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Experts provide ACA answers during open enrollment period

Health
Travis Boland
  • Travis Boland
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The Affordable Care Act enrollment period ends Friday, and there are a few changes health plan shoppers should know about before picking 2018 plans.

South Carolina has become the fifth state to have a single insurer providing plans for 2018. BlueCross BlueShield takes the responsibility after Aetna and UnitedHealthcare left the marketplace in the state.

BCBS spokeswoman Patti Embry-Tautenhan said there will not be a change in the company’s business model or its focus on helping people find the best plan.

“We have many doors, but one destination,” Embry-Tautenhan said. “As the only insurer in the ACA, we own all the risk in a state where the population tends to use more health care services than most.”

Shelli Quenga, director of programs for state health care advocate The Palmetto Project, said most of the people she speaks with are unsure whether they can still enroll in an ACA plan.

“There is always confusion for people who haven’t enrolled, or are newly eligible to the marketplace,” Quenga said. “It’s important to know that you can change your coverage at any time during the year. Just because you sign up for one plan now doesn’t mean you can’t make a change depending on your circumstances.”

Other questions Quenga has been fielding during the open enrollment, which runs until Dec. 15, center on cost. She said cost is always a driving factor when it comes to picking a plan.

With the government recently eliminating cost-share reductions, Quenga says many are afraid plans will be out of their price range.

According to a report from the Kaiser Family Foundation, 60% of marketplace enrollees ages 18-64 were “very” or “somewhat” worried about copays and deductibles becoming so high they won’t be able to afford to get the health care they need. In that same group, 55% were “very” or “somewhat” worried that health insurance premiums will increase so much they won’t be able to afford the plan they have now.

BCBS raised premiums 31% on its Silver Plans on the exchange to help offset the cost of the CSRs (cost-share reductions). Despite the increase, BCBS said a majority of customers should see less than a $10 change in premiums going forward, and many will be eligible for subsidies or tax credits.

“That 31% increase will make the tax credit go up,” Quenga said. “CSRs are still available to the customers. The federal government is refusing to reimburse the insurers, which is causing the increase.”

Quenga said it’s important for customers to know that they are choosing a plan for what they expect their taxable income to be for 2018.

“Many in South Carolina are in a better place when they realize they don’t need to pick a plan based on what they are making now,” Quenga said. “The Silver Plan tax credits are still going to be a benefit to all involved. This is a different year, and not the same marketplace.”

During open enrollment, Quenga said S.C. small-business owners have a lot to think about.

According to Healthcare.gov, qualified small businesses can receive up to a 50% tax credit for offering group health insurance. Individuals below 400% of the federal poverty level can receive substantial premium assistance. An individual with an income up to $48,240, and a family of four with income up to $98,400, are eligible for premium assistance.

“We are asking business owners to check out a group plan through the ACA Insurance Marketplace,” said Frank Knapp Jr., president and CEO of the S.C. Small Business Chamber of Commerce. “If they opt not to offer a group plan, we urge them to make sure their employees get an individual plan. Healthy employees have health insurance, so it is in the best interest of the employer to help them in this process.”

Here are a few tips Quenga said people should know prior to enrolling:

  • The Affordable Care Act is still a law, and those that do not purchase a plan could be subject to a penalty.
  • There are a number of discounts in the marketplace this year. It would be smart to shop around and not just rely on the plan you had last year.
  • If you have any unpaid premiums, those must be paid prior to enrolling for a plan for 2018.

The enrollment period ends Dec. 15, and new plans take effect Jan. 1.

This story first appeared in the Nov. 20, 2017, print edition of the Columbia Regional Business Report. 

Reach Travis Boland at colanews@scbiznews.com.

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