Connecticut health insurance open enrollment starts Nov. 1. Here's how expiring subsidies could impact you

Oct. 23—After three weeks of the government shutdown, lawmakers have yet to determine how they will address the expiration of health care tax credits, even as the open enrollment period rapidly approaches.

The annual two-and-a-half-month period when residents across the state can review, compare and select or re-enroll in health and dental insurance for the upcoming year lasts from Nov. 1 to Jan. 15, 2026, with insurance coverage starting on Feb. 1, 2026. If residents enroll by Dec. 15, they will have coverage starting Jan. 1.

During the 2025 open enrollment period, 151,151 residents signed up for coverage, with 90% receiving some form of financial aid through the state's Affordable Care Act marketplace, Access Health CT. Many who rely on that aid may face higher costs or lose eligibility altogether in the coming year, said marketplace CEO James Michel. As a result, many may choose to buy a plan with less covered health services or forgo coverage altogether because of costs.

This week, Connecticut residents enrolled through Access Health will learn how much their insurance could cost next year if they stay on the same plan.

"These are real people in Connecticut who face skyrocketing costs for their health insurance if Congress does not act. These are your neighbors, your friends, maybe even you or members of your family," Michel said at a press conference on Tuesday. "Congress and the President need to act now. The more time that passes for consideration for the extension of financial help, the more confusion the renewal process will be for our Connecticut residents."

Here's what top state officials want you to know ahead of open enrollment.

What are the enhanced tax credits?

Since 2013, specific individuals enrolling in health insurance through the state's Affordable Care Act marketplace have been eligible for financial assistance.

Financial aid is given out based on household size, home address, and tax information, such as annual and projected income. It can come in the form of premium tax credits, which reduce the monthly payment through a subsidy paid directly to the insurance company. Others may be eligible for cost-sharing reductions that lower out-of-pocket deductibles, co-payments and coinsurance.

Michel said the assistance was initially offered to people living at or below 400% of the federal poverty level, qualifying around 70% of the consumers.

During the COVID-19 pandemic, former President Joseph Biden enhanced the subsidies as part of the American Rescue Plan Act, and the 2022 Inflation Reduction Act extended the aid through 2025. Michel said this change allowed more people to qualify by removing the income limit and making insurance more affordable.

If the enhanced subsidies expire on Dec. 31, Michel said this means aid eligibility would revert to the original income cap.

Who does this impact?

It's hard to predict the exact number of people who could be affected, but Michel hundreds of consumers will see their premiums increase if they decide to keep their health plan and the aid isn't extended. Some consumers may see their financial aid disappear altogether.

Estimates show that 30% to 35% of the 151,000 Connecticut residents enrolled in an Access Health CT plan — roughly 52,000 people — could lose coverage by 2034 if the financial aid is not extended and Medicaid is cut severely. Another 130,000 people might see their financial help reduced.

When people go without health insurance, the impact extends to the broader community by rising care costs for all, said state Comptroller Sean Scanlon.

Ahead of the federal cuts, for example, health coverage plans through the marketplace received approval from the state's Insurance Department for increases averaging 16.8% for individual customers and 11% for small-group coverage. Insurers asked for higher rates to compensate the potential major shifts in the consumer population.

Meanwhile, Connecticut hospitals are projected to lose $22 million in revenue when the tax credits expire, according to an analysis by the Robert Wood Johnson Foundation. The amount hospitals spend on uncompensated care is also expected to rise by $5 million.

"You're going to see a lot of people who will choose to not go with insurance because they can't afford it, who will go off the exchange, but they'll still get sick, they'll still go to the doctor, they'll still go to our hospitals," Scanlon said. "When that uncompensated care gets delivered, that will just be passed on to everybody else."

About 52,000 CT residents could lose coverage if aid ends; 130,000 may see reduced help.

What could the increases look like?

The cost increases and changes vary from household to household, especially if they re-enroll into their plan without the subsidies. Some examples provided by Access Health include:

* A married couple in their mid-50s residing in East Hartford with an annual income of $95,000 currently pays $673 per month for their health insurance. Without the subsidies, their premium for the same plan is projected to increase to $2,608 per month — a 288% rise.

* One family of four living in Milford with an income of $130,000 a year currently pay $921 for their health plan. Their cost is projected to increase to $2,882 a month, around a 206% increase.

* A single person living in Greenwich earning $64,000 a year currently pays $453 per month for their health insurance. Their monthly premium for the same plan will rise to $765, a 69% increase, without the subsidies.

How do Medicaid cuts come into play?

The cost increase, however, doesn't take into account the thousands of people expected to lose their Medicaid coverage through Trump's reconciliation bill and new regulatory changes.

According to Access Health, some of the people who will feel the immediate impacts include:

* Deferred Action for Childhood Arrival (DACA) residents who would no longer be eligible for coverage as of August 2025.

* Starting January 1, 2026, green card holders who are not eligible for Medicaid because they have not been residents for at least five years will no longer qualify for tax credits that provide critical financial assistance.

* The Special Enrollment Period for low-income consumers will be eliminated.

Other changes to the Medicaid program like increased administrative eligibility checks and shorter open enrollment periods may also impact who re-enrolls for coverage.

"It's really an amazing situation that we find ourselves in, where you have the richest country on Earth and some people could die simply because they're poor and they don't have access to health care," Michel said.

Could Connecticut make up the loss?

Gov. Ned Lamont said that if the enhanced subsidies expire, Connecticut won't be able to replace the lost federal money. Calling a special session on health care costs remains a possibility, but he said the question now is more about when lawmakers will convene.

In the meantime, Lamont added that they are working closely with DSS to curtail and minimize the impact as much as possible, like shifting eligible residents to Covered CT, a program in which the state of Connecticut pays the consumer portion of premiums and cost-sharing after federal subsidies.

"We're going to do whatever we can at this level to hold down overall health care costs, but it's really bad policy what I see coming out of Washington," said Lamont at the press conference. "It's incredibly erratic, and it's just putting an extra load on middle class families who are just trying to get by."

What happens if they extend the subsidies during open enrollment?

It'll be confusing and logistically messy, Michel said, but it's something Access Health staff are preparing for.

Michel said the state insurance department would need to approve new rates, and Access Health would have to inform people of how that'll affect their coverage. It could also be disruptive for consumers who enroll and pay early for their insurance to have coverage by Jan. 1, who would now have to re-enroll.

If the enhanced subsidies are approved after open enrollment closes, Michel said everyone who enrolled since November would have to re-enroll to get access to their financial aid.

Will financial aid still be available for open enrollment?

The short answer is yes, Michel said, but they may be offered to fewer people and have less money available.

He said Access Health staff, such as certified insurance brokers, can help individuals and their families determine the best insurance plan for their financial situation and health needs at no cost. Some individuals, especially those below the 400% of federal poverty line, may still be eligible for financial aid.

"You should always apply for health insurance coverage because you may qualify for financial assistance, or you may qualify for Medicaid," Michel said.

Enrollees who don't meet the income qualifications for HUSKY may be eligible for Covered CT.

More than 50,000 people are enrolled in the program, and the number continues to grow, said Andrea Barton Reeves, commissioner for the Department of Social Services at a press conference.

Some of the funding for Covered CT comes from the federal enhanced subsidies, but Reeves emphasized that the program would remain intact. This means, however, that the state budget may need to be considered and evaluated if the enhanced subsidies end.

"This is one of the reasons that we're asking people to really please wait until December, because there is a possibility that some action may be taken that would make this particular issue one that is moot, and that actually would be the most preferred," Reeve said.

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