South Carolina Blues - Health Care Reform FAQs


Health Care Reform FAQs

Health care reform will bring many changes. We want you to understand what this means to you. Read the answers to the top questions on health care reform.

Why Do We Have the Affordable Care Act (ACA)?

There are many reasons why the ACA was passed, but here are a few important ones:

  • High percentage of uninsured individuals -- The Congressional Budget Office estimated that 55 million Americans under the age of 65 were uninsured as of July 2012. The rate of the uninsured will continue to rise without the ACA.
  • Unsustainable spending -- In 2010, health care spending made up 17.9 percent of the gross domestic product in the U.S. and is expected to reach 20 percent by 2020.
  • Lack of emphasis on prevention -- According to the Centers for Disease Control and Prevention (CDC), preventable diseases such as obesity, diabetes, high blood pressure, heart disease and cancer cause seven in 10 deaths in the U.S., and 75 percent of our health care dollars are spent treating such diseases.

What Are The Different Types of Health Insurance?

  • Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
    HMOs and EPOs use networks of doctors, hospitals and other health care providers to keep costs down for members. If you use a doctor or facility outside of the network, you may have to pay the full cost of services.
  • Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
    With PPO and POS plans, you can use out-of-network providers and facilities, but it may cost you more. PPOs do not use referrals for out-of-network visits, but with a POS you’ll need a referral for out-of-network visits.
  • Catastrophic Health Insurance plans
    These plans are available if you are under 30 years old or you have a “hardship exemption” because the Marketplace determined you’re unable to afford coverage. Plans will typically cover only three primary care visits per year before you meet your deductible. The premiums are likely to be lower than other plans, but out-of-pocket costs for deductibles, copayments and coinsurance are generally higher.

How Will You Purchase Health Insurance in 2014?

Starting in 2014, all plans for individuals and small groups will cover the same set of essential health benefits. You’ll have several options for where to purchase your insurance:

  • Direct from BlueCross BlueShield of South Carolina
    If you’re happy with the coverage you get from us, you can choose to stay with it. Depending on your current plan, you may be able to keep your exact coverage or you may have to transition into a new ACA-compliant plan.
  • With the help of an agent or broker
    Whether you choose to use the Marketplace or our private exchange, an agent or broker can walk you through your options and help with your purchase.

How Much Will Marketplace Health Insurance Cost?

The prices of Marketplace plans will not be set until Oct. 1, 2013, when open enrollment starts. Marketplace plans are offered through private insurance companies. Each company will decide which plans they want to offer and how much they’ll charge. The prices will be approved by state insurance departments.

Lower costs based on income are available from the Marketplace. The Health Insurance Marketplace will tell you if you qualify for lower costs on your monthly premium or out-of-pocket costs.

When Can You Change Plans?

In 2013, you can begin enrolling in a new health plan on Oct. 1, 2013, but the plan will not be effective until 2014. This enrollment period will last until March 31, 2014.

In 2015, the annual open enrollment period will begin on Oct. 15 and end on Dec. 7.

How Will Your Premiums Be Affected?

This depends on what type of health insurance plan you choose and whether or not you qualify for financial help. The ACA-compliant plans are required to have standardized benefits, so it’s possible that they will cost more than your current plan. But this is not true for every case.