Connecticut has some of the best health care options for residents in the nation. According to a study by US News, the state has the fourth best health care in the country. That study is based on access, quality, and good public health.
Health insurance options in Connecticut
According to the Connecticut Insurance Department, there are several ways for residents to access health care.
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid (HUSKY Health)
Where do most Connecticut residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 54% | ||
| Individual or family | 5% | ||
| Medicaid | 21% | ||
| Medicare | 14% | ||
| Military | 1% | ||
| Uninsured | 5% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Five percent of CT residents are uninsured, significantly less than the national average. That’s great news for policyholders! Why? More uninsured people leads to higher costs for insured people.
Connecticut health insurance costs and rate factors
CT residents spend an average of $9,859 per year on health care, more than the national average. What determines your health care costs in your state? Rates vary person to person, but are primarily based on these factors:
Health insurance plan type
If you want more health coverage, you’re going to have higher rates. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
So, how much should you expect to pay in CT? These are the average monthly costs for a middle-aged state resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $340 | $547 | $533 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Gold plans in CT costs about 57 percent more than a bronze plan. That price increase is because gold plans cover 80 percent of medical costs, whereas bronze plans only cover 60 percent of medical costs. Interestingly, an average gold plan is slightly cheaper than a silver plan. Silver plan premiums increased sharply from $448 in 2019 to $547 in 2020, while gold plans dropped from $574 in 2019 to $533 in 2020.
You may also qualify for a catastrophic plan, the lowest level of coverage available in the marketplace. These plans are available to people who have financial exemptions or are under the age of 30. They come with low monthly premiums but a yearly deductible of $8,150.
A catastrophic plan essentially exists to prevent you from going bankrupt after a medical emergency. Purchasing a bronze or silver plan may save you money if you need to use your health insurance.
Body mass index
According to the CDC, a high body mass can lead to several serious health conditions. That’s why health insurance companies analyze your BMI to determine your risk-level. A high BMI leads to higher monthly premiums.
In 2018, CT had a 27.4 percent obesity rate, the seventh lowest rate in the country. Out of the many state residents who used QuoteWizard to compare health insurance plans, 32 percent have a BMI in the obese range.
Tobacco use
It’s no surprise that smokers pay more for health insurance due to the numerous health conditions tobacco causes. About 12.7 percent of CT residents are smokers, the third lowest rate in the country.
Age
According to HealthCare.gov, a plan for an older person costs up to three times more than a younger person. CT residents who used QuoteWizard to shop for health insurance are, on average, 42 years old.
Location
Your zip code plays a major role in your monthly premiums. That’s because every state has different rules, regulations, and providers regarding insurance.
Also, health insurance companies use a community-rating system to determine your prices. Rates depend in part on the combined claims everyone files. That means if your state files a high number of claims, your prices could jump.
That’s why living in a health-conscious state could lead to lower health insurance rates. According to America’s Health Rankings, CT is the fifth healthiest state in America!
Connecticut health insurance companies
CT has an expanded health care marketplace, which include these health care companies:
- Anthem
- ConnectiCare
These companies offer both individual and family plans in your state. The policy you qualify for may depend on the county you live in. Use Access Health CT to find out how coverage varies and apply for health plans.
Connecticut health care insurance laws
The Affordable Care Act mandates what insurers can consider while pricing your policy.
- Pre-existing conditions: The ACA doesn’t allow insurers to use a pre-existing condition as a reason to charge you more.
- Gender: The ACA limits providers from charging women and men different prices for the same plan. That’s good news, especially because a study determined that women historically pay more for health care.
- Insurance and medical history: Insurance companies used to analyze your medical history and previous insurance. Any lapses in these categories led to skyrocketing prices- if you could even get coverage to begin with.
There’s a limit to how much you pay out-of-pocket for a marketplace plan. In 2020, the yearly out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
As a CT resident and Access Health CT member, health insurance companies are required to offer coverage for the following services:
- Emergency room visits
- Lab tests
- Inpatient care
- Preventative care
- Prescription drugs
- Care before and after birth
- Mental health and substance abuse treatment
There are additional services insurance companies need to provide. Find the full list of essential health benefits on Access Health CT.
Medicare and Medicaid in Connecticut
Medicare and Medicaid are both government-funded health care programs. They offer affordable coverage to people in need. Medicare aids seniors, whereas Medicaid helps low-income families and children.
Medicare
CT residents 65 and over qualify for Medicare. There are several options within the program including parts A, B, C, D, and supplemental coverage plans. You may also qualify for one of these Medicare Savings Programs:
| Program | Single | Couple |
|---|---|---|
| QMB | $2,243.63 | $3,031.35 |
| SLMB | $2,456.29 | $3,318.68 |
| ALMB | $2,615.79 | $3,534.18 |
Medicaid
Connecticut is a state with an expanded Medicaid program called HUSKY. These are the state’s Medicaid financial requirements:
| Household size | Region A (Southwestern CT) | Region B and C (Northern, Eastern, Western CT) |
|---|---|---|
| Single person | $633.49 | $523.38 |
| Married couple | $805.09 | $696.41 |
Connecticut Insurance Department
- Website:
- Homepage
- Insurance Commissioner:
- Katharine L. Wade
- Insurance Hotline:
- (800) 203 – 3447
- Office Hours:
- Monday - Friday
8:00 am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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