Here’s a look at the standard plans sold through Access Health CT, the state’s health insurance exchange, for 2015.
A few things to note:
These are the templates for standard plans, meaning that they’ll be offered by each insurer (with the exception of the platinum plan, which only one insurer is selling). The carriers will also sell additionals plans with unique designs.
To see how the 2015 standard plans differ from those being sold in 2014, click here.
Most plans have a deductible, meaning that members have to pay a certain amount of money for their care before the insurance company begins chipping in. It’s important to pay attention to what services are subject to the deductible. In some plans, the deductible only applies for certain services, like hospitalization, and the insurance company will pay for other services from the start. In other plans, people will have to pay out of pocket for nearly all services until they fulfill the deductible.
Another number to pay attention to: the out-of-pocket maximum. That’s the maximum amount members have to pay for medical care under the plan. Premiums don’t count toward that figure.
Finally, it’s important to know the difference between a copay and co-insurance. A copay is a fixed dollar amount, like $30, that you pay when you get medical care. It doesn’t change regardless of how much the service costs. Co-insurance means you have to pay a certain percentage of the cost of care, like 10 percent or 40 percent.
Standard bronze HSA (health savings account)
Deductible: $4,600 for an individual, $9,200 for a family (for in-network services)
Out-of-pocket maximum: $6,450 for an individual, $12,900 for a family (for in-network services)
Nearly all services are subject to the deductible.
Standard bronze
Deductible: $5,000 for an individual, $10,000 for a family (for in-network services)
Out-of-pocket maximum: $6,600 for an individual, $13,200 for a family
Nearly all services are subject to the deductible, but people can receive up to three mental health and three medical visits before the deductible applies.
Standard silver
Deductible: $2,600 for an individual, $5,200 for a family (for in-network services).
There is a separate deductible for prescription drugs: $25 for an individual, $50 for a family (for in-network)
Out-of-pocket maximum: $6,600 for an individual, $13,200 for a family
Most medical services are not subject to the deductible. Instead, members have copays in most cases. Hospital services are subject to the deductible.
Standard gold
Deductible: $1,000 for an individual, $2,000 for a family (for in-network services)
Out-of-pocket maximum: $3,000 for an individual, $6,000 for a family
Most medical services are not subject to the deductible. Instead, members have copays in most cases. Hospital services are subject to the deductible.
Standard platinum
Deductible: This plan has no deductible for in-network services
Out-of-pocket maximum: $2,000 for an individual, $4,000 for a family
ConnectiCare Benefits is the only insurance company offering a standard platinum plan in 2015.