Monthly Archives:November 2013

Will the IRS allow subsidies for carrier direct policies?

27 Nov , 2013,
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We recently receive news of another possible workaround for the problem plagued healthcare.gov website. Last week we learned that the National Association of Health Underwriters has requested clarification from the IRS on the subject of subsidy eligibility for consumers who purchase a Qualified Health Plan directly from an insurer. Specifically, it was asked if subsidy determination could be made at a later date, for example, at the time of 2014 tax filing. Currently, as the law stands, coverage must be purchased through the Federal Marketplace to be subsidy eligible. However, a change in this interpretation of the law could open the door for many more consumers to get enrolled, without the burden of applying through healthcare.gov. The downside, however, is that consumers would have to finance the entire unsubsidized cost of the premium up front. Considering the median household income in South Carolina is roughly $42,000 per year, this could present a financial challenge for many residents who are already struggling with high premiums. However, we view any additional enrollment options as a move in the right direction. See below for the full NAHU update on the subject of carrier direct policy subsidies:

Finally, NAHU is seeking clarification from the IRS on a subsidy issue, which if resolved could also facilitate enrollment more directly. We have requested immediate clarification if individuals who can afford to advance the premium on their own monthly but might also be subsidy eligible could by an exchange offered QHP directly from a carrier “off the marketplace” and with out getting a marketplace subsidy determination. We have asked if it would be permissible for those individuals to obtain a subsidy determination and advance premium credits later, when the marketplace is working better, or simply claim the credit on their 2014 taxes with an exchange-based determination. As soon as we get resolution to this issue, we will let the membership know

Coventry now has MUSC in the Tier 1 network in the Charleston metro area plans

22 Nov , 2013,
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Great news! We have recently learned that the Coventry health plans offered through the Federal Marketplace in Charleston, Berkeley & Dorchester counties now have the Medical University of South Carolina contracted in the Tier 1 network! We confirmed this earlier in the week with our Coventry sales representative. But don’t take our word for it! Check out the screenshot below of a Tier 1 network hospital search from the Coventry website. The Post & Courier recently reported that Coventry had an exclusive contract with Roper St. Francis, however, made no men.tion of MUSC participating in the Tier 1 network. As your #1 South Carolina Obamacare agent, we work hard to bring you the most up to date information during the 2014 open enrollment season!

If you found this, or any other information on the site helpful, please feel free to choose us as your agent during your healthcare.gov enrollment. When filling out your application online, you can add me as your agent in Section 3, titled “Help Applying for Coverage” – select Agent/Broker and enter the following information: Name: Joshua Dickerson, NPN: 7889453, FFM ID: jtdickerson. As your agent we can coordinate with your insurer of choice to insure that your enrollment application is complete and processed correctly. We are licensed and appointed with all insurers on the federal exchange/marketplace in South Carolina. Need help applying on the Federal Marketplace? We can help! Contact us today to schedule a virtual meeting where we can get you logged into healthcare.gov and assist with your enrollment from the comfort of your own home. Our agency uses join.me to create secure virtual meetings to assist South Carolina residents applying on the federal marketplace. Why wait? The marketplace is NOW WORKING for most applicants!!!!

Coventry MUSC Tier 1


Carolina Care Plan Cancellation letter?

18 Nov , 2013,
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On July 1st, 2013 Carolina Care Plan announced they were leaving the South Carolina Health Insurance market. With this announcement, approximately 37,000 South Carolina residents received notification that their plans would end December 31, 2013. According to Carolina Care Plans parent company, Medical Mutual of Ohio, exiting the South Carolina market was a result of new legislation under the Affordable Care Act, and a desire to focus on their core market in Ohio.

What does Carolina Care Plans exit mean for South Carolina residents?

As one of the larger insurers in the individual health insurance market in South Carolina, Carolina Care Plan helped many residents obtain quality individual health coverage without exclusion riders. Prior to January 1st, 2014, insurers are allowed to charge applicants more, or even deny coverage for pre-existing conditions. Carolina Care Plan Exits SC

Because of current regulations allowing insurers to deny coverage, many of these SC residents may not be eligible for a new individual health plan until January 1st, 2014. Under the Affordable Care Act, also known as PPACA, ACA or “Obamacare”, insurers are no longer allowed to charge more or deny coverage for pre-existing health conditions. This is great news for many South Carolina residents who are currently “stuck” with Carolina Care Plan!

 We can help you REPLACE your Carolina Care Plan policy!

If you still have a Carolina Care plan because you have a pre-existing condition we can help you apply for a new 2014 plan with NO pre-existing condition exclusions! Contact us today and we will be happy to help you replace your Carolina Care Plan policy with a new 2014 health insurance plan – with NO pre-existing condition exclusions! OR checkout our South Carolina Health Exchange Rates page to view your 2014 health plan options and calculate any subsidies you may be eligible for!


SC Obamacare Delay?

14 Nov , 2013,
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Updated 11/14/2013 at 6:25pm EST

Currently, news channels and websites are abuzz about President Obama’s announcement to “fix” insurance cancellations. Of course, for anyone paying attention, talk about insurance cancellations has been a hot button issue in the news for the past few weeks.

Obamacare delayed in SC

As Moneynews.com reports: “It’s unclear what the impact of Thursday’s changes will be for the millions of people who have already had their plans canceled. While officials said insurance companies will now be able to offer those people the option to renew their old plans, companies are not required to take that step.”

Is this a SC Obamacare delay?

In South Carolina, the largest population of people losing their current plans are Carolina Care Plan policyholders. In July of 2013, Carolina Care Plan’s parent company, Medical Mutual of Ohio, made the decision to exit the state of South Carolina effective 1/1/2014. Unfortunately, we do not believe the White House “fix” announced today will affect these South Carolina policyholders.  Considering that Carolina Care plan is the second largest health insurer for South Carolina, we are somewhat disappointed. It seems highly unlikely that Medical Mutual of Ohio will choose to reverse their exit strategy. Many current Carolina Care Plan policyholders are having difficulty accessing the healthcare.gov website, and for many of these South Carolina residents, a subsidized health insurance plan from the Federal Marketplace is the only available option.

Our answer to “Is this a SC Obamacare delay?” – unfortunately not, for many South Carolina residents.

Are you losing your South Carolina Health Plan in 2014? Don’t count on a SC Obamacare delay! Contact us today for help, or check out our Quote Engine for South Carolina Health Exchange Rates.

Updates below:

SC Obamacare Delay Update from CIGNA  – 11/14/2013 – 6:24 PM EST

President Obama announced today that insurers may renew certain individual and small group health plans for 2014 without having to comply with new Affordable Care Act (ACA) requirements scheduled to take effect on January 1, 2014. Eligible policies include those with an effective date betweenJanuary 1 and October 1, 2014 that would have otherwise been terminated.

According to the President, this change is “targeted” to those individuals who are in these policies today; it does not allow the sale of non-compliant plans to people not currently in plans.

With this decision, state governors and insurance commissioners may allow insurers to continue to offer plans that may have otherwise been cancelled until the end of 2014.

Insurers that elect to take advantage of the transitional policy are required to:

  1. Notify enrollees about ACA requirements that are not met by the coverage they are renewing
  2. Notify enrollees about the new health plan options and tax credits available on the public Marketplaces to those who qualify

Cigna’s Position

Cigna is already working with all of our comprehensive individual medical customers to give them the choice of keeping their present plans.

Cigna’s Starbridge and Fundamental Care limited-benefit programs are not eligible for extension under this guidance. We are continuing to sunset these programs on December 31, 2013, as previously communicated.

Cigna is not active in the Small Group market.

3 Tips to Remember when you create a Marketplace Account

13 Nov , 2013,
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The following blog entry from healthcare.gov contains a few tips for establishing a Marketplace Account. I highly recommend using the Internet Explorer browser when attempting to setup your Marketplace account. And of course, if you found anything from schealthconnector.org useful, please consider designating us as your agent/broker. On section 3 of your subsidy application, entitled “Help Applying for Coverage”, enter the following information: Name: Joshua Dickerson, NPN: 7889453, FFM ID: jtdickerson. You can see an example of the Agent designation process in the image

Below is the link to the 3 tips to remember when you create a Marketplace Account:


3 Tips to creating a marketplace account



Healthcare.gov Update Tuesday – 11/12/2013

12 Nov , 2013,
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NEW Weekend Alert: The Health Insurance Marketplace online application isn’t available from approximately 1 a.m. to 5 a.m. EST daily while we make improvements. In addition, between Saturday evening, November 9 and early morning on Tuesday, November 12, there will be times when you can fill out your application, but you will need to return and log in Tuesday afternoon to review and submit it. The rest of the site and the Marketplace call center remain available during these hours.

South Carolina Healthcare Reform Quick Update – 11/08/2013

9 Nov , 2013,
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South Carolina Healthcare Reform Quick Update – 11/08/2013

The federal marketplace website has been working somewhat more reliably. However, as of Thursday 11/07/2013 the site indicated the HUB was down. Although we could complete and submit a subsidy application, we could not receive a subsidy determination. Stay tuned for more news! Currently, 11/09/2013, it appears applications are not available for access.

AMA study finds South Carolina Market 6th least Competitive

Nov , 2013,
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Nov. 7, 2013

CHICAGO – The American Medical Association (AMA) today announced its annual list of 10 states with the lowest levels of competition among commercial health insurers. Those are among 15 states in which a single company had a majority share of the market.

The list was developed from the newly released 2013 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets. The AMA study offers the largest, most complete picture of competition in the commercial health insurance markets across the United States. Based on 2011 data, the study examined state and metropolitan markets for the health insurance industry’s chief products, including point-of-service plans (POS), health maintenance organizations (HMO) and preferred provider organizations (PPO).

Top 10 States with the Least Competitive Commercial Health Insurance Markets
Top 10 States with the Least Competitive HMO Markets
Top 10 States with the Least Competitive PPO Markets
Top 10 States with the Least Competitive POS Markets

“In far too many states, one or two insurance companies dominate the market, which can hurt patients, physicians and employers,” said AMA President Ardis Dee Hoven, M.D. “Without rivals to compete against, a large health insurance company can take advantage of patients by raising premiums and dictating important aspects of patient care.”

Dominant market power increases the risk of anti-competitive behavior by big health insurers and can place physicians at a significant disadvantage since most work in small or solo practices. A report released in September by the AMA found that almost 60 percent of patient care physicians in the U.S. work in small or solo medical practices.“An absence of competition in health insurance markets places a particular strain on physicians in small practices who don’t have the leverage to be equal negotiating partners with large health insurers,” said Dr. Hoven. “The new AMA report is intended to help researchers, lawmakers, policymakers and regulators identify markets where mergers and acquisitions among health insurers may cause competitive harm to patients, physicians and employers.”

The AMA’s 12th annual report on the level of competition in the health insurance industry examined both fully-insured and self-insured plans in 386 metropolitan areas representing all 50 states and the District of Columbia.

Findings from the AMA study show:
The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Hawaii, 3. Michigan, 4. Delaware, 5. Alaska, 6. South Carolina, 7. North Dakota, 8. Nebraska, 9. Louisiana and 10. Rhode Island.
Fifteen states had a single health insurer with a commercial market share of 50 percent or more.
Forty-Five states had two health insurers with a combined commercial market share of 50 percent or more.
The 10 states that experienced the biggest drop in competition levels between 2010 and 2011 were: 1. Louisiana, 2. Idaho, 3. Oklahoma, 4. Iowa, 5. Texas, 6. Missouri, 7. Nebraska, 8. Kansas, 9. Ohio and 10. Arkansas.

Low levels of health insurer competition were present in 71 percent of the metropolitan areas studied by the AMA. These markets are rated “highly concentrated,” based on the 2010 Horizontal Merger Guidelines issued by the U.S. Department of Justice and Federal Trade Commission.
Competition in Health Insurance: A Comprehensive Study of U.S. Markets is free to AMA members. Non-members can purchase the study for $150. To order the study, please visit the online AMA Store, or call (800) 621-8335 and mention item number OP427113.

“Use It or Lose It” – IRS Modifies FSA Rules

1 Nov , 2013,
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On November 1, 2013 the Internal Revenue Service issued new guidance affecting Flexible Spending Accounts. How will this guidance affect South Carolina residents?

The new guidance allows up to $500 of unused FSA funds at the end of a plan year in a health FSA to be paid or reimbursed to plan participants for qualified medical expenses incurred during the following plan year, provided that the plan does not also incorporate the grace period rule. The new rule does not change the maximum annual contribution limit of $2500 to health FSA’s. In addition, the new guidance does not make the new carryover rules mandatory for employers.

Read more HERE….

IRS guidance HERE