What is Health Insurance?

Health insurance is a complex part of the healthcare system in the United States. But until significant, fundamental reform is adopted, health insurance will remain necessary. In order to get the most out your insurance, you need to: 

    • Know your healthcare needs – What services do you use most?
    • Understand plan types – Each works differently
    • Learn key terms – Deductible, copay, coinsurance
    • Set a realistic budget – For example, how much can you afford monthly?
    • Know your rights – What you're entitled to under your plan

    Important: No plan covers everything. Even services required to be "free" under the Affordable Care Act may have different rules depending on your specific plan.

    It is very important that you receive a copy of your Summary Plan Description/Certificate of Coverage from the insurer. That document, however lengthy, is the contract that specifies all of the terms of your coverage, as well as the responsibilities of all parties, including you and the insurer.

Types of Health Insurance

Private Health Insurance

Private health insurance includes plans offered by employers and individual plans purchased directly from insurance companies. These plans can be fully insured (regulated by state law) or self-funded (regulated by federal ERISA law). Common types include HMOs, PPOs, POS plans, and High Deductible Health Plans with optional Health Savings Accounts.

Best for: Most working adults and their families who have access through employers or need individual coverage.

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Medicare

Medicare is a federal health insurance program primarily for people 65 and older, though some younger people with disabilities or end-stage renal disease may also qualify. Medicare has different parts that cover hospital services (Part A), medical services (Part B), prescription drugs (Part D), and Medicare Advantage plans (Part C) that combine multiple parts.

Best for: Adults 65+ and certain younger people with qualifying disabilities or conditions.

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Medicaid/HUSKY

HUSKY is Connecticut's Medicaid program that provides comprehensive health coverage for individuals and families with limited income. It's funded through a combination of state and federal money and offers extensive benefits including medical, dental, and behavioral health services.

Best for: Low-income individuals and families, pregnant women, children, and people with disabilities who meet income requirements.

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COBRA

COBRA allows you to continue your employer's group health plan temporarily after losing job-based coverage. You pay the full premium (your portion plus what your employer was paying) plus a 2% administrative fee. Coverage typically lasts 18 months but may extend longer in certain circumstances.

Best for: People who recently lost employer coverage and want to maintain the same benefits and providers before transitioning to new insurance.

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TRICARE - Active Duty Military & Family

TRICARE is the health care program for uniformed service members, retirees, and their families. It offers several plan options including TRICARE Prime (HMO-style), TRICARE Select (PPO-style), TRICARE For Life (Medicare supplement), and specialized programs for National Guard, Reserve members, and young adults.

Best for: Active duty military personnel, military retirees, National Guard and Reserve members, and their eligible family members.

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Indemnity Insurance

Indemnity insurance is traditional fee-for-service coverage that allows you to use any doctor, hospital, or provider. You pay the provider directly and then file claims for reimbursement. These plans offer maximum flexibility but typically have higher out-of-pocket costs and are rare in today's market.

Best for: People who want complete freedom to choose any healthcare provider and are willing to pay higher costs for that flexibility.

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Limited Benefit Plans

Limited benefit plans cover only certain health services or cap the amount they'll pay for benefits. They have lower premiums but provide significantly less comprehensive coverage than traditional health insurance. These plans may not meet minimum essential coverage requirements under the Affordable Care Act. Some of these plans, such as Health Care Sharing Ministries, are not even technically insurance products and come with substantial risk that your claims may not be paid.

Best for: Temporary or supplemental coverage only - not recommended as primary health insurance due to significant coverage limitations.

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The Health Insurance Marketplace

Pursuant to the Affordable Care Act, Connecticut established Access Health CT (AHCT), the official health insurance marketplace for the state. Individuals and businesses can use AHCT to enroll in coverage during open enrollment or during special enrollment periods, if applicable.

Financial assistance available: Only plans sold through AHCT qualify for subsidized support through Advance Premium Tax Credits. If your household income is below 400% of the Federal Poverty Level, you may be eligible for this assistance, which can significantly reduce your monthly premium costs.

The Office of the Healthcare Advocate (OHA) can provide support with eligibility and enrollment issues related to AHCT coverage.

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