Health Insurance Marketplace in South Carolina
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
South Carolina has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under South Carolina’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP in South Carolina:
Who can help you (the Navigators)
DECO Recovery Management, a national leader in medical assistance eligibility management and patient advocacy, has taken a lead role in the establishment of a consortium with strategically located partners in South Carolina, to perform the cooperative agreement activities as a Navigator. DECO and its consortium partner TBB-SC will conduct targeted marketing campaigns and public education events throughout the state.
The Cooperative Ministry is establishing the Health Insurance Education Cooperative to provide pathways to better health and quality for uninsured persons in South Carolina. This effort targets eight counties that comprise the Columbia-Orangeburg-Newberry Region, and aims to reach, engage, and help enroll all eligible consumers in that area.
Beaufort County Black Chamber of Commerce will utilize existing networks and infrastructures within various parts of the region to provide outreach around new coverage options. BCBCC will be conducting workshops, community meetings and individual counseling activities as part of the overall education and outreach efforts.
Who you can contact for more help
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in South Carolina
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- South Carolina Research Foundation SC – Health Care Innovation Award
- Eau Claire Cooperative Health Centers, Inc. SC – Health Care Innovation Award
- University Of North Texas Health Science Center SC – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- Amedisys Home Health of Charleston East Charleston, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Hilton Head Hilton Head Island, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Myrtle Beach Myrtle Beach, SC – BCPI Initiative: Model 3
- CareOne Home Health Services, an Amedisys Company Bluffton, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Conway Conway , SC – BCPI Initiative: Model 3
- Amedisys Home Health of Georgetown Georgetown, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Georgetown East Georgetown, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Camden Camden, SC – BCPI Initiative: Model 3
- Amedisys Home Health of Charleston North Charleston, SC – BCPI Initiative: Model 3
- Providence Hospitals Columbia, SC – BPCI Initiative: Model 4
- Upstate Care Transitions Coalition Greenville, SC – Community-based Care Transition Program
- Beaufort-Jasper-Hampton Comprehensive Health Services, Inc. Ridgeland, SC – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Jefferson Medical Office Jefferson, SC – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Lugoff Medical Office Lugoff, SC – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- New Horizon Family Health Services – Slater Travelers Rest, SC – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Medical University of South Carolina – Florence Florence, SC – Strong Start for Mothers and Newborns Initiative
- Medical University of South Carolina – Walterboro Walterboro, SC – Strong Start for Mothers and Newborns Initiative
- Charleston BirthPlace Charleston, SC – Strong Start for Mothers and Newborns Initiative
- Medical University of South Carolina – Mount Pleasant Mount Pleasant, SC – Strong Start for Mothers and Newborns Initiative
- Medical University of South Carolina – Sumter Sumter, SC – Strong Start for Mothers and Newborns Initiative
- Medical University of South Carolina – Columbia Columbia, SC – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in South Carolina
On November 15, 2012, Governor Nikki Haley (R) informed federal officials South Carolina would default to a federally-operated health insurance exchange.1 This decision was largely based on findings from the South Carolina Health Planning Committee which had concluded the state cannot implement a state-based exchange as required by the Affordable Care Act (ACA) and should instead encourage the establishment of private exchanges.2 The Governor created the Committee via Executive Order to assist with policy recommendations regarding whether and how South Carolina should establish a health insurance exchange; however, her influence over the Committee’s findings was called into question in December 2011.3,4
Prior to the announcement that the state would not operate its own exchange, the Governor signed into law S 0102, a bill prohibiting plans in a state exchange from offering abortion coverage, except in cases of rape, incest, or to avert the death of a pregnant woman.5
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since South Carolina has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of South Carolina- Business Blue Complete, PPO.
In September 2011, the South Carolina Department of Insurance received a federal Exchange Planning grant of $1 million. Governor Haley stated South Carolina would not pursue any more federal grant money to fund a possible state-run exchange.6
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
South Carolina is not participating in Medicaid expansion.
The federal government will assume full responsibility for running a health insurance exchange in South Carolina in 2014.
Additional information about South Carolina’s Health Planning Committee can be found at: http://www.healthplanning.sc.gov
1. Letter from Governor Haley toHHS. November 15, 2012.http://governor.sc.gov/Documents/Gov%20Nikki%20Haley%20Letter%20to%20HHS%20Secretary.pdf
2. “Improving the Health Care Marketplace in South Carolina: Strategies and Policies Recommended by the South Carolina Health Planning Committee.” November 2011.http://doi.sc.gov/Documents/ACA%20Grants/SCHPCFinalReport.pdf
3. Executive Order 2011-09: http://www.scstatehouse.gov/reports/executiveorders/exor1109.htm
4. ‘Harkin Blasts South Carolina Over Exchange’. December 23, 2011. Kaiser Health News.http://www.kaiserhealthnews.org/daily-reports/2011/december/23/south-carolina-exchange-grant.aspx
5. S 0102. 2012 Legislative session. Signed June 7, 2012.http://www.scstatehouse.gov/sess119_2011-2012/bills/102.htm
6. Largen, Stephen. ‘Haley to shun federal funds.’ Go Upstate. July 1, 2011.http://www.goupstate.com/article/20110701/ARTICLES/110709990
Also of interest
Provided by the Henry J. Kaiser Family Foundation