Open enrollment for health insurance through the federal marketplace began Nov. 1, and a number of rule changes may help many who were previously ineligible for financial assistance get affordable health care through the American Rescue Plan.
“The Affordable Care Act (ACA) and the federal marketplace saved so many people from not having insurance when they were laid off from work during the pandemic,” said S.C. Small Business Chamber of Commerce president and CEO Frank Knapp. But some of the strict requirements of the plan kept some from getting on board.
Previously, those who earned the equivalent of at least 400% of the federal poverty line would automatically be ineligible for federal assistance. According to data from the national Kaiser Family Foundation nonprofit, that’s roughly 35.6% of South Carolina’s population, many of whom may have lost access to employer-provided health care during the pandemic.
“It made it incredibly difficult for small business owners,” Knapp said. “They were having to pay full rates while premiums have been steadily going up for years. They were turning to these short-term, low-benefit policies and then finding out, ‘Well crap’ … They couldn’t use it — their health care expenses weren’t covered. This is an opportunity for those small business owners to revisit their health insurance and look at getting a policy through the marketplace.”
While ACA help has historically been aimed primarily toward low-wage workers, many of whom could get free plans in the past, premium assistance has been dramatically increased. That helps everybody, Knapp said.
Employers are paying premiums that are 27% lower, on average, than previous years, according to a press release from the S.C. Small Business Chamber of Commerce. And 35% of all workers with individual plans are now paying less than $10 per month. Low-wage workers with incomes between 100-150% of the poverty line are getting full-coverage plans with no premiums at all.
“It’s especially helpful to those between the ages of 60 and 64,” said Palmetto Project program director Shelli Quenga. “Premiums go up based on your age, and so too, hopefully, does your income, so they may not have gotten any financial assistance for their higher premiums. Now they can.”
Both Palmetto Project and the S.C. Small Business Chamber of Commerce work to help South Carolinians navigate the marketplace and find a plan that works for them, and with the number of options now available, having that guidance is more important than ever, Quenga said.
“For the whole state, but especially in our area, the plan options are vast,” she said. “For some counties, there are four different carriers to choose from, so all the carriers expanded where they’re offering coverage.” And none reduced coverage, she said.
“So there is certainly a lot of choice for consumers, but that means it can be more confusing, and not paying attention to the details of the plan can be a real problem,” she said. “You have to look more closely at the plan, and that means people have to understand what things like ‘deductible’ mean in order for things to make sense.”
The Palmetto Project, which helped thousands of families get approved for federal subsidized health care through the marketplace during the special enrollment period earlier this year, has its largest support team ever, nine people dedicated to helping people find an insurance plan that works for them.
And after being longtime supporters of the federal marketplace, the S.C. Small Business Chamber of Commerce is working under a federal navigator grant to help them connect people to insurance policies.
“What we’re encouraging people to do is contact us for more information,” Knapp said. “The number I give is our telephone number, and it goes right to my desk. We talk, we find out what they need and we hook them up with a navigator. We don’t make any money, we don’t sell insurance, this is just something we’ve been supportive of for years.”
“Even if they don’t call us, if they have their own agent, hopefully we’ve inspired them to call them to look at policies on the marketplace,” he said. “They may know somebody at the community health centers, and maybe they call them.”
Quenga said many small clinics in the Lowcountry and statewide are also Certified Application Counselors, recognized by the federal government as people who are capable of helping clients find an insurance plan through the marketplace.
“It’s really important to look for someone local you trust to help you figure it out, because there are so many plans for our area,” she said.
Enrollment normally runs through Dec. 15, but has been extended through Jan. 15, 2022, due to the pandemic. And if you do enroll ahead of the Dec. 15 deadline, but want to make changes, you can switch prior to Jan. 15.