application, and you will also
receive a confirmation by mail (1-3 business days) or through your online account inbox.
What if I no longer qualify for HUSKY Health?
If you no longer qualify for HUSKY Health, you can shop for health and dental coverage through
Access Health CT. There are full coverage options available at little or no cost. Contact Access
Health CT to find out what you may qualify for:
•
Online at Access Health CT
•
Over the phone at 1-855-805-4325 (If you are deaf or hearing impaired, you may use the
TTY at 1-855-789-2428 or contact us at 1-855-805-4325 with a relay operator)
What do I need to do now?
Update your household and contact information! You can call us or follow the steps below to
make your updates online. Make sure we have the most up to date information about your
household, including your annual income and your contact information
•
If you don’t have any updates to report, wait for a notice telling you when it’s time to take
further action
•
There is no need to contact us until you receive your notice | What are the key takeaways from this text? | Continuous Enrollment Unwinding and HUSKY
Health Coverage
Written by Kecia Stauffer | Last published at: January 08, 2025
What is the Continuous Enrollment Unwinding?
During the pandemic, Connecti |
Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment determines when your health and/or dental coverage will
start:
For coverage starting January 1, 2025, you must enroll and complete your application by
December 15, 2024.
For coverage starting February 1, 2025, you must enroll and complete your application between
December 16, 2024 and January 15, 2025.
ii. Enrolling in health and/or dental insurance outside of the Open Enrollment requires a Qualifying
Life Event. You typically will have a period of 60 days from the Qualifying Life Event date, which is
referred to as a Special Enrollment Period, to enroll. The date your coverage will start will depend on
the type of Qualifying Life Event you had for your Special Enrollment Period.
iii. Connecticut residents that are eligible for the new Covered Connecticut Program can enroll at any
time. Your coverage will start on the first of the month after you complete your enrollment and
application.
2. Can I change my effective date?
Your coverage effective date is based on the date you enroll and cannot be changed. For more
information, call Access Health CT at 1-855-805-4325. | What is the main topic of this document? | Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment det |
Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment determines when your health and/or dental coverage will
start:
For coverage starting January 1, 2025, you must enroll and complete your application by
December 15, 2024.
For coverage starting February 1, 2025, you must enroll and complete your application between
December 16, 2024 and January 15, 2025.
ii. Enrolling in health and/or dental insurance outside of the Open Enrollment requires a Qualifying
Life Event. You typically will have a period of 60 days from the Qualifying Life Event date, which is
referred to as a Special Enrollment Period, to enroll. The date your coverage will start will depend on
the type of Qualifying Life Event you had for your Special Enrollment Period.
iii. Connecticut residents that are eligible for the new Covered Connecticut Program can enroll at any
time. Your coverage will start on the first of the month after you complete your enrollment and
application.
2. Can I change my effective date?
Your coverage effective date is based on the date you enroll and cannot be changed. For more
information, call Access Health CT at 1-855-805-4325. | Who is mentioned in the document? | Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment det |
Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment determines when your health and/or dental coverage will
start:
For coverage starting January 1, 2025, you must enroll and complete your application by
December 15, 2024.
For coverage starting February 1, 2025, you must enroll and complete your application between
December 16, 2024 and January 15, 2025.
ii. Enrolling in health and/or dental insurance outside of the Open Enrollment requires a Qualifying
Life Event. You typically will have a period of 60 days from the Qualifying Life Event date, which is
referred to as a Special Enrollment Period, to enroll. The date your coverage will start will depend on
the type of Qualifying Life Event you had for your Special Enrollment Period.
iii. Connecticut residents that are eligible for the new Covered Connecticut Program can enroll at any
time. Your coverage will start on the first of the month after you complete your enrollment and
application.
2. Can I change my effective date?
Your coverage effective date is based on the date you enroll and cannot be changed. For more
information, call Access Health CT at 1-855-805-4325. | What are the key takeaways from this text? | Coverage Effective Dates for Qualified
Health Plans
Written by Yessenia Milan | Last published at: January 30, 2025
1. How are effective dates determined?
i. When you enroll during Open Enrollment det |
Covered CT Program
Written by Yessenia Milan | Last published at: January 08, 2025
Covered CT
Some Connecticut residents that meet specific eligibility requirements are paying $0 for their
health insurance coverage, thanks to the new Covered CT Program created by the State of
Connecticut. The Covered CT Program provides health insurance coverage, dental coverage
and Non-Emergency Medical Transportation (NEMT) administered by the Connecticut
Department of Social Services. This Program is for residents between the ages of 19–64.
Want to see if you qualify? Complete an application with Access Health CT online or with
some free help.
For eligible Connecticut residents enrolled in the Covered CT Program, the State of Connecticut
pays the customer’s portion of the monthly payment (premium) directly to their insurance
company (Anthem, ConnectiCare Benefits, Inc. and ConnectiCare Insurance Company, Inc.)
and also pays for the cost-sharing amounts (deductibles, co-pays, co-insurance and maximum
out-of-pocket costs) that customers would typically have to pay with a health insurance plan.
Residents must meet the following requirements to participate in the Covered CT
Program:
•
Have a household income up to and including 175% of the Federal Poverty Level (FPL)
and don't qualify for Medicaid due to income*
•
Be eligible for financial help, including Advance Premium Tax Credits (APTC) and Cost-
Sharing Reductions (CSRs), and use 100% of the financial help available to you
•
Enroll and remain enrolled in a Silver Plan for the duration of the plan year
*If your household income makes you eligible for HUSKY Health/Medicaid, you are not eligible
for the Covered CT Program. Medicaid provides comprehensive benefits, please contact the
Connecticut Department of Social Services for more information.
Income Guidelines for 2025 Coverage (For applications submitted on or after December
1, 2024)
Household
Size
1
2
3
4
5
6
7
8
Ineligible for
HUSKY/
Medicaid an
d have
household
income up
to and
including
175% FPL
$26,35
5
$35,77
0
$45,18
5
$54,60
0
$64,01
5
$73,43
0
$82,84
5
$92,26
0
How to Enroll in the Covered CT Program
Complete an application at AccessHealthCT.com and we will let you know if you qualify for the
Covered CT Program. You can also call our call center for free enrollment and eligibility help at
1-855-805-4325. If you are deaf or hearing impaired, you may use the TTY at 1-855-789-2428 or
contact us at 1-855-805-4325 with a relay operator.
Already enrolled through Access Health CT?
If you are enrolled in a Qualified Health Plan through Access Health CT, you can update
your application with any recent changes to your household information. You may
qualify if your household income or home address has changed since you enrolled.
FREQUENTLY ASKED QUESTIONS
If I am already paying a very low premium, should I take any action?
Probably. Many customers are already enrolled in plans that cost nearly $0 per month.
But, with the Covered CT Program, they may be eligible for a plan with
no premium (monthly payment) and no out-of-pocket expenses (what you pay for a
covered healthcare service).
Am I eligible if my income isn't the same every month?
Yes. The Covered CT Program income requirements are based on annual income, so you
will need to estimate what your total annual household income will be for the year. If you
experience a significant change in household income after you enroll, you must report it
to Access Health CT immediately.
What types of health care or services will be covered through this program?
•
All health care and services must be medically necessary and covered by the health
insurance plan to be paid by the State of Connecticut.
•
Please visit the Department of Social Services website for more information about Dental
and Non-Emergency Medical Transportation benefits.
Will eligible customers really have $0 premium and $0 cost-sharing plans through the
Covered CT Program?
Yes! The State of Connecticut will pay the customer portion of the premium (monthly payment)
and all out-of-pocket expenses (what you pay for a covered healthcare service) that customers
were previously responsible for paying under their health insurance plan through Access Health
CT. There will also be dental benefits and Non-Emergency Medical Transportation benefits
included at no additional cost.
I am comparing plans and the plans do not show $0 premium and $0 cost sharing. Why is
this?
When shopping for a plan, please be sure to:
1.
Complete your application
2.
Make sure you are eligible for the "Covered Connecticut Program" on the Eligibility
Determination screen
3.
Select a Silver Plan
4.
Select 100% of the Advance Premium Tax Credits (APTCs).
After completing these steps, you will see the premium of the Silver Plan update to $0 on your
plan purchase summary.
Please note, you will also see an alert at the top of your screen during Silver Plan and
APTC selection informing you of your potential eligibility for the Covered CT Program, even
though you have already confirmed your eligibility for the Program on the Eligibility
Determination screen; please disregard this message and continue Silver Plan and
APTC selection to complete enrollment into the Covered CT Program.
Is this financial help available only through Access Health CT?
Yes. This is the reason we encourage everyone to take a look at plans available through Access
Health CT, even if you already have other health insurance coverage.
How do I estimate my household income?
Please include all estimated income and disclose any unemployment benefits.
Should I contact a broker or my broker?
If you want advice about whether to change plans or for selecting a plan if you are new to
Access Health CT, you should speak to your broker to review your options and your needs. If
you do not have a broker you can find one here.
If eligible customers do not elect to use all Advanced Premium Tax Credits (APTCs)
available to them, will they still benefit from the Covered CT Program?
No. Customers who want to participate in the Covered CT Program must elect to use all APTCs
available to them. Depending on the customer’s current application status and preferences, they
may not have elected to use all APTCs available to them. Access Health CT will communicate
with customers who have not updated their accounts but may benefit from the Covered CT
Program.
Do I need to verify any of my household information after I enroll?
Maybe. Access Health CT attempts to verify all reported information with third-party sources. If
we are unable to verify some of your information, we will contact you to request verification of
such information. You should always make sure you have accurately listed your annual
household income and that you provide verification documentation, if requested, to make sure
you receive the correct amount of financial assistance throughout the year. Always remember to
make updates to your household income and other information right away if there are any
changes during the year.
Are American Indians and Alaska Natives eligible for the Covered CT Program?
Yes.
When can Covered CT Program participants expect new identification card(s)?
You will get two identification cards after enrolling in the Covered CT Program.
You can expect a new identification card from your insurance company about one week after
enrollment. Contact your insurance company if you need a temporary card before you receive
the new insurance card. If you are charged for any cost-sharing while seeking medical care or
services, or visiting a pharmacy, you can contact your insurance company to submit a
reimbursement request.
In addition, the Connecticut Department of Social Services will send an identification card to
Covered CT Program participants for their Dental and NEMT benefits approximately two weeks
after enrollment.
What if I enroll in the Covered CT Program but I already paid my premium (monthly
payment) to my insurance company for the next month?
Your insurance company will reimburse you.
Can I be reimbursed for premium (monthly payment) or cost-sharing amounts
(deductibles, co-pays, co-insurance and maximum out-of-pocket costs) I incurred before
I was enrolled in the Covered CT Program?
No. You are still responsible for any balances due for premiums, care or services received
before you enroll in the Covered CT Program.
What else should I keep in mind?
Application details like household size and estimated income will impact the financial help you
may be eligible for through Access Health CT. It is important to report any changes as soon as
possible.
Remember that updates to your application could result in changes to
the type of coverage you may select.
How do I use dental benefits after I enroll?
Please visit the Department of Social Services website for more information about dental benefits,
including details on benefits and how to find a provider.
How do I access Non-Emergency Medical Transportation after I enroll?
Please visit the Department of Social Services website for more information about Non-
Emergency Medical Transportation (NEMT) benefits. | What is the main topic of this document? | Covered CT Program
Written by Yessenia Milan | Last published at: January 08, 2025
Covered CT
Some Connecticut residents that meet specific eligibility requirements are paying $0 for their
health |
Covered CT Program
Written by Yessenia Milan | Last published at: January 08, 2025
Covered CT
Some Connecticut residents that meet specific eligibility requirements are paying $0 for their
health insurance coverage, thanks to the new Covered CT Program created by the State of
Connecticut. The Covered CT Program provides health insurance coverage, dental coverage
and Non-Emergency Medical Transportation (NEMT) administered by the Connecticut
Department of Social Services. This Program is for residents between the ages of 19–64.
Want to see if you qualify? Complete an application with Access Health CT online or with
some free help.
For eligible Connecticut residents enrolled in the Covered CT Program, the State of Connecticut
pays the customer’s portion of the monthly payment (premium) directly to their insurance
company (Anthem, ConnectiCare Benefits, Inc. and ConnectiCare Insurance Company, Inc.)
and also pays for the cost-sharing amounts (deductibles, co-pays, co-insurance and maximum
out-of-pocket costs) that customers would typically have to pay with a health insurance plan.
Residents must meet the following requirements to participate in the Covered CT
Program:
•
Have a household income up to and including 175% of the Federal Poverty Level (FPL)
and don't qualify for Medicaid due to income*
•
Be eligible for financial help, including Advance Premium Tax Credits (APTC) and Cost-
Sharing Reductions (CSRs), and use 100% of the financial help available to you
•
Enroll and remain enrolled in a Silver Plan for the duration of the plan year
*If your household income makes you eligible for HUSKY Health/Medicaid, you are not eligible
for the Covered CT Program. Medicaid provides comprehensive benefits, please contact the
Connecticut Department of Social Services for more information.
Income Guidelines for 2025 Coverage (For applications submitted on or after December
1, 2024)
Household
Size
1
2
3
4
5
6
7
8
Ineligible for
HUSKY/
Medicaid an
d have
household
income up
to and
including
175% FPL
$26,35
5
$35,77
0
$45,18
5
$54,60
0
$64,01
5
$73,43
0
$82,84
5
$92,26
0
How to Enroll in the Covered CT Program
Complete an application at AccessHealthCT.com and we will let you know if you qualify for the
Covered CT Program. You can also call our call center for free enrollment and eligibility help at
1-855-805-4325. If you are deaf or hearing impaired, you may use the TTY at 1-855-789-2428 or
contact us at 1-855-805-4325 with a relay operator.
Already enrolled through Access Health CT?
If you are enrolled in a Qualified Health Plan through Access Health CT, you can update
your application with any recent changes to your household information. You may
qualify if your household income or home address has changed since you enrolled.
FREQUENTLY ASKED QUESTIONS
If I am already paying a very low premium, should I take any action?
Probably. Many customers are already enrolled in plans that cost nearly $0 per month.
But, with the Covered CT Program, they may be eligible for a plan with
no premium (monthly payment) and no out-of-pocket expenses (what you pay for a
covered healthcare service).
Am I eligible if my income isn't the same every month?
Yes. The Covered CT Program income requirements are based on annual income, so you
will need to estimate what your total annual household income will be for the year. If you
experience a significant change in household income after you enroll, you must report it
to Access Health CT immediately.
What types of health care or services will be covered through this program?
•
All health care and services must be medically necessary and covered by the health
insurance plan to be paid by the State of Connecticut.
•
Please visit the Department of Social Services website for more information about Dental
and Non-Emergency Medical Transportation benefits.
Will eligible customers really have $0 premium and $0 cost-sharing plans through the
Covered CT Program?
Yes! The State of Connecticut will pay the customer portion of the premium (monthly payment)
and all out-of-pocket expenses (what you pay for a covered healthcare service) that customers
were previously responsible for paying under their health insurance plan through Access Health
CT. There will also be dental benefits and Non-Emergency Medical Transportation benefits
included at no additional cost.
I am comparing plans and the plans do not show $0 premium and $0 cost sharing. Why is
this?
When shopping for a plan, please be sure to:
1.
Complete your application
2.
Make sure you are eligible for the "Covered Connecticut Program" on the Eligibility
Determination screen
3.
Select a Silver Plan
4.
Select 100% of the Advance Premium Tax Credits (APTCs).
After completing these steps, you will see the premium of the Silver Plan update to $0 on your
plan purchase summary.
Please note, you will also see an alert at the top of your screen during Silver Plan and
APTC selection informing you of your potential eligibility for the Covered CT Program, even
though you have already confirmed your eligibility for the Program on the Eligibility
Determination screen; please disregard this message and continue Silver Plan and
APTC selection to complete enrollment into the Covered CT Program.
Is this financial help available only through Access Health CT?
Yes. This is the reason we encourage everyone to take a look at plans available through Access
Health CT, even if you already have other health insurance coverage.
How do I estimate my household income?
Please include all estimated income and disclose any unemployment benefits.
Should I contact a broker or my broker?
If you want advice about whether to change plans or for selecting a plan if you are new to
Access Health CT, you should speak to your broker to review your options and your needs. If
you do not have a broker you can find one here.
If eligible customers do not elect to use all Advanced Premium Tax Credits (APTCs)
available to them, will they still benefit from the Covered CT Program?
No. Customers who want to participate in the Covered CT Program must elect to use all APTCs
available to them. Depending on the customer’s current application status and preferences, they
may not have elected to use all APTCs available to them. Access Health CT will communicate
with customers who have not updated their accounts but may benefit from the Covered CT
Program.
Do I need to verify any of my household information after I enroll?
Maybe. Access Health CT attempts to verify all reported information with third-party sources. If
we are unable to verify some of your information, we will contact you to request verification of
such information. You should always make sure you have accurately listed your annual
household income and that you provide verification documentation, if requested, to make sure
you receive the correct amount of financial assistance throughout the year. Always remember to
make updates to your household income and other information right away if there are any
changes during the year.
Are American Indians and Alaska Natives eligible for the Covered CT Program?
Yes.
When can Covered CT Program participants expect new identification card(s)?
You will get two identification cards after enrolling in the Covered CT Program.
You can expect a new identification card from your insurance company about one week after
enrollment. Contact your insurance company if you need a temporary card before you receive
the new insurance card. If you are charged for any cost-sharing while seeking medical care or
services, or visiting a pharmacy, you can contact your insurance company to submit a
reimbursement request.
In addition, the Connecticut Department of Social Services will send an identification card to
Covered CT Program participants for their Dental and NEMT benefits approximately two weeks
after enrollment.
What if I enroll in the Covered CT Program but I already paid my premium (monthly
payment) to my insurance company for the next month?
Your insurance company will reimburse you.
Can I be reimbursed for premium (monthly payment) or cost-sharing amounts
(deductibles, co-pays, co-insurance and maximum out-of-pocket costs) I incurred before
I was enrolled in the Covered CT Program?
No. You are still responsible for any balances due for premiums, care or services received
before you enroll in the Covered CT Program.
What else should I keep in mind?
Application details like household size and estimated income will impact the financial help you
may be eligible for through Access Health CT. It is important to report any changes as soon as
possible.
Remember that updates to your application could result in changes to
the type of coverage you may select.
How do I use dental benefits after I enroll?
Please visit the Department of Social Services website for more information about dental benefits,
including details on benefits and how to find a provider.
How do I access Non-Emergency Medical Transportation after I enroll?
Please visit the Department of Social Services website for more information about Non-
Emergency Medical Transportation (NEMT) benefits. | Who is mentioned in the document? | Covered CT Program
Written by Yessenia Milan | Last published at: January 08, 2025
Covered CT
Some Connecticut residents that meet specific eligibility requirements are paying $0 for their
health |
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