Many people were turned off last year by the troubled launch of federal health care reform. But with enrollment on the federal health care exchange open again, many are finding it easier the second time around.
Before she signed up this month, 43-year-old Melanie Durocher of Rock Hill hadn’t had insurance for a year. Hers was one of several families that fell into the South Carolina “donut hole” when the state decided not to participate in the Medicaid expansion created by the Affordable Care Act. She and her husband, Nathan, a warehouse worker in Charlotte, had incomes too high for coverage from the existing Medicaid program, but not high enough to qualify for subsidies on the federal health care exchange.
“We made too little money,” Durocher said. “It was scary.”
Durocher recently went to Piedmont Medical Center for a heart rhythm problem, a condition exacerbated by the removal of her thyroid during cancer treatments. Because she did not have insurance, the mother of four had stopped going to the doctor for regular checks on her condition.
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That’s when Diane Hall, PMC’s certified application counselor, found a plan Durocher’s family could afford.
She was told last year by another navigator that a plan for her and her husband would cost $600 a month, but she is now paying $51 a month. Helped by the fact her husband is now making slightly more money, the plan she signed up for has a $2,000 deductible, no co-pay for regular doctor’s visits, a $20 co-pay for a specialist and $5 per prescription for generic drugs.
Hall and other health care professionals hope Durocher’s story represents the second year of enrollment under President Obama’s signature law restructuring the U.S. health insurance market. Open enrollment for 2015 health plans on the federal exchange began Nov. 15 and will continue until mid-February. To be enrolled by the beginning of 2015, however, you must sign up for a plan by Dec. 15.
If, unlike Durocher, you were one of the 7 million Americans who managed to sign up for a plan last year even though the federal website was all but unusable for the first two months of enrollment, you will be re-enrolled in your current plan automatically. But cost-conscious shoppers might still want to check out what options may have changed.
A recent survey by the McKinsey Center for U.S. Health System Reform found newer plans can offer customers significant savings on the cheapest plans, and a breakdown by region shows local health care shoppers might have some of the most significant savings in the state. In York County, a 40-year-old single non-smoker with a 2014 “silver” plan faces a monthly premium of $309 for 2015, or more than a 4 percent increase, whereas switching to a new silver plan will save customers an average of $288, or almost 3 percent below their current plan.
The same person in Chester and Lancaster counties faces an even greater savings, with monthly premiums under the newer plans down 5.2 percent and 6.4 percent respectively.
Hall said she’s seen more people come in hoping to get insurance this year, not only because the plans are affordable but because more patients seem comfortable with the health care law and trusting of the process. The biggest hurdle might be sitting down with her for the 45-minute enrollment process.
“Still worth the wait,” she said.
Not everyone qualifies for federal assistance, but for those who don’t, Hall seeks other options to help them.
“We won’t turn you away,” she said. “We will get you the resources.”
One year after the Affordable Care Act went into effect, many more people need to be reached. More than 41 million Americans were uninsured in 2013, according to the U.S. Department of Health and Human Services, including more than 16 percent of South Carolinians.
The law mandates individuals buy insurance or face a tax penalty. The penalty increases from $95 per adult and half of that per child, or 1 percent of household income in 2014, whichever is higher, to $325 per adult and $162.50 per child, or 2 percent of household income in 2015.
BlueCross BlueShield of South Carolina, the state’s largest insurer, is encouraging its customers to meet with an agent to review their new or existing plans. New options may be available, especially if a person’s income changed enough to affect eligibility for subsidies.
“If you’re pleased with what you have now, you can stay on your plan, but we can do a bit of housekeeping,” said BlueCross spokesman Adam Myrick.
BlueCross has a mobile bus unit criss-crossing the state during the enrollment period, with scheduled stops in Rock Hill at Doctors Care on Cherry Road on Dec. 14-17 and Walmart on Dave Lyle Boulevard on Feb. 4-7.
BlueCross BlueShield is one of several companies with plans available on South Carolina’s health insurance exchange, along with BlueChoice Health Plan, Consumers’ Choice Health Plan, Coventry Healthcare of the Carolinas and 2015 newcomer Assurant Health.
Durocher was initially distrustful of the ACA, particularly when finding a plan proved to be unaffordable. But that changed once she and her family found coverage they had lacked for so long.
“I started crying,” she said. “Finally, we had a plan that works for us.”