Federal Marketplace Offers Help as Health Insurance Costs Rise – Greenville

Small business owners and workers across South Carolina have
found good news on affordable health insurance through the federal Health
Insurance Marketplace, where plans from private insurance companies could be
obtained with premiums based primarily on income but not on one’s health
status.

Rule changes last year delivered big savings on premiums paid by
small business owners and their employees for individual health plans through
the Marketplace.

No longer is there an income cap on who can receive premium
subsidies. That cap had shut out individuals making over 400 percent of the
federal poverty level from the premium assistance that made the health
insurance affordable. 

As a result, small business owners turned to less costly short-term,
low-benefit plans outside of the Marketplace. 

Now, many of these small business owners with the low-benefits
plans have switched to full-benefit plans through the Marketplace and are
paying less in premiums.

The other rule change was a dramatic increase in the premium
subsidies. As a result, health plans through the Marketplace became even more
affordable for low- and moderate-income workers. 

National data shows that four out of five workers enrolling in a
Marketplace plan found great coverage for $10 or less a month. Low-wage workers
with incomes between 100 percent and 150 percent could get full-coverage health
plans that had no premiums.

The need for affordable health insurance in South Carolina is
reflected in our state ranking seventh in Marketplace enrollment as of
mid-December out of the 33 states that use the federal program.  

Credit for this success goes to the South Carolina Primary Health
Care Association (SCPHCA), which has received a federal grant to provide
funding for 16 Marketplace navigators working in community health centers.
Insurance companies with plans in the Marketplace and independent insurance
brokers also deserve much credit for promoting the affordable health
insurance. 

My organization, the South Carolina Small Business Chamber of
Commerce, has worked with the SCPHCA to educate small business owners not
offering group health plans for employees. Our message has been that these
small business owners should learn about affordable coverage for themselves and
allow a navigator to talk to their workers about their opportunities.

Unfortunately, the open enrollment for the Marketplace ended Jan.
15. No longer can individuals simply enroll with the help of a navigator or
online at healthcare.gov with no questions asked.

However, there are 16 exceptions to this deadline that small
business owners and employees need to know about. An individual can obtain a
Marketplace plan outside of the official open enrollment period if they have
one of these “qualifying life events”: 

You get married;

You get divorced;

You have a baby or adopt a child;

The death of an individual living in your home reduces your
reported household size;

You experience a change in household size that impacts what you
report to the government for your household tax subsidy;

You have a change in income (either an increase or decrease) and
need to report it to adjust your tax subsidy;

You have an increase in income and no longer qualify for
Medicaid;

You lose your employer health insurance coverage;

Your health insurance plan cancels your coverage, even though
you’ve paid your premiums;

Your COBRA coverage expires;

You turn 26 years old and can no longer stay on your
parent’s healthcare plan;

You moved to a different ZIP code;

You are released from jail;

You experience domestic abuse;

You are discharged from the Armed Forces; and

When applying for health insurance, an error is made – either
human or technical error – which results in you not obtaining coverage.

Someone having one of these qualifying life events has 60 days to
enroll in the Marketplace and receive full premium assistance benefits.

Employers not providing group health insurance should help their
uninsured workers know about this opportunity for a Marketplace plan.

Small business owners that offer employees a group health
insurance plan should take particular notice of this qualifying life event –
the loss of employer health insurance coverage.

The cost of small business health insurance group plans increased
over 9 percent last year.  

A national survey by Small Business for America’s Future found
that 53 percent of small business owners who do offer insurance have considered
dropping it because of rising costs.

If a small business owner makes the difficult decision to drop
their group health plan, they need to know that the federal Health Insurance
Marketplace is there for them and their employees.

Small business owners understand that it is critical that all of
us have some form of quality health insurance. With good coverage, they and
their workers are healthier and more productive.

Finding solutions to the ever-rising cost of health insurance has
been a priority for the South Carolina Small Business Chamber of Commerce since
we began 22 years ago.

Our work on this issue continues today by spreading the knowledge
of the opportunity afforded by the federal Health Insurance Marketplace.

Frank Knapp is the President and CEO of the South Carolina Small
Business Chamber of Commerce and Co-chair of Small Business for America’s
Future. He can be reached at 803-252-5733 or [email protected]