With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make healthcare insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in South Carolina, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in South Carolina
South Carolina ranked 42nd in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a moderate rate of binge drinking, moderate immunization coverage among children, and a small disparity in health status by educational attainment. Challenges include the state’s low high school graduation rate, a high incidence of Salmonella and chlamydia infections, and low immunization coverage among adolescents.
South Carolina individual and family health insurance
When the Obamacare health insurance exchanges opened for business Oct. 1, 2013, South Carolina defaulted to the Federal Health Insurance Marketplace. South Carolina’s residents may buy individual and family coverage through the federally facilitated exchange. Those who buy health insurance through healthcare.gov may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
South Carolinians can also buy qualified health insurance plans in the private marketplace through websites such as HealthCare.com. To find out if you qualify for an Obamacare tax credit, use HealthCare.com’s tax subsidy calculator. If you do, visit South Carolina’s health insurance exchange to shop and enroll in health insurance coverage.
The U.S. Department of Health and Human Services reported that 118,324 individuals in South Carolina selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in South Carolina enrolled in a marketplace plan increased to 210,331 during the open enrollment period.3
|South Carolina’s health insurance exchange:||healthcare.gov|
|South Carolina Department of Insurance:||doi.sc.gov|
South Carolina small group health insurance plans
South Carolina’s small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program marketplace, at healthcare.gov/marketplace/shop and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from South Carolina’s federally facilitated exchange.
South Carolina state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
South Carolina’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2–19|
|Maximum continuation period – standard||6 months|
|Maximum premium Increase||100 percent|
|State legislation reference||South Carolina Continuation Law – Section 38-71-770|
|More information||800-768-3467 (in state only)/803-737-6180 – SC Department of Insurance Consumer Services Division|
|Additional notes||Eligible employees must be covered under the group policy for at least six months prior to the qualifying event.|
South Carolina high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
South Carolina’s federally run PCIP program ended April 30, 2014.6 However, the state continues to operate its high-risk pool and, according to the National Association of State Comprehensive Health Insurance Plans, as of April 8, 2014, there has been no legislation to terminate it.7 Visit the South Carolina Department of insurance at doi.sc.gov/703/South-Carolina-Health-Insurance-Pool for more information on the South Carolina Health Insurance Pool (SCHIP), eligibility and application.
South Carolina Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).8
South Carolina did not expand its Medicaid program in 2014.9 A resulting coverage gap exists for those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange. Medicaid/CHIP open enrollment take place year-round.
The information below is specific to South Carolina’s Medicaid program, Healthy Connections:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||South Carolina Department of Health and Human Services|
|Where to apply||healthcare.gov / apply.scdhhs.gov/CitizenPortal/application.do|
|Open-enrollment period||Year-round in all states|
|Eligibility10||South Carolina resident, U.S. citizens and qualified non-citizensCertain criteria apply. Those encouraged to apply include individuals who:
Have very low or no income
South Carolina CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to South Carolina’s health insurance program for low-income children:
|Program name||Healthy Connections|
|Where to apply||healthcare.gov / apply.scdhhs.gov/CitizenPortal/application.do|
|Eligibility11||South Carolina resident, U.S. citizens and qualified non-citizens under 19; income qualifications and other criteria determine eligibility|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 South Carolina Department of Insurance. “Health Insurance: What Happens to My Coverage If I Lose My Job?” N.D. Retrieved from http://www.doi.sc.gov/DocumentCenter/Home/View/2557.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Pre-Existing Condition Health Insurance Plan. “PCIP Coverage Ended April 30.” N.D. Retrieved from https://www.pcip.gov.
7 National Association of State Comprehensive Health Insurance Plans. “State Risk Pool Status Report.” NASCHIP.org. June 2014. Retrieved from http://naschip.org/2014/PoolEnrollmentSurvey%200614.pdf.
8 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
9 Centers for Medicare & Medicaid Services. “South Carolina.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/south-carolina.html.
10 South Carolina Department of Health and Human Services. “Frequently Asked Questions.” South Carolina Health Connections Medicaid. N.D. Retrieved from https://www.scdhhs.gov/FAQs.
11 South Carolina Department of Health and Human Services. “Frequently Asked Questions.” South Carolina Health Connections Medicaid. N.D. Retrieved from https://www.scdhhs.gov/FAQs.