Finding health insurance can be tough — but it doesn’t have to be. We’ll take a look at how health insurance works and where you can find coverage in Connecticut.
Get Health Insurance in Connecticut
Tip: compare 2-3 companies
The Best Health Insurance in CT:
- Best Overall in CT: Anthem
- Most Affordable in CT: UnitedHealthcare
- Best for Telemedicine: ConnectiCare
- Best for Preventive Care: HealthyCT
- Best for Dental & Vision: Humana
What is Health Insurance?
Health insurance is a type of coverage that pays for a portion of your medical bills. Most people in the United States get their health insurance through their employers. However, if you’re unemployed, self-employed or ineligible for coverage through your job, you can buy an independent plan through the Affordable Care Act (ACA) Marketplace. You can shop health insurance plans by creating an account at Healthcare.gov.
Health insurance protects you from medical bankruptcy. If you don’t have health insurance, you could be liable for tens of thousands of dollars if you’re involved in an accident. Maintaining some kind of health insurance will alleviate your financial responsibility if you’re hospitalized.
When you shop for health insurance, you’ll notice a few different dollar amounts and prices listed on each plan. Let’s go over a few of the most common terms you’ll see when you shop.
- Premium: Your premium is a monthly payment you make to your health insurance company to keep your coverage current. Your premium is due every month, even if you don’t use your insurance in a given month.
- Deductible: Your deductible is the amount of money you need to pay toward your own medical care costs before your insurance starts to pay. For example, if you have a plan with a $1,000 deductible, it means that you need to pay $1,000 toward your own medical care before your insurance “kicks in” and starts paying. Your premium doesn’t count towards your deductible.
- Coinsurance: Once you meet your deductible, you’ll only pay your coinsurance percentage toward your medical care. Each insurance plan has a different coinsurance rate. For example, if you have a plan with a 20% coinsurance rate and you receive a doctor’s bill for $100, you’ll pay $20 toward your bill. Your insurance provider will cover the remaining $80.
- Out-of-pocket maximum: Your out-of-pocket maximum is the most money you will spend in a year toward your medical care. Once you hit your maximum, your insurance covers 100% of your medical care costs.
Average Cost of Health Insurance in Connecticut
The average resident of Connecticut pays about $452 per month for an individual ACA-approved plan. If you earn less money or you cannot afford your monthly premium, you might qualify for a subsidy through the ACA Marketplace. To learn whether you qualify, visit Healthcare.gov and create a profile. From there, you’ll learn more about specific plans available to you and any financial assistance you qualify for.
Types of Health Coverage
There are multiple types of health insurance plans. The differences between these plan types usually deal with which providers you can see on your plan. Let’s take a look at some of the most common plan structure types you’ll see when you shop for health insurance in CT.
- Health maintenance organization (HMO): When you enroll in an HMO plan, your plan provider will give you a list of in-network care providers and primary care physicians. You need to choose a primary care provider and you must stay within your plan’s network. If you go outside of your network, your insurance may not cover your care. HMO plans also require you to get a referral before you can see a specialist. Though they offer the most limited use of your plan benefits, HMO plans are typically the most affordable health insurance option.
- Preferred provider organization (PPO): PPO plans give you more freedom to use your insurance in exchange for a higher monthly cost. PPO plans allow you to see both in-network and out-of-network care providers — though you can usually save money by choosing an in-network provider. You also don’t need a referral to see a specialist. If you have a doctor who you want to continue seeing who isn’t in a network offering plans in your area, you might be willing to splurge for a PPO plan.
- Point-of-service (POS) plans. POS plans were created to balance costs and plan usage. With a POS plan, you can see any provider you like. However, you must get a referral before you can see a specialist. POS plans are typically more expensive than HMO plans but less expensive than PPO plans.
What Does Health Insurance Cover?
Before the introduction of the ACA, individual health insurance providers could pick and choose which services and treatments they covered. Now, every ACA-approved insurance plan must offer at least these 11 essential benefits:
- Ambulatory patient services: This includes care that you receive without being admitted to an emergency room or hospital.
- Emergency services: This includes care that you receive in an emergency room or ambulance. Your insurance provider must cover care at any emergency room, regardless of whether the emergency room is in-network or not.
- Hospitalization: This includes planned stays in an inpatient medical setting — for example, after and during a surgical procedure.
- Pregnancy, maternity and newborn care: Your insurance provider must cover all pregnancy-related services you need before, during and after you give birth. This coverage extends to breastfeeding support.
- Prescription drugs: Your insurance provider must offer some form of coverage for all major classes of prescription drugs. However, your insurance doesn’t need to cover every drug in each class. If you already take a certain drug, you can search for plans that cover it on Healthcare.gov.
- Mental health and substance abuse treatment: This includes inpatient and outpatient psychotherapy, counseling and behavioral health treatment.
- Rehabilitative and habilitative services: This includes treatment to help regain mobility after an accident (like physical and occupational therapy) and devices to assist mobility (like crutches or a wheelchair).
- Laboratory services: This includes diagnostic tests like lipid panels, X-rays and upper GI scans.
- Preventive and wellness services: This includes preventive screenings and services like your annual physical and STD tests.
- Pediatric services: Plans must provide all essential benefits to children enrolled on your plan. Your insurance provider must also include coverage for dental and vision services for children.
- Birth control: Your insurance provider must also include coverage for birth control if you’re a female. This coverage extends to both physical methods (like the diaphragm) and hormonal methods (like birth control pills). Your insurance must also cover emergency contraceptives like ella and Plan B.
Keep in mind that these essential benefits only apply to long-term ACA-approved plans. Short term health insurance plans and catastrophic plans may not include coverage for all of these services.
What Does Health Insurance not Cover?
There are a few treatments and services that no health insurance plan will cover. Some common exclusions you’ll see include:
- Dental and vision coverage for adults: The ACA only dictates that children on your plan receive dental and vision coverage. If you want benefits for adults on your plan, you’ll typically need to buy a separate plan with its own terms, inclusions and deductible.
- Cosmetic surgery: Even the best health insurance won’t cover surgery deemed non-medically necessary.
- Experimental treatments: The ACA only requires insurance providers to cover FDA-approved treatments and therapies. If you have a rare condition and your insurance provider says that a treatment is experimental, you may be able to petition to extend your coverage.
- Weight-loss surgery: There is no federal mandate that requires insurance providers to cover bariatric surgery. However, some individual health insurance providers choose to cover this treatment.
- Male methods of birth control: The ACA’s birth control requirement only extends to females. This means that you’ll typically need to cover male methods of birth control (like condoms and vasectomies) out of pocket.
- Travel vaccinations: The ACA requires that insurance providers cover “routine and necessary” vaccines only. If you need a non-standard vaccine for a trip abroad (like yellow fever or typhoid vaccines) you’ll almost always need to pay for it yourself.
Best Health Insurance Providers in CT
You’ll see multiple plan providers and plan options when you shop for a Marketplace plan. Let’s take a look at some of the health insurance companies that offer ACA-approved plans in Connecticut.
1. Anthem Health Plans
Anthem Health Plans is an individual and family health insurance provider that offers ACA-approved plans in Connecticut. You can quickly view your Anthem plan options online through the ACA Marketplace and the health insurance provider also offers a number of tiers to help you balance costs and coverage.
In addition to individual and family health insurance plans, Anthem also offers dental, term life and vision insurance plans. If you need an add-on dental or vision plan, you can quickly get all of the coverage you need though Anthem.
UnitedHealthcare is one of the largest health insurance providers in the United States. It offers everything from ACA-approved plans to Medicare supplemental plans. UnitedHealthcare even offers special discounted plans for self-employed individuals, which can make health care more affordable for freelancers and those just getting started with a new business.
UnitedHealthcare offers a comprehensive set of plan tiers, giving you more options to customize your coverage. Like Anthem, it’s also incredibly easy to add on dental and vision insurance to your plan when you shop.
ConnectiCare is a local, Connecticut-based health insurance provider that offers affordable family and individual plans with a few rare benefits. Unlike most insurance providers, ConnectiCare plans include coverage for vision exams for adults on your plan. Some plans even include coverage for dental services and visits.
ConnectiCare plans also include $0 deductibles for preventive services, ranging from vaccinations to annual checkups. Its unique telemedicine services also make it easier to find doctors and service providers within your network.
Another Connecticut-based insurance provider, HealthyCT offers a wide range of plans for individuals, families and employers. Its plans include PPO coverage at multiple tiers and plans are available with deductibles as low as $1,000 for individuals.
You’ll find over 12 coverage tiers in most parts of Connecticut, which makes it easier to find a plan you can afford. All HealthyCT plans also include 100% coverage for preventive care, like routine checkups and bloodwork.
Unfortunately, Humana doesn’t currently offer ACA-approved health insurance plans in Connecticut. However, if you want to add on affordable dental and vision coverage, Humana offers some of the most affordable options in CT. Dental plans are available from just $19 a month in most parts of the state and you can add a vision plan for just $16 more.
Humana’s dental insurance options have low deductibles (starting at just $50 for individuals) and its vision insurance includes a generous $150 allowance for frames or contacts. Consider extending your protection with Humana after you find the health insurance that’s right for you.
Get Health Insurance Now
Now is the time to get the health insurance you need to protect yourself in the event of an emergency. But figuring out how to get health insurance can be difficult — let alone choosing a plan option. Start by creating a profile at Healthcare.gov. Healthcare.gov is the official federal website for the health insurance Marketplace and contains plenty of information on plan choices, tiers and coverage. Just enter your email address, answer a few questions about your income and personal information and compare plan options.