Health Insurance Help and Surprises

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Jeff McLean, an insurance agent with HealthMarkets in Mount Pleasant, recently worked with a local family of three who were surprised to learn that they qualified for financial assistance to buy a new health insurance plan. He helped them navigate their options by using HealthCare.gov, the website set up to enroll individuals through the Affordable Care Act, known also as Obamacare.

“There are still a lot of South Carolinians who are not aware of how the ACA can benefit them,” McLean said.

Anthony Kelley, the outreach director at Foothills Community Health Care in Easley agreed.

Kelley has worked for five years as a navigator, an individual certified to assist individuals free of charge to enroll through HealthCare.gov. He knows insurance can include some tricky terms and rules.

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“Although you can go directly to the website and apply and enroll in insurance, it is often a huge help to have someone who knows the system well help with the process,” Kelley said.

Match With These Providers

The ACA was enacted in March 2010. The law provides insurance options to people who are not already covered by a public program or by their employer. The ACA also includes new benefits and protections such as preventing insurance companies from denying coverage to people with pre-existing conditions and requiring insurance companies to cover certain preventive care services. The law also made it possible for children to stay on their parents’ health insurance plan until they are 26.

Rural Health Services is another organization that helps people enroll in the ACA. Two of its navigators, LaToya Bates and Sarah Christian, travel throughout the state to help those who do not have a navigator in their immediate area. They not only help people apply and enroll; they also help individuals understand their current coverage.

So who is eligible for financial assistance through subsidies?

When residents apply for coverage, they find out if they qualify for financial assistance that lowers their monthly premium. They also can get an estimate of how much they’ll save before they apply.

The subsidies work on a sliding scale, so families with lower earnings would be eligible to save more. According to the calculator at HealthCare.gov, an eligible family of four earning $80,000 in Charleston County could receive an $800 tax credit, which means they could choose a plan costing them $100 a month.

Because elements of each plan can vary extensively, depending on which providers are in the network, average cost of visits and deductible amounts, navigators encourage individuals and families to carefully consider their options.

While sign up can feel overwhelming, South Carolina has organizations at the ready.

The Palmetto Project is a nonprofit committed to helping South Carolinians access quality, affordable care. Sonia Donnelly, associate director of programs, said her organization partners with other groups, including the hospital association, libraries and other nonprofits to remind residents that there is help available, either in person or by phone.

“Awareness of options for lower-cost plans is especially low if [individuals] have been covered through their employer previously,” Donnelly added.

The sign-up period for ACA runs from Nov. 1, 2022, until Jan. 15, 2023.

Bates and Christian, with Rural Health Services, expect “there will be more insurance carriers [participating] this year, which means there will be more options for plans for consumers.”

During the rest of the year, residents may also be eligible to enroll if they experience a life event, such as getting married or having a child.

To find free assistance throughout the state, search within your ZIP code at HealthCare.gov or GetCoveredAmerica.org, or call 800-318-2596 for assistance.

By Lisa Wack

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