10 things you need to know about Monday’s federal health insurance sign-up deadline

jholleman@thestate.com March 29, 2014 

Here are 10 things you need to know about Monday’s Health Insurance Marketplace deadline:

1. It’s only sort of a deadline. Anyone who has started the registration process online or by phone, but isn’t able to finish by March 31, will be given time to complete the process after March 31. The Centers for Medicaid and Medicare Services compare it to voting. If you’re in line at 7 p.m. on Election Day, you get to vote. The time limit for complete registration is squishy, though CMS says it must be done “quickly.”

2. If you’re 65 or older, you qualify for Medicare and don’t need to worry about the Health Insurance Marketplace. If you have health insurance through your job, you don’t need to worry about it. If you have private health insurance that you’re happy with, you don’t need to worry about it.

3. If you earn less than $11,500 annually you don’t qualify for tax subsidies that make the Health Insurance Marketplace policies more affordable. Without those subsidies, you won’t be able to afford a policy. You’re in a gap created when South Carolina leaders turned down the federal expansion of Medicaid.

4. Most people are required by the Affordable Care Act to have health insurance this year. The penalty for not having insurance is $95 per person or 1 percent of annual income, whichever is greater. It will come due when you file your 2015 taxes.

5. A lot of people in South Carolina, however, will be exempt from the penalty. Anyone making less than $15,300 is exempt. So are Native Americans, illegal immigrants and some religious groups that refuse health care. Of course, people 65 and older don’t need to worry either – see No. 2.

6. If you sign up for a policy on the Health Insurance Marketplace, you’ll have multiple choices. There are four companies on the federal marketplace in South Carolina – Blue Cross and Blue Shield of South Carolina, BlueChoice Health Plan, Consumers’ Choice, Coventry. They offer policies at three levels – bronze, silver and gold. Generally, premiums are lowest at bronze and highest at gold, while benefits are best at gold and worst at bronze. Because of the way the tax subsidies are structured, silver plans often are the best value.

7. The federal government gave grants to local groups to provide Navigators to help people through the process. You’ll find Navigators at most of the registration events in these final days. You also can register on your own online at healthcare.gov, through the insurance companies selling policies or through a private insurance broker.

8. You need to understand the nuances of physician networks, deductibles and out-of-pocket expenses. The Q&A at healthcare.gov does a good job of explaining those. If you read those explanations and are still confused, you probably need to get the help of the folks mentioned in No. 7.

9. People who have used the policies in the first three months of the year have had the most problems with physician networks. If you have a preferred primary care physician, call that office to make sure they accept Health Insurance Marketplace policies. Don’t rely entirely on lists on the insurance company websites. Also, if you have a preferred hospital, make sure they are on your policy’s network. Many hospitals are on only one or two of the policy networks.

10. If you are younger than 30, you are eligible for a low-cost catastrophic plan. It’s not a bad deal if you’re generally healthy. You get three free primary care visits a year, and it protects you from a long-term hospital stay bankrupting you. But you don’t get much else.

The Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service