As enrollment falls, Charter Oak health plan premiums rise

Because she’s self-employed, Donna Faulknor spent years buying her own health insurance. She figures she’s paid more for coverage than her mortgage. But when the premiums hit four figures for a plan with a $10,000 deductible, she and her husband joined the ranks of Connecticut’s uninsured.

Eventually, they turned to the state’s Charter Oak Health Plan, which offered coverage for $307 a month. She dropped the plan when the monthly cost rose to $446 last fall, but a health scare convinced her it was worth struggling to pay for the program.

Now the state is again raising the monthly cost of Charter Oak, this time to $589 as of Jan. 1 — a 32 percent hike. And that’s left Faulknor in a familiar position.

“I’m not going to be able to pay that, so I’ll be uninsured again,” she said.

charter oak chart

Faulknor, who is 60 and owns a store in Clinton, is one of 5,947 members left in Charter Oak, a program that once enrolled more than 14,500. Gov. M. Jodi Rell began it in 2008 as a way to help the uninsured, offering coverage to people regardless of medical history.

Those below certain income levels got state assistance with their premiums. But in 2010, state lawmakers eliminated the subsidies for new members, and, last year, required the plan’s premiums to reflect the cost of medical claims.

The state Department of Social Services says the upcoming premium increase reflects higher claims costs, as well as the inability to use state funds to offset them.

Critics of Charter Oak have said that the program’s experience reflects the pitfalls of a poor insurance plan design. When premiums rose, those who had other coverage options, or who were healthy enough to go without insurance, dropped out. That left older and sicker members in the risk pool, further raising costs.

Currently, the vast majority of those still in Charter Oak — just under 75 percent — are aged 51 to 64.

Premiums will also rise for the 35 percent of Charter Oak members who still receive state subsidies for their premium costs. They currently pay, depending on income, $215 to $369, and will face new rates of $284 to $487.

A HUSKY increase, too

Separately, premiums are also rising for a portion of the state’s HUSKY B program, which covers children whose families earn more than 300 percent of the poverty level. That portion of the program is not subsidized by the state, and enrolls 1,298 children. Their premiums will rise from $270 to $314, a 16 percent increase.

When Rell introduced Charter Oak, critics panned the program for offering limited benefits. But Faulknor says she’s grateful for it.

She and her husband paid for their own private insurance until it got too costly, around the same time the economy slumped. During the year or so they were uninsured, her husband developed symptoms of what turned out to be heart failure. They went to the emergency room at midnight the day his Charter Oak coverage took effect.

“The program was actually very good,” Faulknor said. It paid the majority of her husband’s medical bills.

He’s now old enough to be in Medicare.

Donna Faulknor joined Charter Oak later than her husband so she could get routine preventive care, like mammograms. She had her first colonoscopy this week, which found three polyps. She thinks they’ll turn out to be fine, but wonders what will happen if the biopsies show a problem and she has to drop her health coverage.

“I don’t know what I’ll end up doing at that point. I’ll have to take it as it comes,” she said. “There’s no way I could sustain [almost] $600 a month, especially if I was sick, because then I wouldn’t be working.”

It’s frustrating being in the middle, between the very poor and the well-off, she said. She and her husband are college educated and have always worked, but not at jobs that paid lots of money.

“It seems as if what happens is if you’re very poor, you end up with Medicaid; and if you’re wealthy, and if you have a good company you’re working for, they provide health-care insurance,” she said.

Those who fall in the middle, working part-time or self-employed like she is, are left with few, if any, options. She wishes she could buy into Medicare until she’s old enough to qualify.

“Everybody has stories like that,” she said. “People come in and they tell me stories that are a lot worse than mine.”