Access Health CT’s 2015 plans: See what’s changing

The plans sold through Access Health CT, the state’s health insurance exchange, are changing next year. Here’s an early look at the changes and new options, which are expected to go on sale Nov. 15. They will replace the plans the exchange currently sells.

These templates show the standard benefit designs that each insurer selling plans on the exchange must follow in 2015. The differences from the 2014 plans are highlighted in yellow.

Insurance companies will also be allowed to sell additional plans with different designs, but those aren’t available yet.

Standard bronze plan 1

There will be two standard bronze plans in 2015. This one is closest to the standard bronze plan offered this year.

What’s different from 2014

• This plan has a higher deductible than the 2014 standard bronze plan — $5,000 for an individual and $10,000 for a family. (The 2014 plan’s deductibles are $3,200 for individuals and $6,500 for families.)

• The out-of-pocket maximum cost a member can face for out-of-pocket costs is also higher — $6,600 for an individual and $13,200 for a family.

Two other changes were made to ensure that people could get some basic care at lower costs.

• In 2015, members will be allowed three primary care office visits and three mental health office visits without the deductible applying. People would pay a $40 copayment for each visit. After using up those visits, they would have to pay the full price for future visits until hitting their deductible.

• Members would also be able to get generic drugs for a $5 copay, regardless of whether they have reached the deductible or not. In the 2014 plan, they must pay the full price until hitting the deductible.

Effect on premiums

Actuaries consulting for the exchange projected that the changes to this plan design will result in a 2.9 percent decrease in premiums compared to the 2014 plan. That doesn’t mean that the actual premiums will drop, however, because the calculations didn’t take into account other factors that increase insurance costs, such as rising health care prices. But it means that, if the actuaries are correct, the design changes could hold down any potential increase or lead to a decrease in price.

The items highlighted are changes from the 2014 plan. For details, click on the highlighted areas.

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Standard bronze HSA

People who buy this plan can use it with a health savings account. Members can put tax-free dollars into the account and use the money to pay for medical care.

What’s different from 2014

This is a different plan from the current bronze standard plan.

• It has a higher deductible than the current standard bronze plan: $4,600 for an individual and $9,200 for a family.

• It also has a higher limit on out-of-pocket costs members could face: $6,450 for individuals and $12,900 for families.

One key difference between this plan and the other standard bronze plan for 2015 is that all services are subject to the deductible, meaning that the plan won’t start paying for people’s coverage until they spend at least $4,600 on care (or, for a family plan, $9,200). Preventive services are an exception: Those are covered at no charge to the member.

Another difference applies to family plans. In the exchange’s other plans, one person within a family who has a lot of medical costs would only have to meet the individual deductible level before the plan begins contributing to that person’s cost of care. In this plan, the insurance company won’t pay for any coverage until the family deductible ($9,200) is met.

Effect on premiums

Actuaries consulting for the exchange have projected that this plan design will result in a 3 percent decrease in premiums. That doesn’t mean that the actual premiums will drop, because it doesn’t take into account other factors that increase insurance costs, such as rising health care prices or insurers’ projections that members will need more medical care.

For details on the highlighted items, click on the yellow areas.
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Standard silver plan

What’s different from 2014

• This plan has a lower deductible for medical services than the 2014 standard silver plan. In 2015, the deductibles will be $2,600 for individuals and $5,200 for families. That’s down from $3,000 for individuals and $6,000 for families in 2014.

• The plan has a separate deductible for prescription drugs, but it’s getting significantly lower in 2015. In 2014, the drug deductible is $400 for individuals and $800 for families. In 2015, it will be $25 for individuals and $50 for families.

• The maximum out-of-pocket expenses members can face will rise from $6,250 to $6,600 for individuals, and from $12,500 to $13,200 for families.

• The copay for specialist visits is rising from $45 to $50.

• People who go to urgent care centers will also have to pay the full cost until they fulfill their deductible for the year. In 2014, that services is not subject to the deductible.

Effect on premiums

Actuaries consulting for the exchange have projected that this plan design will result in a 2.7 percent increase in premiums. That doesn’t mean that the actual premiums will rise by that amount, because it doesn’t take into account other factors that increase insurance costs, such as rising health care prices or insurers’ projections that members will need more medical care.

The highlighted items are changes from the 2014 plan. For details, click on the yellow areas.

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Standard gold plan

What’s different from 2014

• In 2015, this plan will no longer have a deductible for prescription drugs. In 2014, individuals had a drug deductible of $150 and families had drug deductibles of $300.

• The copay for laboratory services and services including physical, speech and occupational therapy is rising from $20 to $30.

Effect on premiums

Actuaries consulting for the exchange have projected that this plan design will result in a 0.7 percent increase in premiums. That doesn’t mean that the actual premiums will rise by that much, because it doesn’t take into account other factors that increase insurance costs, such as rising health care prices or insurers’ projections that members will need more medical care.

The highlighted items are changes from the 2014 plan. For details, click on the yellow areas.

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Standard platinum plan

None of the insurance companies selling plans through the exchange offered a platinum plan in 2014. Exchange officials decided to leave the standard platinum plan design unchanged for 2015. ConnectiCare Benefits will offer a platinum plan option in 2015.

What’s different from 2014

Nothing
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