The South Carolina Health Insurance Marketplace
South Carolina has a federally-run health insurance exchange, through which various private insurers sell individual health plans for an affordable cost. As a Southern state with a track record of high premiums and unfair rating practices, this subsidized, guaranteed issue coverage should certainly be welcome in South Carolina’s cities and small towns. Health plans for individuals, families and small businesses in the state are now more easy to obtain under the Affordable Care Act. Through this federal law, each state was able to set up an exchange for insurers to sell benefit-rich health plans with discounts for low-to-moderate income residents.
Under the health law, everyone is required to get covered, and the marketplace helps bridge the gap for many residents with tax credits. If you can’t afford coverage on the marketplace, you might be eligible for SC Healthy Connections, the state’s Medicaid program.
Through subsidies for premiums and cost sharing, those who shop the marketplace can lower their coverage costs substantially. Many individuals applying for health plans on the exchange are eligible for reduced rates and medical expenses, including residents who earn poverty-level income up to four times the current FPL. On top of cost reductions, the exchange guarantees ten categories of essential health benefits are covered in each plan. This includes services that are very essential to most Americans, such as prescriptions, maternity care and doctor’s office visits.
The exchange is an innovative source of strong health plans at reasonable prices for individuals, families, and small businesses in South Carolina. For assistance and guidance with costs and coverage options, contact a licensed agent at 888 803 5917.
Each individual and family plan sold through the marketplace belongs to one of four “metallic” coverage tiers: bronze, silver, gold or platinum. These levels indicate how much your plan pays for covered medical services, and the amount of coinsurance, copayments, or deductibles you pay when receiving care. Bronze and silver plans offer more affordable premiums, while gold and platinum plans tend to be higher as they pay a larger portion of your expenses.
Premium Tax Credit
South Carolina’s health insurance exchange offers help paying for coverage to those who earn between 100 and 400 percent of poverty. Lower income residents receive the highest subsidies, while those earning closer to 400 percent FPL will receive a smaller discount. As Healthy Connections was not expanded under the ACA, those who earn between the program’s income limits and the poverty line cannot receive assistance. Marketplace applicants earning between 100 and 250 percent of FPL also are eligible for a cost sharing tax credit reducing the cost of copays, coinsurance, and deductibles.
Tax credits are calculated by income and family size, then the cost of the second lowest-cost silver plan in your region is applied as a percentage of your income. According to income, you can determine about how much their premium share will be in the table below. Any amount over that percentage is covered by your subsidy.
The South Carolina insurance market is quaint to begin with in most areas, and only four insurers participate on the exchange. This doesn’t mean you can’t still find a great policy, however. Insurer selection is different in each region, offering PPOs and HMOs with smaller networks so that coverage can be affordable. Trusted South Carolina health plans including BCBS and Coventry provide subsidized plans.
- BlueCross BlueShield of South Carolina
- BlueChoice Health Plan
- Consumers’ Choice Health Plan
- Coventry One
For a simplified shopping experience, all marketplace plans are required to cover the same types of care. Expenses and exact services may differ from one carrier to another, but essential health benefits are required to be in each plan by federal law. Some services, such as prevention, can be obtained at no cost to you, while others are subject to deductibles, coinsurance or a copay.
Essential Health Benefit categories of covered care:
- Office visits
- Emergency care
- Laboratory tests
- Maternity and newborn care
- Prescription drugs
- Preventive, wellness, and chronic disease management services
- Pediatric care, including dental and vision
- Mental health and substance abuse services, including behavioral health care
- Rehabilitative and habilitative services and devices
Small Business Health Options Program
The Small Business Health Options Program (SHOP) is another facet of the South Carolina exchange. Small business owners from the beach to the mountains can cover their workers for less than plans the traditional small group market if they qualify for the Small Business Health Care Tax Credit, awarded to very small businesses. To qualify for the SHOP, you must have 49 workers or less. Subsidies are given to companies with up to 25 full-time equivalent employees (at least 30 hours per week) who earn $50,000 per year or less each. The largest tax credit an employer can receive covers half of their premium contribution, which is given to companies with 10 or fewer workers with yearly income up to $25,000 each.
How to Apply
You can sign up for South Carolina marketplace plans through the federal portal at HealthCare.gov, in person at a community health center, or through a licensed insurance agent at 888.803.5917. East Coast Health Insurance is licensed to sell individual health plans on and off the exchange. Regardless of how you apply, it is important to know your options for affordable coverage and get connected to a good policy from a reliable carrier.
Compare South Carolina Marketplace Plans
Below is a cost comparison tool designed to give you an idea of what to expect on the exchange in your area. These rates are estimates based on the averages released by the insurers selling on the exchange. While this tool is for research purposes, our agents can provide an accurate quote of coverage costs and subsidy eligibility, and help you enroll in marketplace coverage, call a licensed agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.