No matter how old and versed in health insurance we may get, there will always be a question or two that needs clarifying or answering. Because we believe health insurance should be simple, we also believe that the answers to Frequently Asked Questions (FAQs) should be; simple to read and simple to understand. If, for any reason, you should still have questions or want more clarification, please call our South Carolina health insurance Advisors at (888) 554-3287.
- What is a qualified health plan?
A qualified health plan is one that has limits on cost sharing (e.g. deductibles, out-of-pocket maximums, copayments, etc.), provides the appropriate level of coverage by including the minimum essential coverage, and meets other requirements as determined by the Affordable Care Act, otherwise known as Obamacare. A qualified health plan must also be certified by the Health Insurance Marketplace. To avoid paying the health insurance penalty, a person must be covered by a qualified health plan.
- How do I know which health insurance plan is best for me?
As you are looking for the best plan for you, consider two major things: 1) your previous year's medical costs, any known upcoming healthcare costs, and any potential healthcare costs, and 2) each potential plan's premium cost, deductible amount, and out-of-pocket or co-pay amounts. As you evaluate these two things, try to find the sweet-spot between your upcoming healthcare needs and the benefits and coverage offered in each plan. We recommend that you find the health insurance option that makes your total cost of healthcare most affordable and that also gives you the best healthcare coverage. It is tempting to pick the option with the lowest monthly premiums, but if that results in you paying large dollar amounts for every visit to the doctor or hospital or to hit your deductible, it might not be the best option by the end of the year (learn more about how a deductible impacts you premium).
- What is open enrollment and how does it work?
Open enrollment is the annually designated period when you can enroll in an insurance plan or change your existing health insurance coverage from the previous year.
- When is the open enrollment deadline?
Insurance plans typically follow the open enrollment deadline of the Health Insurance Marketplace; for 2017 the deadline for enrollment is January 31, 2017. The open enrollment period starts November 1, 2016 and ends January 31, 2017.
- What if I missed the open enrollment deadline?
If the Marketplace open enrollment deadline has passed, you may be able to get health insurance coverage if you have had or will have a Qualifying Life Event (e.g. getting married or having a baby) that allows you to qualify for a Special Enrollment Period. You can also attempt to apply for short term health insurance, Medicaid, CHIP (the Medicaid Children's Health Insurance Program), or Medicare; all of these insurance programs accept applications all year long depending on your eligibility.
- How much do I have to pay if I don't have health insurance?
Since the 2014 enforcement of the Affordable Care Act or Obamacare, all individuals who reside in the United States are required to have active health insurance coverage through a qualified health plan. You will be required to pay a penalty for any time in which you do not have this minimum coverage. This penalty should be paid when you file your federal taxes for the tax year in which you did not have coverage. For the year 2016, the fee is 2.5% of your household income or $695.00 per adult and $347.50 per child under 18 (whichever is higher). The penalty for 2017 is fairly similar with the household income percentage fee of 2.5% remaining the same, while the flat fee will be adjusted for inflation.
- Where do I buy health insurance if I live or work in two different states?
If you live or work in two different states, seek a multi-state plan from either the private or public Marketplace. Multi-state plans will provide you with more coverage options as you move between states.
- How does a deductible impact your premium?
With health insurance, you will either pay more in your monthly premium or pay more out-of- pocket when accessing care. If you opt for a lower monthly premium payment, you will most likely be responsible to hit a higher deductible before insurance coverage kicks in and/or pay a higher co-pay or percentage of the cost of medical care.
- Can I be denied coverage for a pre-existing condition?
No, since the signing of the Affordable Care Act, or Obamacare, it is no longer legal for health insurance companies to deny anyone heatlh insurance coverage based on a pre-existing condition. Pre-existing conditions can include pregnancy and any medical condition that was diagnosed prior to enrollment in a health insurance plan.
- Is pregnancy a pre-existing condition?
Since the passing of Obamacare, the Affordable Care Act, you can no longer be denied health insurance coverage for pregnancy or any other pre-existing condition. All Medicaid and Marketplace plans are required to cover pregnancy, regardless of the timing of the pregnancy.
- How do I update my health insurance if I am recently divorced or widowed?
Any change in marital status, such as divorce or the death of a spouse is considered to be a Qualifying Life Event. These qualifying life events allow you to participate in a Special Enrollment Period 60 days before or after the date of the event. Find out how to update your insurance if you've had a Qualifying Life Events.
- Can I update my insurance if I get married or divorced, have a baby or adopt a child, or change jobs?
Significant life events such as a change in marital status, having a baby or adopting a child, or experiencing a change in employment are all categorized as Qualifying Life Events. When you have a qualifying life event, you have up to 60 days prior to or after that event to participate in a Special Enrollment Period. Check to see if your recent or upcoming life event is a Qualifying Life Event.
- Is health insurance tax deductible?
If you are self-employed, your health insurance premiums may be tax deductible. Deductions are for long-term, medical, dental insurance premiums that typically cover the self-employed individual, their spouses, and dependents. See if you qualify for deductions. According to the IRS, "You may deduct only the amount of your total medical expenses that exceed 10% of your adjusted gross income or 7.5% if you or your spouse is 65 or older. The 7.5% limitation is effective only from January 1, 2013 to December 31, 2016 for individuals age 65 and older and their spouses. You figure the amount you are allowed to deduct on Form 1040, Schedule A."
- What information and documents should I have when I'm signing up for health insurance?
When signing up for a health insurance plan, you will need to verify your annual income and U.S. citizenship or immigration status.
- Who can buy individual health insurance?
Anyone can opt to buy individual health insurance through a private Marketplace or through the federal Marketplace. Most typically, people buy individual health insurance when they do not feel that their company group insurance options adequately meet their needs or they are not offered group insurance benefits through their employer.
- Does health insurance auto renew each year like my auto insurance?
It depends, each health insurance provider and plan functions a bit differently. A majority of health insurance companies will require you to enroll or reenroll in an insurance plan each new year. There are some health insurance providers that will auto-renew you each year into the same plan you had and some may auto-renew you into a similar plan if your current plan does not exist that next year. All Medicare and most Medicaid plans and programs will not require reenrollment, unless your situation has changed from the previous coverage year.
- What does it mean to be on-exchange or off-exchange?
If you are on-exchange, then you purchased your coverage via the Health Insurance Marketplace. If you are off-exchange, then you opted to purchase your coverage via a private insurance. Learn more about exchanges and marketplaces.
- What is a Special Enrollment Period?
A Special Enrollment Period is granted to those individuals who have had or will have a Qualifying Life Event. The special enrollment period allows these individuals to enroll in a new public or private health insurance plan or update their current health insurance coverage up to 60 days before or after the qualifying life event.
- When is open enrollment for health insurance?
The 2017 health insurance open enrollment period runs from November 1, 2016 to January 31, 2017. These open enrollment dates apply to any public health insurance or private health insurance plans or programs in which you are interested in enrolling.
- What is health insurance?
Health insurance is a type of insurance that covers medical, surgical, hospital, and prescription expenses for the insured individual and/or their covered dependents. The level of healthcare coverage varies from plan to plan. This coverage determines the amount of the expense that the insured will be responsible to pay and how much the insurance provider will be responsible to pay.
- How much does group health insurance cost?
The cost of group health insurance will depend on the negotiated contract between the group applying for health coverage and the insurance company. Group rates typically vary based on the number of participants in your group, location, demographics, the insurance carrier, desired plan coverage, plan structure, and the availability of providers. According to a study by Kaiser Family Foundation (KFF), group policies in 2015 averaged $6,251 annually with the employer paying 83% of the premium costs ($5,179). This left the employee with 17% of the cost ($1,071). The average annual family premium cost is $17,545. All premiums for single and family coverage have increased about 4% between 2014 and 2015.
- Can I get group insurance without an employer?
Yes, you can get group insurance without going through an employer-sponsored program. There are many professional groups that offer insurance options such as alumni groups, the AARP, the Small Business Service Bureau, and more.
- What is small business health insurance?
Small businesses that have two or more employees have the ability to apply for group insurance. To qualify, at least one other employee (other than the owner) must be a non-relative or non-household dependent. The maximum employees for small business health insurance categorization is often capped at 50-100 employees, depending on the current state regulations. Small businesses benefit by enrolling into a small business health insurance plan as they often qualify for special tax breaks.
- How do I know if my private health insurance satisfies the Obamacare requirement?
Verify with your insurance provider that your health insurance plan meets the standards for an Obamacare or Affordable Care Act, qualified health plan and has been certified by the Health Insurance Marketplace.
- Do I have to have health insurance if I'm in college?
Yes, even college students are required to have health insurance. If you are a college student and do not have health insurance, you will face paying a penalty. There are several options for college students that are affordable, some of which are offered through college health centers.
- How long can I stay on my parent's insurance plan as a dependent?
If your parent's plan allows you to be covered as a dependent, you can stay on their plan until your 26th birthday. This is the case even if you are not claimed as a dependent on their state or federal taxes, are married, or are not in school.
- What is Obamacare or the Affordable Care Act?
The Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. The Affordable Care Act, often referred to as Obamacare, was intended to broaden affordable healthcare access to a larger population base and includes regulations that require all U.S. citizens to have minimum qualifying health insurance coverage as of 2014.
- Do I have to have Obamacare if I live in South Carolina?
Since the enforcement of Obamacare, the Affordable Care Act, all U.S. Citizens are required to have a qualified health plan (includes minimum viable coverage) to avoid a tax penalty. This health insurance coverage can be purchased through a variety of vendors in a private or federal Marketplace.
- Where do I find the Obamacare plan options for South Carolina?
The Federal Health Insurance Marketplace will contain the public health insurance options for South Carolina.
- How much does Obamacare cost in South Carolina?
The cost of your Obamacare health insurance plan will depend on the tier of coverage you select. You can choose between the Bronze Plan (plan pays 60% of healthcare costs, you pay 40%); Silver Plan (plan pays 70% of healthcare costs; you pay 30%); Gold Plan (plan pays 80% of healthcare costs; you pay 20%), and Platinum Plan (plan pays 90% of your healthcare costs; you pay 10%). See more on the various tiers of Obamacare coverage here.
- What are government insurance subsidies and how do I qualify for them?
People that fit into the middle- or low-income tax bracket are eligible for government subsidies. These subsidies come in the form of tax credits. The amount of subsidy you are eligible to receive will be based on your income, the amount of people in your household, and the cost of the benchmark Silver Obamacare Marketplace plan in your region.
- What is the penalty for not having health insurance in South Carolina?
The Obamacare penalty for not having health insurance coverage in 2016 is $695 per adult ($347.50 per child) or 2.5% of annual income claimed on a tax return without health insurance (whichever is larger). The health insurance penalty for 2017 will be similar, however the $695 flat fee will be adjusted for inflation.
- What if I missed the Obamacare Enrollment Deadline?
If you missed the Obamacare Enrollment Deadline, you will need to wait until the next Open Enrollment period or you may qualify for a Special Enrollment Period if you experience or have experienced a qualifying life event.
- How do I get an Obamacare quote?
The Federal Health Insurance Marketplace will allow you the ability to input your personal information and receive an Obamacare quote. You can access the Marketplace through the healthcare.gov website.
- What is an Obamacare exchange or marketplace, do I need to use it, and how do I use it?
The South Carolina Obamacare Marketplace or Exchange is a service that allows you to compare and enroll for medical insurance in your state. It can be accessed through different websites (healthcare.gov), calling, or in person. You will need to use the Marketplace to apply for government subsidies.
- How do I know if I'm exempt from Obamacare in South Carolina?
To be exempt from the Obamacare, or Affordable Care Act penalty in South Carolina, you will need to fill out a hardship exemption form and file it with the Federal Health Insurance Marketplace. Some hardships that qualify for exemption include: homelessness, eviction or foreclosure, domestic violence, the death of a family member, a natural or human-caused disaster, or filing for bankruptcy. For other qualifying hardships, see the Federal Health Insurance Marketplace hardship exemption page.
- What information and documents should I have when I'm signing up for Obamacare?
To sign up for an Obamacare health insurance plan you will need documents that verify your annual income and United States citizenship.
- Where can I get help with my Obamacare application?
The Federal Health Insurance Marketplace is a source that can help you with your health insurance applications. You may also call the government's helpline for assistance at (800) 318-2596.
- What is a Navigator?
A navigator is an individual or organization that is required to be unbiased as they help consumers, small businesses, and their employees explore health insurance options in the Marketplace. Navigator services are free to the public. They are trained to offer guidance in many areas, including how to complete eligibility and enrollment forms.
- What does Obamacare cover in South Carolina?
Obamacare, or the Affordable Care Act (ACA), states that health insurance companies must cover treatment associated with any and all medical conditions, these are called essential health benefits. Obamacare removes the ability of insurance companies to discriminate or deny coverage for any pre-existing medical condition. Additionally, once you are enrolled in an insurance plan, you cannot be denied coverage for any condition and your rates cannot be increased based upon your health. This coverage applies to pregnancy as well as pre-existing conditions. Learn more about what all Marketplace health insurance plans cover here.
- How can I decrease the cost of my health insurance in South Carolina?
Your health insurance costs will be dependent on the type of health insurance plan that you select. Health insurance plan costs fluctuate based on monthly premium costs and deductibles. In most cases, if you have a higher monthly premium, your deductible will be lower. Alternatively, if you want a lower monthly premium cost, you can opt for a higher deductible. Learn more about how your deductible affects your monthly premium here.
- How do I find Obamacare plans?
You can find the qualified Affordable Care Act (Obamacare) health insurance options on the Federal Health Insurance Marketplace.
- Are Obamacare health insurance premiums tax deductible?
If you are self-employed, Obamacare health insurance premiums may be tax deductible.
- Do I need Obamcare if I already have other health insurance?
If your existing health insurance plan meets the minimum essential requirements of a qualified health plan, as determined by the Affordable Care Act, you can keep your existing plan and avoid the tax penalty.
- Where do I buy Obamacare if I live or work in two different states?
If you live of work in two different states, it is recommend that you look for multi-state federal health insurance coverage (Obamacare), which is available in the federally regulated Marketplace.
- Will short term insurance help me avoid the Obamacare penalty?
No, short term coverage does not meet the minimum viable coverage of a qualified health plan according to Obamacare, the Affordable Care Act (Obamacare). Without additional health insurance coverage you will be subject to an ACA tax penalty.
- Who runs Obamacare marketplace in South Carolina?
The State of South Carolina has a Federally-facilitated Marketplace. The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
- What if I can't afford Obamacare? Is there cost assistance?
Yes. If you are unable to pay for the cost of Obamacare coverage, you may find that you qualify for government subsidies. Subsidies depend on income and the number of family members in the household.
- Does South Carolina Obamacare cover pre-existing conditions like maternity, IVF, diseases or illnesses?
Yes, under the Affordable Care Act, it is illegal for health insurance companies to deny coverage due to pre-existing conditions or maternity.
- Do I need to buy additional or supplemental insurance on Obamacare?
This depends on the level of your desired coverage. You may want to pursue supplemental insurance for specific health scenarios.
- Obamacare health insurance plans vs COBRA
COBRA allows you to continue to utilize your previous employer's insurance plan regardless of your employment status for a designated period of time by paying the entire premium. This is generally not cost effective and a similar option can be purchased at a smaller dollar amount via the Federal Exchange.
- I'm on Medicare, how does that impact me with Obamacare?
If you are on Medicare A, you are considered to be adequately covered by a qualified health plan and you do not to seek additional coverage. Medicare B, however, is not considered sufficient and additional coverage would need to be obtained to avoid the Obamacare penalty.
- How do I qualify for an Obamacare exemption?
There are a few exemptions to the Obamacare penalty that are available to individuals who are experiencing significant hardships. You can apply for Obamacare exceptions status through the Federal exchange. Find out if you are exempt from Obamacare in South Carolina.
- How has Obamacare affected health insurance in South Carolina?
In South Carolina, the Congressional delegation opposed health care reform and has opted to not expand Medicaid or open a state exchange. Even without Medicaid expansion, there has been a 10% growth in the Medicaid population because of outreach and education efforts. In addition, the uninsured rate has had a slight decrease from 15.8% to 12.3% from subsidies offered on the public exchange. The National Health Interview Survey determined the uninsured national average to be 9.1%.
- Can I enroll in a short term insurance plan at anytime?
You can enroll in short term coverage whenever you find yourself having a lapse in health insurance coverage.
- Does short term insurance have a time limit?
Short term insurance plans do have a limit. The time limit for short term insurance is 1-12 months depending on varying state regulations.
- Can I be kicked off short term insurance?
If you have met the 12 month time limit for short term insurance, you may be forced off short term insurance completely or be auto enrolled into a another plan that provides appropriate insurance coverage.
- How long should I keep my short term insurance?
It is recommended that you use short-term insurance as a temporary solution
- What are the benefits of short term insurance?
The benefit of short term insurance is that it provides a relatively inexpensive option to cover short periods of time where you may be experiencing a lapse in health insurance coverage.
- What does short term insurance not cover?
Short term insurance does not cover pre-existing conditions, preventative care, or any other healthcare needs that may occur when not on United States soil.
- Is short term insurance the same as temporary insurance?
Yes, the phrase short term insurance is sometimes referred to as temporary insurance. Short term insurance (and temporary insurance) offers consumers a way to temporarily access certain health insurance benefits during times when they are unable to access other health care options.
- Do employers in South Carolina offer short term insurance?
No, employers in South Carolina do not offer short term insurance. If you are fired or let go from your employment, you will most likely be offered COBRA health insurance. Learn the difference between short term insurance and COBRA.
- What is the difference between short term insurance and COBRA?
Short term insurance is significantly less expensive than COBRA but covers fewer costs, such as vaccinations, physicals, or pregnancy. Whereas COBRA allows you the access to the exact health insurance plan that you had access to with your previous employer, but at a much higher cost.
- If I am let go or fired in South Carolina, will my employer offer me short term insurance?
No, your employer will not offer you short term health insurance, but will most likely offer you the opportunity to sign up for COBRA insurance. Learn the difference between short term insurance and COBRA.
- What information and documents should I have when I'm signing up for short term insurance?
When you are signing up for short term health insurance you will need to have proof of your annual income and residency status.
- Can I get short term insurance if I am recently divorced or widowed?
You could get short term insurance while pending the beginning of a new or updated insurance coverage window. Keep in mind that change in marrital status, i.e. divorce or being widowed, typically falls under the category of a qualifying life event and makes you eligible for a Special Enrollment window.
- How does short term insurance work with life events?
Short term may be a good way to tie you over while you wait for the beginning of a coverage window. Keep in mind that most major life events like marriage, birth of a child, change in employment fall under the category of a qualifying life event and thus you are eligible for a Special Enrollment window that allows you access to many different insurance options.
- Can I get Obamacare cost assistance with short term insurance?
Short term insurance does not meet the minimum health insurance coverage requirements of a qualified health plan as mandated by the Affordable Care Act (Obamacare) and you will be subject to a tax penalty. Additionally, because short term health insurance does not meet the minimum ACA requirement, it does not qualify for cost assistance.
- What is Medicare?
Medicare is the federal health insurance for those who are 65 years of age or older, or those who have specific disabilities such as End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS).
- Who is eligible for Medicare?
Individuals automatically become eligible for Medicare upon becoming 65 years old. Medicare also covers End-Stage Renal Disease (ESRD), Lou Gehrig's Disease (ALS), and those who receive disability from Social Security or the Railroad Retirement Board.
- How can I find out if I am eligible for Medicare?
The initial enrollment period for Medicare will begin three months before your 65th birthday. You can apply online on the social security website or in the local Social Security office.
- What is Medicare Advantage?
Medicare Advantage provides an alternative to the traditional Medicare Part A or B. Advantage plans are provided through private insurance companies who have contracted with Medicare to provide the same benefits that one would have with Original Medicare, but allows for additional coverage for things like chronic conditions, nursing homes and long-term care, dental, and vision. In order to be eligible for Medicare Advantage, you must already be enrolled in Medicare A or B and live in the appropriate service area.
- What is Medicare Rx, Medicare Part D?
South Carolina Medicare Part D, also known as Medicare Rx, provides additional coverage for prescription drugs. While you are automatically eligible for Medicare Part A and Part B when you turn 65, you must specifically sign-up for Part D if you want its benefits. In order to be eligible for Part D, you must first be enrolled in Medicare Part A and B. After you are enrolled, find the appropriate Medicare D program for your service area. Penalties can be assigned if you do not have appropriate prescription drug coverage, so you will want to ensure that you verify that this step is completed. If you currently have a Medicare Advantage Plan, you will not need Medicare Part D.
- Does Medicare satisfy the health insurance requirement?
Yes, if you currently have Medicare Part A, you are covered and satisfy the health insurance requirement. If you only have Medicare Part B, you are not covered and may incur a penalty if you don't have additional health insurance coverage.
- How does Obamacare work with Medicare?
Medicare has expanded its coverage with the Affordable Care Act to include more wellness visits, health screenings, and other preventive care services.
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are qualified for South Carolina Medicaid:
- Children 0-18 years with a household income less than 200% of the Federal Poverty Line (FPL - Current Income Limit);
- Pregnant women with a household income less than 185% of the FPL;
- Parents with dependents and a household income 50% of the FPL.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in South Carolina, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of South Carolina's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
