What is Health Insurance?

Health insurance is a complex part of the healthcare system in the United States. 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 - 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 Subscriber Agreement 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

What plan is right for me?

Select the option that best describes your situation

Employer-Sponsored Insurance is often your most affordable option because employers typically pay part of the premium costs.

What to know:

  • Plans vary widely in design, network, and costs
  • You can choose during annual open enrollment (usually once per year)
  • New employees may have a waiting period (30-90 days) before eligibility
  • Can cover spouse and children (kids can stay on until age 26)
  • Special enrollment window when you first become eligible

Best for: People with access to employer benefits who want affordable, comprehensive coverage.

Learn more

HUSKY Health (Connecticut Medicaid) provides comprehensive coverage with little to no cost.

HUSKY A - Children, parents/caregivers, and pregnant women

  • Children (up to 19): Family income up to 196% of Federal Poverty Level
  • Pregnant women: Income up to 258% FPL
  • Parents/caregivers: Income up to 155% FPL

HUSKY B - Children in higher-income families

  • May have monthly premiums and cost-sharing based on income

HUSKY D - Adults without dependent children

  • Income up to 138% of Federal Poverty Level

What's covered: Doctor visits, hospital care, prescriptions, mental health, dental, vision, and more—usually with no monthly premiums and minimal copays

Special benefits:

  • Can cover you retroactively up to 90 days from application date
  • May pay outstanding medical bills from before you applied
  • Eligibility based on current monthly income (including unemployment benefits)

Best for: Low to moderate-income individuals and families who qualify, especially those recently unemployed with reduced income

Learn more

Medicare provides health insurance for seniors and people with certain disabilities.
 
Original Medicare:
  • Part A (Hospital): Inpatient care, skilled nursing—most pay no premium
  • Part B (Medical): Doctor visits, outpatient care
  • Part D: Prescription drug coverage (optional, through private plans)
  • Medigap: Supplemental insurance to help with deductibles and coinsurance
Medicare Advantage (Part C):
  • Private plans combining Parts A & B
  • Often includes prescription coverage
  • May offer extra benefits like dental, vision, hearing
  • Network restrictions apply

Learn about Medicare

HUSKY C - For seniors and people with disabilities who also qualify for Medicaid

  • Income limit: about $835/month for individuals

  • Asset limit: $1,600 for individuals

  • Includes long-term care services

Special enrollment periods:

  • 8 months to enroll in Parts A & B after losing employer coverage

  • 63 days for Part D or Medicare Advantage

  • 63 days for guaranteed Medigap enrollment after employer coverage ends

  • Penalties may apply if you miss these windows

You qualify if you're:

  • 65 or older, OR

  • Under 65 with disabilities (after 24 months of Social Security Disability), OR

  • Have End-Stage Renal Disease or ALS

Learn about HUSKY

Access Health CT Marketplace offers plans for individuals and families without employer coverage.

What you get:

  • Multiple plan options from private insurers
  • All plans cover essential health benefits
  • Four metal categories: Bronze, Silver, Gold, Platinum
  • No denial for pre-existing conditions

Financial help available:

  • Premium Tax Credits: Reduce monthly costs for incomes 100-400% of Federal Poverty Level
  • Cost-Sharing Reductions: Lower deductibles and copays for incomes below 250% FPL
  • Based on projected annual income

When to enroll:

  • Open Enrollment: November 1 - January 15 annually
  • Special Enrollment: 60 days after life events like losing coverage, marriage, having a baby, or moving
  • Coverage begins first day of the month after you enroll

Best for: Self-employed individuals, people between jobs, or those whose employers don't offer insurance

Learn more

You have several options when you lose employer coverage, each with specific timing requirements:

COBRA Continuation Coverage

  • Keep your exact same employer plan temporarily

  • Usually 18 months (up to 36 months in some cases)

  • More expensive but provides continuity of care

Learn more about COBRA coverage

Join Family Member's Plan

  • Enroll in spouse/partner's or parent's employer plan (if under 26)

  • Must act within 30 days of losing coverage

  • Coverage typically starts the next month

Access Health CT Marketplace

  • 60-day special enrollment period after losing coverage

  • May qualify for financial assistance based on income

  • Coverage begins first day of month after enrollment

HUSKY Health (if income qualifies)

  • Based on current monthly income (including unemployment benefits)

  • Can apply any time during the year

  • May cover retroactively up to 90 days and pay outstanding bills

Medicare (if 65+)

  • Special enrollment periods: 8 months for Parts A & B, 63 days for Part D
  • Penalties apply if you miss enrollment windows

Learn more

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.

Learn more

Coordination of benefits

Coordination of Benefits (COB) is a provision in most health plans that allows families with two wage earners covered by health benefit plans to receive up to 100% coverage for medical services. COB rules determine which plan is primary for you, your spouse, and your dependent children.

How Coordination of Benefits Works

When you have coverage under two health insurance plans, the coordination processfollows these steps:

Primary Plan Pays First: The primary plan pays your claims as if there were no other insurance. 

Secondary Plan Fills Gaps: Your secondary plan then pays for what your primary plan did not cover, provided it's a covered benefit under the secondary plan.

Learn how coordination of benefits works

Get information for employers

The Office of the Healthcare Advocate offers  resources and assistance to help employers  navigate health insurance options and address employee benefit concerns
Learn more 

Learn About Dual Coverage

Having dual health insurance coverage means  you're covered under two health insurance plans  simultaneously.
Learn more 

Learn About the Birthday Rule

For children covered under both parents' plans, the  "Birthday Rule" determines which plan is primary.
Learn more 

Additional Health Insurance Information

Using preventive care benefits and understanding your bill are two ways you can save money.

Health Insurance Terms

Consumers usually make monthly premium payments to have insurance coverage (or employers do). But what are all those other out of pocket costs we pay when we use our insurance for our health care?
Read about common cost and billing terms 

Preventive Care

If you have health insurance coverage, you can probably get free preventive services, with no deductible or other out of pocket expenses

 

Learn about the benefits of preventive care 

Insurance mandates and contract negotiations

It s important to understand the laws and regulations for health insurance.

Health Insurance Mandates

These are laws and regulations that require health insurance plans to cover specific treatments, procedures, services, or health conditions, ensuring consumers have access to essential healthcare and that coverage is comprehensive and consistent
Learn about the types of mandates 

Health Insurance Contract Negotiations

Time and time again, health care insurance and provider contract negotiations threaten to upend the lives of Connecticut residents who are caught in the middle. 
Read OHA s recommendations 

Request OHA assistance

Get help 

Have a question or need help?

To get help from OHA, fill out our online form, send an email, or call us. The quickest way to get help is via email.
  • Call OHA 
    Call: 1-866-466-4446 Our phone lines are staffed Monday through Friday from 8:00 a.m. to 4:30 p.m. by knowledgeable advocates ready to assist with your questions and concerns.
  • Email OHA 
     Email: Healthcare.Advocate@ct.gov Email is often the quickest way to receive assistance. Include your contact information and a brief description of your issue for the fastest response.
  • Release form (PDF) 
    Online Form: Submit Request for Help Complete our online inquiry form and any appropriate authorization forms to initiate the assistance process. An advocate will contact you within 1-2 business days.
  • Appointment of rep. form (PDF) 
    If you have Medicare, fill out a Medicare Representative form.
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