Flood of inquiries as state launches new health plan

By JENNIFER L. KRONHOLM

As of July 1, Connecticut has universal health care. The new Charter Oak Health Plan provides health insurance to adults ages 19 to 64 who do not get insurance through an employer.

More than 1,000 people called the Charter Oak call center Tuesday, July 1, to sign up for the plan.

“The fact that they got more than 1,000 calls on the first day it was offered is a pretty telling statement of how great the need is in our state,†said state Sen. Andrew Roraback (R-30)

Members of the plan pay a premium of between $259 and $75 a month, based on income. The state will subsidize the premium for residents making up to 300 percent of the federal poverty level (for a break down of premium based on income and family size, visit charteroakhealthplan.com). The annual deductible is also based on income and ranges from $150 to $900 for an individual and $300 to $1,750 for a family.

“Obviously the deductibles are an issue, but I think it certainly represents a good faith first step toward solving an enormous — I would say the single biggest policy issue we face,†Roraback said.

There is a six-month wait to switch from private insurance to the Charter Oak Plan. Anyone with private insurance is encouraged to keep it through the waiting period. There is no wait for those without insurance — they will be covered the first of the month following the processing of their paperwork.

Not perfect, but a start

Some complaints about the plan include lack of dental or vision coverage, incomplete mental health care coverage and low maximum annual benefit limits for those with chronic illnesses.

But the plan covers 100 percent of preventive care costs and accepts those with pre-existing conditions.

“There are no limitations for pre-exisiting conditions, which is huge,†Roraback said. “And no co-pay for preventive care represents a policy shift. We try to get people to take better care of themselves so we can avoid costs down the road.â€

[For a list of benefits, see the sidebar.]

Northwest Corner response

This plan could be very helpful to residents of the Northwest Corner, many of whom are self-employed or small business owners who can’t afford to offer their employees health care.

For Peggy O’Brien, a self-employed attorney in Lakeville, the plan looks attractive.

“I just do Blue Cross Blue Shield and hope for the best,†she said. “I’m in very good health and in my early 40s, but my premium has gone up from $190 to $265 and I never use it. At my next birthday, it’ll probably go up another $30.â€

O’Brien said she also takes advantage of alternative health care options, such as acupuncture, which she pays for out-of-pocket. She said she doesn’t use the prescription benefits and she keeps the insurance mainly in case of catastrophic illness or injury.

“It’s not choking me,†she said of her premiums. “There are some others ones that are really high.â€

Despite having relatively affordable private health insurance, O’Brien said she will look into the state plan. She said she worries her private insurance would drop her if she “got too expensive.â€

For Colleen Kopec, a Sharon resident and the owner of Skintastic in Lakeville, the Charter Oak Plan is not enticing.

“It’s great if somebody doesn’t have insurance and can pay that,†she said. “I just don’t know how long it’s going to last at that price.â€

Kopec currently has a Health Savings Account (HSA) and a high-deductible insurance plan. She puts pre-tax earnings into the HSA to pay for her medical expenses.

“I was paying $625 a month because you have to have it,†she said. “I was thrilled when I found out about the HSA. It’s like a savings account.†Kopec added that her premium for the high-deductible plan is $380 a month. “I’m going to stick with what I have.â€

Paying for the plan

In 2007, the state Legislature set aside $11 million to launch the Charter Oak Plan. Participants paying the full, unsubsidized premium are paying the full cost of the insurance. The state is paying only to subsidize the premiums for low-income participants and for advertising.

The plan is administered by three private insurers, Aetna Better Health, AmeriChoice of Connecticut and Community Health Network of Connecticut.

Massachussetts, which instituted a universal health care plan in 2007, has been struggling with cost and the inability of health-care providers to keep up with the demand. The state has passed legislation offering incentives to medical students who go into primary care in underserved areas. Another law allows clinics to open in pharmacies.

Whether Connecticut will face similar problems is yet to be seen. The cost of the plan is, of course, a looming issue.

“Because this is our first year, if [the actual cost] turns out to be $15 million, we’ll have to find another $4 million,†Roraback said. He also said the cost of the Charter Oak Plan will be built into the budget for the next fiscal year. “I don’t think we want to turn people away.â€

For more information or to apply for the Charter Oak Health Plan, call 877-772-8625 or visit charteroakhealthplan.com.

Charter Oak Health Plan benefit package

Premium: $75-$259 (based on income)

Deductible: $150-$900 individual or $300 to $1,750 family (based on income)

Primary care office visit: $25 co-pay

Specialist office visit: $35 co-pay

Preventive care office visit: 100 percent coverage, no co-pay

Emergency room visit: $100 (waived if emergency)

Prescription medication: Three-tiered co-pay as low as $10; $7,500 annual benefit limit

Durable medical equipment: $4,000, no co-pay

Behavioral health services: $35 co-pay (provided through Connecticut Behavioral Health Partnership)

Outpatient rehabilitation: $35 co-pay, 30 visits per year

Maternity pre- and post-natal care: 100 percent covered

Inpatient rehabilitation/skilled nursing: 14 days per year, 80 percent covered after deductible met

Inpatient hospital visits: 90 percent covered after deductible met

Outpatient surgical: 80 percent covered after deductible met

Annual benefit maximum: $100,000

Lifetime benefit maximum: $1 million