South Carolina health insurance industry preps for open enrollment

Sept. 21--The South Carolina Department of Insurance won't release premium prices for Obamacare plans until early October and, in the meantime, even experts can't seem to agree on what consumers should expect.

Five insurance companies will offer plans to South Carolina customers on the federal marketplace this year -- up from four companies last year. Also, the number of plans shoppers can choose from will more than double.

"In good American economics, that means there is more competition and it could drive down the price. We just don't know," said Shelli Quenga, programs director for the nonprofit Palmetto Project, which recently won a $1 million federal grant to help residents in this state enroll in an Affordable Care Act insurance policy. The Beaufort County Black Chamber of Commerce won a similar, but smaller grant.

Enrollment through HealthCare.gov begins Nov. 15. Ray Farmer, the state's Insurance Department director, said customers shopping on the website tended to focus only on the price of the premiums last year. That's a mistake, he said.

"It's not about the premium payment exclusively. Obviously, that's a concern, but, any longer, that cannot be the sole criteria. We've learned that this year. Out-of-pocket expenses are enormous," Farmer said.

An insurance premium is the amount the customer pays every month for the plan. The out-of-pocket cost sets a limit for the maximum amount they will spend on their medical expenses in a year. These amounts vary from plan to plan. Preventative care, such as a routine visit to your primary care doctor's office, usually only requires a relatively low co-payment. But out-of-pocket expenses tend to accumulate for patients with complex medical needs -- such as surgery or specialty care.

"(Out-of-pocket costs) will run a couple thousand dollars per individual up to $6,660 per individual for this next year, depending on the plan," Farmer said. "And for a family, up to $13,200 -- now, that's the max. Most people will probably come in below that, but that's the max. For individuals who may or may not have had insurance in the past, who are new to the system, that's a big outlay. It's a tremendous outlay."

Still, these are fine-print details for many shoppers. For better or worse, the price of the monthly premium often drives their final decisions. Jim Ritchie, executive director of the South Carolina Alliance of Health Plans, said there's little chance those prices will shrink this year.

"Prices will likely rise overall," Ritchie said. "Some states are experiencing substantial increases -- double digit increases. I do not think you'll see that high of a jump in South Carolina."

An analysis published earlier this month by the Kaiser Family Foundation shows the difference between 2014 premiums and 2015 premiums varies widely by market. For example, the price may decrease by nearly 16 percent in Denver for some plans sold on the federal marketplace and increase by more than 8 percent in Nashville. South Carolina prices were not included in the report.

"I don't think they're going to go down," said Colin Smoak, a benefits consultant based in Mount Pleasant. "The amount of competition is not significant enough to drive it down."

While it's still too early to make final decisions, Smoak encouraged shoppers to sit down with a qualified insurance agent or an Affordable Care Act navigator to consider their options. Farmer said the insurance department's website also offers helpful information before enrollment begins.

"We're putting a ton of information on the website," he said. "This past year, people spent an average of 15 minutes to shop for health insurance. We're not shopping as long as we need to. For 15 minutes -- that could be one of the more prominent decisions you make all year."

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Reach Lauren Sausser at 937-5598.

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For more information

The following companies will offer a variety of health insurance plans for South Carolina shoppers on HealthCare.gov starting Nov. 15:

BlueChoice Health Plan

BlueCross BlueShield of South Carolina

Consumer's Choice Health Plan

Coventry Health Care of the Carolinas

Time Insurance Company -- marketed as Assurant Health

For more information about these companies, visit sc.doi.gov.

To contact an Affordable Care Act navigator for free advice about your insurance options, call Palmetto Project, 1-888-998-4646.

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