Are you tired of stressing out of your health insurance? If you need some help deciding, we’re here for you. Between major medical insurance, short-term health insurance, Christian health plans, and more, evaluating all of your different options can be confusing and frustrating. But our insurance experts have a plethora of knowledge to help you weigh the pros and cons of each. After you’re done reading this, we hope you’ll have learned enough new information to make a good decision. But if not, we are standing by and ready to help.
Major Medical Insurance in South Carolina
The Patient Protection and Affordable Care Act has been law since it was passed back in 2010. Two things came about as a result of this legislation: the federal Health Insurance Marketplace, and the laws and regulations which dramatically changed the way major medical coverage works in the US. Major medical coverage is now much more comprehensive and has many more consumer protections than it did in the past. And the federal Health Insurance Marketplace is the place you go to apply for this type of coverage and see if you qualify for money-saving subsidies.
Because South Carolina does not have its own state Exchange, you have to apply through the federal exchange by visiting HealthCare.gov and filling out an application online. You can also call a local office and ask for assistance if you would rather not fill out an online application. The application is fairly simple and straightforward, can be filled out in an afternoon, and mostly asks questions about your income, household size, and tobacco use. Once you fill out the application and give them your information, you can see whether or not you qualify for major medical coverage.
Major medical coverage is considered one of the best options in the healthcare industry today. With these types of insurance policies, no health insurance company can reject you for coverage if you are approved by the federal Marketplace. This is true even if you have pre-existing conditions or if you aren’t a perfectly healthy, ideal health insurance candidate. As a matter of fact, the only things that can alter whether or not you qualify for coverage and how much money your insurance company can charge you for your monthly premiums are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Major medical coverage is one of the only ways to get the 10 guaranteed Essential Health Benefits as outlined by the ACA legislation. What’s so special about these health benefits? They are the benefits that you and your family need in order to maintain optimal health and wellness while also saving you money on your medical costs over time. And those benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Unfortunately, many insurance companies have to raise their rates and charge more money to make guaranteed issue policies with all of these comprehensive benefits available to their customers. But there are federal subsidies which can help make these policies more affordable and save you hundreds of dollars a month in premium costs. You just have to make a minimum of 138% of the federal poverty limit in order to qualify for one of these subsidies. If you’re unsure as to whether your income qualifies you and your household for this premium tax credit, just take a look at the chart below:
|Household Size||Annual Income (138% of FPL)||Annual Income (100% of FPL)|
The middle column is the minimum amount you need to make to qualify for a federal tax credit that makes your ACA insurance more affordable. The column on the right is the maximum amount of income you are allowed to make in order to qualify for Medicaid. If you fall somewhere in the middle, you fall into something called the Medicaid expansion gap. The ACA legislation set aside federal funds for all states to expand Medicaid so that people who exist in this gap could apply for Medicaid despite making too much money – but a lower court decision changed the law so that certain states could choose to reject this money and leave people without healthcare if they wanted. South Carolina is one of the states who chose to reject this funding. So if you fall into this gap, the next insurance option you might want to look at is either short-term health insurance or a Christian health plan. And if your income is low enough to qualify for Medicaid, then you simply go to the South Carolina Medicaid website and fill out an application – just understand that most Medicaid programs, including South Carolina’s, ask that you meet additional requirements beyond being low income in order to qualify for this type of healthcare.
Short Term Health Insurance in South Carolina
Short-term health insurance works a little bit differently in South Carolina. In recent years, they passed laws to make it easier for customers to differentiate between legitimate major medical coverage through the ACA and short-term health insurance plans. In order to make the distinction more obvious, they limited the length of short-term health insurance to 11 months initially and a maximum of 33 months, including renewals. Other than that, short-term health insurance works in a similar manner to the rest of the country.
Another big distinction that many people might not know about the difference between short-term health insurance and major medical coverage is medical underwriting. Medical underwriting is the process by which your insurance company evaluates you to see how expensive it might be to offer you coverage. This is the opposite of guaranteed issue, where they treat you equally compared to other applicants (minus certain specific factors). Medical underwriting can get you rejected for coverage from the get-go, or it can make your monthly premium much more expensive. Short-term health insurance also usually doesn’t offer all of the essential health benefits that major medical plans do, although some come close and others may even offer to sell you extra coverage for a higher premium. There are annual and lifetime benefit caps on most short-term health insurance policies, and many of them come with very expensive deductibles (sometimes as high as $5,000 or more) that have to be paid out of pocket by you before your insurance effectively kicks in. For many South Carolina residents, though, this can still be a cheaper and sometimes a life-saving option compared to going without insurance.
Christian Health Plans/Health-Sharing Plans in South Carolina
Another option you might want to consider if you are looking at short-term health insurance is a health-sharing plan, also known as a Christian health plan. These two plans actually have a lot in common, but Christian health plans were more popular a couple of years ago back when there was still an individual mandate in South Carolina. Now that the individual mandate is gone, there’s no reason to purchase health insurance if you don’t have to – but it’s certainly a smart idea to have some sort of coverage in your back pocket in case an unexpected injury or illness happens to you.
When comparing your options, most people compare a Christian health plan to a short-term health insurance plan if they can’t get coverage through the ACA. These plans actually have a lot in common, such as:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed essential health benefits
- Their monthly share payments cost around 33% less than an unsubsidized ACA monthly premium
One of the most obvious differences between a Christian health plan and short-term health insurance in South Carolina is the fact that you can maintain continuous coverage all year, whereas the 11-month limit can make short-term plans difficult to navigate. But short-term plans do have consumer protections so that you can take your insurance company to court if they unjustly deny you benefits or fail to pay out claims; this is not the case for a Christian health plan. Christian health plans will impose membership guidelines that you must follow, like attending church a certain number of times per year or officially declaring a specific religious faith if you want to remain in good standing. Still, these plans are relatively comprehensive despite not automatically containing all of the Essential Health Benefits and are relatively affordable compared to unsubsidized ACA coverage. So it might not be a bad idea to take a closer look at them.
Fixed Indemnity Plans in South Carolina
The best reason to purchase a fixed indemnity plan is as a supplement four major medical coverage, short-term health insurance, or something similar. Fixed indemnity plans work great as a supplement because you aren’t restricted to specific medical networks the way you are with major medical (which usually won’t let you go outside of your HMO or PPO network). This can help you get the care you need at a more affordable price if you would otherwise have to pay out-of-pocket at an out-of-network provider. Fixed indemnity plans payout on a per day, per week, per month, per visit, or per-incident basis.
One thing you probably shouldn’t do is use a fixed indemnity plan to replace major medical coverage. One of the things about major medical coverage and similar options is that your insurance provider will pay out a fixed percentage of your total medical costs, no matter how expensive your care becomes. But fixed indemnity plans only pay out a fixed amount which means that the remainder of your medical expenses can become disastrously costly if you require a lot of care. There’s also medical underwriting that you’ll have to go through which might leave you rejected for coverage are paying higher monthly premiums. On top of only paying at a fixed amount when they do payout on your claims, fixed indemnity plans have caps on lifetime and annual benefits, further increasing your financial burden. At the same time, it can still be better than nothing – especially if you suddenly face an unexpected medical emergency. But these plans still work better as a supplement for more comprehensive types of coverage.
Discount Cards in South Carolina
Some people try to supplement things like short-term health insurance or major medical coverage with a medical discount card membership. But please understand that these cards are not insurance, nor are they a legitimate replacement for insurance. They give you a minor to moderate discount when you purchase things like prescription drugs or get certain medical care, and that’s about it. But you won’t be filing any claims, waiting for any reimbursements, or getting any significant, fixed percentage of your medical costs covered with a medical discount card.
Medical discount cards aren’t for everyone. Some people might not need to get enough medical care or receive large enough discounts to make the cost of membership worth it in the long run. Some medical discount card companies exaggerate or flat out lie about the discount you are eligible for and the providers who participate with them. But sometimes, if you are careful and you do your homework before purchasing a discount card membership, you can get your money’s worth and then some out of the discounts you receive. This is especially helpful for supplementing other, more comprehensive forms of coverage, especially if you have high deductibles or other large out-of-pocket costs.