Compare South Carolina Marketplace And Senior Health Insurance Rates

Affordable individual health insurance rates in South Carolina are available. The  SC Exchange provides low cost coverage for many individuals, families, and small businesses that are not currently covered, or are eligible for federal subsidies. Consumers covered under private plans or through an employer may also be able to lower their rates by purchasing a Marketplace or SHOP plan. Senior Supplement, Advantage, and Part D prescription drug plans are offered to applicants that have reached age 65 and are eligible for Medicare.

We offer direct free online quotes so that you can quickly view the best healthcare prices in South Carolina, and also apply for benefits without paying any fees. You do not have to answer medical questions, pre-existing conditions are covered, and you can not be denied for underwriting reasons. We make it easy to compare multiple policies, calculate your federal subsidy, and apply online in 15-25 minutes. Applicants under age 65 can receive financial assistance based on projected household income. Lower-income households may be eligible for Medicaid.

SC Senior Medigap plans are also available from many of the top-rated carriers. Medicare Supplement options provide 11 different contracts (including a high-deductible F plan) that can eliminate many out-of-pocket expenses, including Parts A and B coinsurance, Parts A and B deductible, skilled nursing facility coinsurance, and three pints of blood. “Advantage” contracts replace original Medicare benefits and provide a low-cost alternative that often includes drug prescription coverage. NOTE: The Senior Open Enrollment period starts on October 15th and ends on December 7th. However, there is a seven-month Medicare eligibility when you reach age 65.

 

What Is The SC Health Exchange?

Under The Affordable Care Act legislation (also referred to as “Obamacare”), each state has established an “Exchange” that serves as a marketplace for all of the different policies that will be offered in 2019, the fifth year of coverage. Because of the complexity of the operation and all of the recent legislative changes, trusted authorities like us help consumers find and compare the best options. Actual Open Enrollment begins on November 1 and ends on December 15th.

South Carolina is one of  many states that allows the federal government to operate its Exchange. It’s a big undertaking, considering the large number of persons that typically need help applying for coverage before the end of Open Enrollment. A federal tax penalty of $695 per adult and $347.50 per child, or 2.5% of total household income (whichever is higher) is  no longer assessed to anyone that does not purchase “qualified” health insurance, or is not covered under another Group plan. The household maximum penalty (shared responsibility payment) of $2,085 has been eliminated.

One of the biggest challenges is always contacting families in lower-income areas that may not understand that a subsidized policy may cost much less than anticipated. In thousands of situations, families can obtain free or near-free benefits by being Medicaid-eligible or qualifying for financial aid that pays the entire premium. It is also possible to be eligible for Medicaid and Medicare (Dual-Eligible).

 

What If I Waited Too Long For Open Enrollment Period?

You can qualify for a “special” exemption (SEP) which allows you to purchase coverage at any time of the year with or without government assistance. There are many approved exceptions including substantial changes in income, loss of existing qualified benefits, moving outside of your service area, divorce, reaching age 26, and no longer being incarcerated!

You can also purchase an inexpensive temporary contract that will provide coverage up to $1 million for 12 months. Since it is not considered an approved Obamacare policy, existing medical conditions will likely not be covered and chronic conditions and non-generic medications may not be sufficiently covered. Several medium-sized carriers offer a temporary plan that can be approved within 48 hours. An initial payment is required along with a small application fee ($20-$50).

This type of policy is not  designed to be kept for longer than 6-12 months, since ongoing chronic treatment will be limited or excluded when the policy is renewed. But it serves as an ideal stopgap plan if you are waiting for other benefits to begin. Depending upon the carrier, network benefits may extend to neighboring states including North Carolina, Georgia, Tennessee, Kentucky, and Alabama.

 

Which Companies Can I Choose From?

Companies that do business in the state must be approved by the SC Department of Insurance, Not all licensed carriers necessarily offer plans on the Exchange. There are also companies that offer short-term/temporary plans, but not long-term coverage. Since UnitedHealthcare, Cigna, and Aetna no longer offer “on-Exchange” coverage, the only companies licensed for offering Marketplace plans are Blue Cross Blue Shield of South Carolina (BCBS) and Absolute Total Care (Ambetter).  BCBS offers plan in all counties while Absolute Total Care offers plans in Charleston County (only).  BlueChoice Health Plan offers private coverage. Additional companies may offer qualified plans within two years, depending upon future legislation.

BCBS offers plans in the Catastrophic, Bronze, Silver, and Gold tiers. “Blue CareOnDemand” is available with all policies at no cost. This free service provides access to physicians through video consultations. Designed to effectively treat minor medical conditions with small copays, a computer or smartphone can be utilized for rapid responses. The flu, fevers, rashes, ear infections, and migraines are several common treatable ailments. Medications can also be prescribed to be picked up at a local pharmacy. For families with several young children, the savings in copays and travel time can be significant.

 

The following carriers are licensed and authorized to offer Group plans or coverage that is considered off-Exchange:

Aetna

BCBS

BlueChoice HealthPlan

UnitedHealthcare

 

Will The Government Pay For My Policy?

Probably not all of your premium, but it’s possible a large portion might be paid by a federal subsidy. Here’s how it works: Assuming you are not currently covered by Medicaid or Medicare, financial assistance is based on your individual or family household income. If your income is between 100% and 400% of the FPR (Federal Poverty Level), you are eligible for the subsidy.

All “Metal” plans are eligible for financial assistance. However, “catastrophic” policies do not qualify for subsidies, since not all applicants can purchase this type of contract. For example, you must be under age 30 or be able to show poof of financial hardship. There are many specific exemptions that are allowed.  Since catastrophic contracts often cost more than Bronze contracts, they are not especially popular. The number of provided office visits that are only subject to a copay, are often limited on catastrophic plans.

Best ealthcare Quotes South Carolina Marketplace

No Medical Questions During Open Enrollment

Your income is likely to be different each year and the FDR also changes annually, so your eligibility (and amount) will have to be re-calculated each year. Single persons (with no dependents) making under $46,000, a couple with income under $62,000 and a family with one child making under $78,000 will likely receive benefits.

Of course, the lower the income, the higher the amount funded by the government. NOTE: Since your household MAGI (Modified Adjusted Gross Income) can change, it’s important to re-calculate your subsidy each year so you are not liable for a large tax penalty the following year.

Sample Premiums

Below, we have listed estimated 2019 monthly rates for several of the most popular plans in the Charleston area. Additional options are available in other counties. For this example, we are showing prices on a family of four (Ages 50, 50, 20, and 18) with household income of $60,000. The federal subsidy has automatically reduced the premium, and lowered deductibles, copays, and out-of-pocket expenses on Silver-tier plans. This “cost-sharing” is only offered in the Silver tier.

Bronze Tier

$0 – BCBS of South Carolina BlueEssentials Bronze 1 –  Deductible is $7,000 with maximum out-of-pocket expenses of $7,90  and 50% coinsurance.  Tier 1 drugs subject to copay of $30 (retail) or $42 (mail-order).

$0 – BCBS of South Carolina BlueEssentials HD Bronze 2 – $6,300 deductible with $6,750 maximum out-of-pocket expenses and 50% coinsurance.

$0 – BCBS of South Carolina BlueEssentials  Bronze 4 – $6,400 deductible with $7,900 maximum out-of-pocket expenses and 50% coinsurance. Office visit copays are $25 and $50. Tier 1 drugs subject to copay of $12 (retail) or $17 (mail-order).

$0 – BCBS of South Carolina BlueEssentials HD Bronze 5 – $6,750 deductible with $6,750 maximum out-of-pocket expenses and 50% coinsurance.

$0 – BCBS of South Carolina BlueEssentials HD Bronze 3 – $5,500 deductible with $6,750 maximum out-of-pocket expenses and 30% coinsurance.

$306 – Ambetter Essential Care 1 – $7,900 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance. Generic drug copays are $20 (retail) and $60 (mail-order).

 

Silver Tier

$386 – BCBS of South Carolina BlueEssentials Silver 29 – $20 and $45 office visit copays with $50 copay for Urgent Care. $5,350 deductible with $5,350 maximum out-of-pocket expenses and 0% coinsurance. Tier 1 and Tier 2 drugs subject to $20 and $50 copays. Tier 3 and Tier 4 drugs subject to deductible.

$398 – BCBS of South Carolina BlueEssentials Silver 30 – $25 and $60 office visit copays with $60 copay for Urgent Care. $4,900 deductible with $5,900 maximum out-of-pocket expenses and 20% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $50 copays. Tier 3 and Tier 4 drugs subject to deductible and 20% coinsurance.

$409 – Ambetter Balanced Care 11 – $20 and $40 office visit copays with $75 copay for Urgent Care. $2,625 deductible with $6,300 maximum out-of-pocket expenses and 40% coinsurance. Tier 1 and Tier 2 drugs subject to $20 and $50 copays.  Tier 3 and Tier 4 drugs subject to deductible and 40% coinsurance.

$410 – BCBS of South Carolina BlueEssentials Silver 34 – $20 and $50 office visit copays with $50 copay for Urgent Care. $4,000 deductible with $5,700 maximum out-of-pocket expenses and 15% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $40 copays. Tier 3 and Tier 4 drugs subject to deductible and 15% coinsurance.

 

Gold Tier

$475BCBS of South Carolina BlueEssentials Gold 4 – $10, $30, and $40  pcp and specialist office visit copays. $2,700 deductible with $6,000 maximum out-of-pocket expenses and 20% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $40 copays. Tier 3 and Tier 4 drugs subject to  $100 copay and 30% coinsurance.

$535 – BCBS of South Carolina BlueEssentials HD Gold 3 –  HSA-eligible plan with $3,000 deductible and $3,000 maximum out-of-pocket expenses and 0% coinsurance.

$543 – BCBS of South Carolina BlueEssentials Gold 2 – $20 and $40  pcp and specialist office visit copays with $50 Urgent Care copay. $1,500 deductible with $5,000 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 drugs subject to $20 and $40 copays. Tier 3 and Tier 4 drugs subject to  $100 copay and 30% coinsurance.

 

Monthly Health Insurance Rates In Columbia (35 Year-Old Male With Income Of $30,000)

$18 – BCBS BlueEssentials Bronze 1

$28 – BCBS BlueEssentials Bronze 4

$29 – BCBS BlueEssentials Bronze 5

$29 – BCBS BlueEssentials Bronze 2

$31 – BCBS BlueEssentials Bronze 3

$204 – BCBS BlueEssentials Silver 14

$206 – BCBS BlueEssentials Silver 7

 

Cheap Charleston SC Healthcare Plans

Charleston Healthcare Rates Are Very Affordable

Are Rates In Charleston  The Same As Other Cities?

Prices  vary, depending upon where you live (see above). So yes, rates in Columbia, Charleston, Rock Hill,  Summerville  and most other cities will be different. The cost of healthcare in your area along with the availability of facilities may impact what you pay. If there are more major hospitals within a 30-mile radius of where you live, you may be charged less than a rural area with limited options. Previously, when more companies offered private plans,more choices for consumers meant lower prices. It is hoped that by   2020, additional companies will return.

Other factors that could impact cost, include your age, amount of federal subsidy you receive (as previously discussed) and your smoking status. If you have used tobacco products within the last 12 months, there will be a modest surcharge. However, medical questions can not be asked, height and weight (BMI) will not be a factor, and pending or recent surgeries will not be considered. Also, there are no price differences between males and females.

Note: If you previously selected a plan from UnitedHealthcare, providers from the Carolina Healthcare System can no longer be used. This includes Roper St. Francis and affiliated physicians and hospitals.  However, it is possible that an agreement will be reached in the future and network privileges will be reinstated. Also, Charleston hospitals (such as Trident and East Cooper) are not impacted.

 

What Is The Cheapest Policy I Can Purchase?

The least expensive plan will likely be a “Bronze” option, since you will potentially have the highest out-of-pocket expenses. The other three types of plans are Platinum, Gold and Silver. Costs are based on “actuarial value,” which is the cost that the owner of the policy is expected to pay, based on projected expenses. For example, the Bronze plan is based on paying 40%, while the Platinum option (the most expensive) is based on only 10%. The five least expensive BCBS plans are BlueEssentials Bronze 1, BlueEssentials HD Bronze 5, BlueEssentials HD Bronze 2, BlueEssentials HD Bronze 3, and BlueEssentials Bronze 4.

However, if your income is between 100% and 150% of the Federal Poverty Level, you can qualify for a policy with lower spending caps (maximums) without spending the money on a “Platinum” option. These are called “HSA Level” contracts and they are ideal if you have serious medical conditions that require multiple medications, treatments and specialty visits.

Income under 100% should qualify for Medicaid (SC) which is being expanded in many states. CHIP is also available to children of low-income families. “Healthy Connections” is the state plan which provides benefits to aged, blind or disabled (ABD), breast and cervical cancer victims and  disabled children. It is possible to have children covered under CHIP, while the parents receive their benefits from a private plan.

 

South Carolina Medigap Coverage For Seniors

Once you reach age 65, you will probably be eligible for Medicare. Benefits can be provided through original Medicare, and a Part D prescription drug plan can be purchased. Also available are Part D prescription drug plans. a Supplement contract can be added to pay for many of the out-of-pocket expenses (deductibles, copays, and coinsurance) not covered. Another option is enrolling in an “Advantage” plan that covers Parts A and B, and often Part D. Premiums are often fairly low. The Part A premium costs $227 per month for most persons. Part A and B deductibles are $1,316, and $183 respectively.

Carriers authorized to offer SC Medicare Supplement plans are listed below:

 

AARP (UnitedHealthcare)

American Continental

American Pioneer Life

American Republic

American Retirement

Americo Financial

Assured Life

Aetna

Bankers Life

BCBS Of South Carolina

Central Reserve Life

Central States

Cigna

Combined Insurance

Conseco

Constitution Life

Continental General

CSI Life

Everest

Family Life

Federal Life

First Health

Gerber

Globe

Great American

Guarantee Trust

Humana

Liberty National

Manhattan Life

Mutual Of Omaha

Oxford Life

PacifiCare

Pennsylvania Life

Physicians Mutual

Provident

Pyramid Life

Reserve National

Shenandoah Life

Standard Life And Accident

State Farm

State Mutual

Sterling Life

Transamerica

United American

USAA

United Teachers

United World

 

SC Medicare Supplement Rates

Prices can frequently change. However, we have posted below the most recent estimated monthly rates for several ages, plans, and counties. Some plans are not offered in all areas.

 

Greenville, Mccormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan A – Female Age 65

$66 – AARP-UnitedHealthcare

$82 – Continental Life

$84 – Transamerica

$85 – Philadelphia American Life

$89 – CSI Life

$94 – Shenandoah Life

$94 – Thrivent

$94 – United American

$95 – Western United Life

$95 – Equitable National Life

$95 – Liberty Bankers Life

$96 – Cigna

$98 – Guarantee Trust Life

$99 – New Era Life

$104 – Greek Catholic Union

$104 – National Guardian Life

$107 – Central States

$109 – Combined Insurance

$112 – Medico

$115 – Humana

$120 – Individual Assurance

$131 – Christian Fidelity Life

$137 – Gerber

$153 – Oxford Life

 

Greenville, Mccormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan F – Female Age 65

$115 – Philadelphia American Life

$118 – Thrivent

$118 – Liberty Bankers Life

$119 – Cigna

$119 – Equitable National Life

$120 – Western United Life

$120 – Guarantee Trust Life

$122 – Continental Life

$124 – AARP-UnitedHealthcare

$124 – National Guardian Life

$129 – Greek Catholic Union

$132 – Transamerica

$134 – Shenandoah Life

$136 – Liberty Bankers Life

$140 – Combined Insurance

$142 – Individual Assurance

$144 – American Retirement Life

$145 – Christian Fidelity Life

$147 – CSI Life

$148 – Humana

$150 – Medico

$155 – Central States

$165 – Oxford Life

$170 – United American

$199 – Gerber Life

 

 

Greenville, Mccormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan F (HD) – Female Age 65

$26 – United American

$32 – Philadelphia American Life

$34 – Cigna

$35 – United World Life

$47 – Continental Life

$56 – Humana

 

Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan F (HD) Male Age-65

$30 – United American

$35 – Philadelphia American Life

#39 – Cigna

$44 – Mutual Of Omaha

$53 – Humana

$54 – Continental Life

 

Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan G Male Age-65

$101 – Philadelphia American Life

$101 – Transamerica

$102 – Greek Catholic Union

$103 – CSI Life

$104 – Western United Life

 

$104 – AARP-UnitedHealthcare

$106 – Cigna

$107 – Equitable National Life

$107 – Thrivent

$108 – National Guardian Life

$108 – Liberty Bankers Life

$109 – Individual Assurance

$109 – Guarantee Trust Life

$111 – Continental Life

$114 – Humana

$116 – Shenandoah Life

$123 – Combined Insurance

$125 – Medico

$125 – Oxford Life

$125 – Christian Fidelity Life

$160 – United American

$175 – Gerber

 

Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan N Male Age-65

$82 – AARP-UnitedHealthcare

$86 – Transamerica

$87 – Greek Catholic Union

$89 – Humana

$90 – Cigna

$90 – Equitable National Life

$91 – Western United Life

$91 – Thrivent

$92 – Guarantee Trust Life

$92 – Liberty Bankers Life

$94 – New Era Life

$94 – Continental Life

$95 – National Guardian Life

$95 – Shenandoah Life

$97 – Individual Assurance

$99 – American Retirement Life

$110 – Christian Fidelity Life

$116 – Medico

$123 – Combined Insurance

$137 – Oxford Life

$142 – United American

 

Charleston, Colleton, and Dorchester Counties Plan C Male Age 65

$143 – AARP-UnitedHealthcare

$146 – Western United Life

$152 – Humana

$154 – Transamerica

$158 – New Era Life

$217 – United American

 

Charleston, Colleton, and Dorchester Counties Plan F (HD) Male Age 65

$33 – United American

$38 – Philadelphia American Life

$42 – Cigna

$53 – Humana

$61 – Continental Life

 

Charleston, Colleton, and Dorchester Counties Plan N Male Age 65

$90 – Transamerica

$96 – AARP-UnitedHealthcare

$97 – Western United Life

$97 – Guarantee Trust Life

$98 – Greek Catholic Union

$98 – Cigna

$100 – Equitable National Life

$100 – Thrivent

$100 – New Era Life

$100 – Humana

$102 – Liberty Bankers Life

$103 – Shenandoah Life

$103 – Continental Life

$104 – CSI Life

$105 – National Guardian Life

$107 – Individual Assurance

$109 – American Retirement Life

$117 – Humana

$121 – Christian Fidelity Life

$125 – Medico

$130 – Combined Insurance

$150 – Oxford Life

$157 – United American

 

 

SC Medicare Part D Prescription Drug Plans

Envision RxPlus – $14.90 monthly premium with $325 deductible. 2,963 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $6 (Tier 2), $35 (Tier 3), 37% (Tier 4), and 26% (Tier 5). 90-day supply preferred pharmacy cost sharing – $2 (Tier 1), $18 (Tier 2), $105 (Tier 3), 37% (Tier 4), and n/a (Tier 5).

SilverScript Choice – $23.50 monthly premium with $415 deductible. 2,995 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $5 (Tier 2), $20 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $15 (Tier 2), $60 (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Aetna Medicare Rx Select – $17.10 monthly premium with $405 deductible. 3,737 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $3 (Tier 2), $47 (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $9 (Tier 2), $141 (Tier 3), 44% (Tier 4), and n/a (Tier 5).

Aetna Medicare Rx Saver – $20.20 monthly premium with $335 deductible. 3,283 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $2 (Tier 2), $30 (Tier 3), 35% (Tier 4), and 26% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $6 (Tier 2), $90 (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Humana Walmart Rx Plan – $28.90 monthly premium with $415 deductible. 3,055 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $4 (Tier 2), 20% (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $12 (Tier 2), 20% (Tier 3), 35% (Tier 4), and n/a (Tier 5).

Humana Preferred Rx Plan – $31.30 monthly premium with $415 deductible. 2,968 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $1 (Tier 2), 25% (Tier 3), 49% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $3 (Tier 2), 25% (Tier 3), 49% (Tier 4), and n/a (Tier 5).

Express Scripts Medicare-Saver– $25.40 monthly premium with $415 deductible. 2,806 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $4 (Tier 2), 18% (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $12 (Tier 2), 18% (Tier 3), n/a (Tier 4), and n/a (Tier 5).

Express Scripts Medicare-Value– $40.50 monthly premium with $405 deductible. 3,242 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $3 (Tier 2), $20 (Tier 3), 48% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $9 (Tier 2), $60 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

Express Scripts Medicare-Choice– $91.60 monthly premium with $350 deductible. 3,681 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $2 (Tier 1), $7 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 26% (Tier 5). 90-day supply preferred pharmacy cost sharing – $6 (Tier 1), $21 (Tier 2), $126 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

WellCare Classic– $28.40 monthly premium with $405 deductible. 3,127 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $1 (Tier 2), $33 (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $3 (Tier 2), $99 (Tier 3), 44% (Tier 4), and n/a (Tier 5).

WellCare Value Script– $14.00 monthly premium with $415 deductible. 3,327 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $8 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $24 (Tier 2), $120 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

BlueCross Rx Value– $41.90 monthly premium with $35 deductible. 3,094 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $15 (Tier 2), $37 (Tier 3), 45% (Tier 4), and 31% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $45 (Tier 2), $111 (Tier 3), 45% (Tier 4), and 31% (Tier 5).

BlueCross Rx Plus– $138.10 monthly premium with $0 deductible. 3,113 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $3 (Tier 2), $20 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $9 (Tier 2), $60 (Tier 3), 40% (Tier 4), and 33% (Tier 5).

Cigna-HealthSpring Rx Secure-Essential– $21.80 monthly premium with $415 deductible. 3,154 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $3 (Tier 2), $20 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $9 (Tier 2), 20% (Tier 3), 50% (Tier 4), and n/a (Tier 5).

 

 

SC Medicare Advantage Plans (HMO or PPO)

AARP MedicareComplete – $215 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $335 for first 5 days, and outpatient hospital copay is $295. Primary-care physician and specialist office visit copays are $10 and $50. Urgent Care and Emergency Room visit copays are $30-$40 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5).

Aetna Medicare Premier – $150 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $320 for first 5 days, and outpatient hospital copay is $45-$295. Primary-care physician and specialist office visit copays are $15 and $45. Urgent Care and Emergency Room visit copays are $15-$45 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $2 (Tier 1), $5 (Tier 2), $42 (Tier 3), $100 (Tier 4), and 30% (Tier 5).

AFC Care Rx – $0 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 5 days, and outpatient hospital copay is $250. Primary-care physician and specialist office visit copays are $10 and $45. Urgent Care and Emergency Room visit copays are $10 and $75. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $45 (Tier 2), $95 (Tier 3), 33% (Tier 4), and n/a (Tier 5).

Allwell Medicare – $0 deductible, $0 monthly premium, and $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for first 5 days, and outpatient hospital copay is $100-$275. Primary-care physician and specialist office visit copays are $0 and $40. Urgent Care and Emergency Room visit copays are $40 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $8 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).

Cigna-HealthSpring Preferred – $300 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for first 5 days, and outpatient hospital copay is $0-$325. Primary-care physician and specialist office visit copays are $10 and $40. Urgent Care and Emergency Room visit copays are $55 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $3 (Tier 1), $13 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 27% (Tier 5).

EON Select – $250 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 5 days, and outpatient hospital copay is $225. Primary-care physician and specialist office visit copays are $10 and $50. Urgent Care and Emergency Room visit copays are $50 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $4 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5).

Humana Gold Plus – $195 deductible, $0 monthly premium, and $5,900 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for first 5 days, and outpatient hospital copay is $360. Primary-care physician and specialist office visit copays are $5 and $45. Urgent Care and Emergency Room visit copays are $5-$45 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $4 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5).

WellCare Premier – $150 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 6 days, and outpatient hospital copay is $225-$400. Primary-care physician and specialist office visit copays are $5 and $45. Urgent Care and Emergency Room visit copays are $30 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $27 (Tier 2), $45 (Tier 3), 35% (Tier 4), and 25% (Tier 5).

WellCare Value – $0 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 4 days, and outpatient hospital copay is $200-$300. Primary-care physician and specialist office visit copays are $5 and $35. Urgent Care and Emergency Room visit copays are $30 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $20 (Tier 2), $47 (Tier 3), 35% (Tier 4), and 33% (Tier 5).

Note: Plans shown above offer prescription drug benefits for Greenville County. Additional plans are offered in all other counties, although rates, availability, and deductibles and copays may differ.

 

Can A Navigator Tell Me To Purchase A Specific Plan In The Exchange?

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No, a “navigator” can not recommend a specific plan or provide  advice regarding which policy to purchase. They are also prohibited from discussing the federal subsidy tax implication and calculating what amount you may be eligible for. The best way to obtain coverage is through our website, the .gov website or through a licensed agent.

So…What can a navigator do and what is their purpose? Essentially, through community outreach programs, they can meet people (also go door-to-door) and discuss basic elements of the enrollment process. Persons that don’t have computers will be greatly helped by them, especially the elderly or persons without transportation.

 

HIEC

The Health Insurance Education Cooperative (HIEC) received more than a  half million dollars from the federal government to assist consumers. Educating persons that may not fully comprehend the process will be one of their primary tasks. With  20% of South Carolina’s population currently uninsured, plenty of help will be needed. However, websites (like ours) and reputable and licensed agents will also be used for enrollment and education.

Grocery stores, hospitals and churches may be places where you may see DECO Recovery Management talking about enrollment. They are one of the groups that received federal aid. They also plan on targeting libraries and community centers. Right now, medical facilities in Greenville, Aiken and Clarendon counties are training their employees to be navigators.

Buying  a South Carolina Health Insurance Exchange plan with the help of a federal subsidy is now possible. Since there are no medical questions required during Open Enrollment, the free quotes you view may save you a significant amount of premium dollars.

 

PAST UPDATES

Aetna has contacted about 3,500 policyholders in the state, informing them that their policies will not be renewed. However, new policies will be offered (probably at a higher rate) that include mandatory benefits, such as maternity and pediatric dental and vision benefits. If the household income meets Federal Poverty Level guidelines, the subsidy may pay for some (or all) of the premium increase.

Also, the navigator program, which received millions of dollars in federal funding, has not been a factor in educating or assisting consumers. “The Cooperative Ministry,” one of the largest organizations to receive money, have had no correspondence from residents that received information in the mail. Perhaps when all of  the glitches are sorted out, more consumers will contact them. Of course, websites (like ours) and experienced brokers are probably much more helpful.

Christian Soura has been appointed by Governor Nikki Haley to run the SC Department of Health And Human Services. Current director Tony Keck is leaving the office next month to accept a position with Mountain States Health Alliance, in Johnson City (Tennessee). The State Medicaid program cost more than $7 billion annual to run. About half of its recipients are children living in poorer counties of the state.

More than 200,000 persons enrolled for SC plans for 2015, about double from last year. The vast majority of applicants received federal subsidies with the average amount at about $300.  With the extension recently announced, more eligible persons will be able to apply for plans through April 15 if they meet certain criteria.

Get ready for new rates. Although not all plan prices are rising, some carriers have requested hefty premium increases. The SC Department of Insurance will determine the final price on all offered plans. Below, you can view projected increases from several popular Marketplace plans.

53.2% – Time Individual Medical

33.6% – Aetna POS-PD

19.6% – UnitedHealthcare Off Exchange

18.5% – Consumer’s Choice CC PPO Individual

14.4% – Coventry Carolinas SC Group PPO

With Obamacare in a “death spiral,” (according to many healthcare experts), one of the biggest unknowns is when Trump Administration plan changes will be effective, and of course, the details and costs of the new policies. We expect South Carolina consumers to be offered more choices and lower rates. However, the full implementation may take another 12-24 months.