Federal Marketplace Offers Help as Health Insurance Costs RiseJan 27, 2022 04:15PM ● By Frank Knapp Jr.
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].