This guide provides an overview of the South Carolina Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for South Carolina residents and small businesses.
Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state Health Insurance Exchanges. Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state Health Insurance Exchange.
All states have three options for setting up a state Health Insurance Exchange for 2014:
Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange
In November 2012, South Carolina announced they would default to a federally-facilitated Health Insurance Exchange. The South Carolina Health Insurance Exchange will open October 1, 2013, for coverage beginning January 1, 2014.
South Carolina Health Insurance Exchange - History
Originally, South Carolina explored creating a state-based Health Insurance Exchange. In March 2011, Governor Nikki Haley created the South Carolina Health Planning Committee via Executive Order 2011-09. The purpose of the Committee was to recommend if and how South Carolina should establish a state-based Exchange. The committee recommended that South Carolina not establish a state-based Exchange siting ambiguous operational guidance and rules. In November 2012, Governor Haley informed the Department of Health and Human Services (HHS) that South Carolina would default to the federally-facilitated Health Insurance Exchange.
South Carolina Health Insurance Exchange - What is It?
The South Carolina Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (branded as the "Marketplace"). According to healthcare.gov, 726,847 or 18% of South Carolina's non-elderly residents are uninsured, of whom 684,987 (94%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if South Carolina participates in the Medicaid expansion.
Through the Exchange, South Carolina residents will be able to shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP. The SHOP Exchange will be available to small businesses in South Carolina for businesses with 100 or fewer employees. Coverage starts January 1, 2014. More information on the federally-run Health Insurance Marketplace can be found here.
South Carolina Health Insurance Exchange - What Plans Will be Available?
All plans offered through the South Carolina Health Insurance Exchange will meet the federal ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in South Carolina, is expected by late summer 2013.
South Carolina Health Insurance Exchange - Role of Insurance Professionals & Navigators
The South Carolina Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers and small businesses.
Insurance professionals will be able to register with the South Carolina Health Insurance Exchange and receive commissions directly from the carriers (using their Exchange ID number and NPN to track sales). For more information see: Role of Agents in Health Insurance Marketplaces.
The South Carolina Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in South Carolina.