One of the Value Added features that sets Ambetter Plans apart from other Marketplace plans in South Carolina is the “My Health Pays” value added benefit!
WHAT IS “MY HEALTH PAYS Rewards”? My Health Pays is a Wellness program that rewards members for healthy behavior. The program uses a My Health Pays Visa card. Member can earn reward dollars for healthy behavior such as a Well Being Survey (worth $50), an annual Well Visit ($50) and getting a flu shot in the Fall ($25). The annual Well Visit will be at no cost to the member, provided that the member visits an in-network provider. Rewards will be loaded onto the My Health Pays Visa card upon completion of the healthy actions & members can earn up to $125 each year!
HOW DO I USE “MY HEALTH PAYS” Rewards? My Health Rewards are loaded onto the Ambetter My Health Pays Visa card & may be spent on eligible expenses. Eligible expenses include: Monthly Ambetter Premium payments, deductibles, coinsurance and copays!
Challenges help Ambetter members set and reach certain goals at their own pace. Power-Ups are activities they can do in a shorter amount of time. As they complete Challenges and Power-Ups, rewards will keep adding up!
And they can continue to be rewarded for activities like completing an annual wellness exam and getting a flu vaccine!
Members can redeem points their way!
Ambetter members can use their points to shop for special items at the online My Health Pays Rewards Store or convert them into dollars to spend on healthcare-related costs, such as doctor copays*, deductibles and coinsurance. It’s their choice!
Beginning 1/1/2020, My Health Pays reward dollars cannot be used at Walmart.
Updated October 15, 2019 to include new plan information!
Big news for South Carolina residents shopping for marketplace health insurance in 2020!
Ambetter by Absolute Total Care will be expanding their health insurance footprint in South Carolina for 2020! This will provide South Carolina residents in 11 counties with more health insurance options for 2020!
Ambetter SC Health Insurance 2020: Where?
Ambetter first offered plans in SC for 2019, covering only Charleston County. For 2020, Ambetter will offer plans in 12 South Carolina Counties: Beaufort, Berkeley, Charleston, Chester, Colleton, Dorchester, Florence, Horry, Jasper, Lancaster, Marion, and York.
For a full list of marketplace plan offerings by county from the South Carolina Department of Insurance, CLICK HERE
Ambetter SC Health Insurance 2020: Plans
For 2020, we expect Ambetter to offer 2 Gold plans, 9 Silver Plans, and 3 Bronze Plans in most South Carolina counties: For plan year 2020, Gold plans will be branded as “Secure Care”. Silver plans will be branded as “Balanced Care”. Bronze plans will be branded as “Essential Care”.
In many areas, we expect the Ambetter SC Essential Care 2 (HSA) plan to be the lowest cost plan Ambetter offers. The Essential Care 2 plan is expected to be a Qualified High Deductible Health Plan (HDHP) eligible for use in conjunction with a health savings account (HSA). See below for a partial listing of proposed plan details, however, please refer to the complete Summary of Benefits (SOB) available from Ambetter or the health insurance marketplace for complete plan coverage and exclusions:
For 2020, we expect the Balanced Care 11 Plan to be the one of the most popular Silver Plans offered by Ambetter SC health insurance. The base Balanced Care 11 plan is expected to have a $6000 deductible and an $8100 out of pocket maximum limit. In addition, the Balanced Care 11 will have various Cost Share Reduction levels (CSRs) for qualifying enrollees. See below for proposed details, however, please refer to the complete Summary of Benefits (SOB) available from Ambetter or the health insurance marketplace for complete plan coverage and exclusions:
Ambetter Bronze Plans available in South Carolina for 2020 will include 3 offerings (click plan name to view Summary of benefits):
For plan year 2020, Ambetter SC health insurance plans will have some great improvements! First, Ambetter has increased the My Health Pays benefit to $500 per member. My Health Pays is a program that rewards members for health behavior. The program uses a My Health Pays Visa card. Member can earn reward dollars for healthy behavior such as a Well Being Survey, an annual Well Visit, and getting a flu shot in the Fall. The annual Well Visit will be at no cost to the member, provided that the member visits an in-network provider. Rewards will be loaded onto the My Health Pays Visa card upon completion of the healthy actions.
In addition, Ambetter SC health insurance plans will offer telehealth with a $0 copay (except for HSA qualified plans) for 2020. To access $0 copay telehealth, members will need to use Teledoc, by calling 1-800-TELADOC (1-800-835-2362) or by going online to www.teladoc.com/ambetter. Ambetter SC health insurance members will need to have their member ID card handy when calling.
Ambetter South Carolina 2020: Network
For 2020, Ambetter has expanded their network of providers in South Carolina. When comparing health insurance plans, it is always important to check the provider network to ensure you can visit the providers you desire.
After clicking above, you will be taken to the South Carolina Health Exchange quote engine page. Our rate tool will help you calculate health plan premiums and estimate your health insurance plan premium subsidy.
The Health Insurance Exchange (also referred to as the “Marketplace”) is a new website where South Carolina residents can go to compare and enroll in health insurance plans for 2014. All health insurance plans offered through these Exchanges cover a set of essential health benefits, are guaranteed-issue, and offer premium subsidies for eligible residents. South Carolina residents can access the Exchange at www.healthcare.gov. Of course, before visiting the Health Insurance Exchange, we recommend you compare South Carolina Health Insurance rates on our websites quote engine.
South Carolina Health Exchange Quotes – Insurance Carriers
Five insurance companies are offering individual qualified health insurance plans through South Carolina’s Health Insurance Exchange for 2016. The participating carriers include:
BlueCross BlueShield of South Carolina
Consumers’ Choice Health Plan
Assurant – Assurant will withdraw from the SC marketplace for 2016.
These four insurance companies will be offering over 52 different individual health plans throughout the state of South Carolina. The health insurance exchange will open on November 1st for 2016 enrollments. South Carolina Exchange Health Insurance Exchange policies can go into effect for SC residents as early as January 1, 2016. The initial open enrollment for the South Carolina Health Exchange for January 1st enrollments is November 1 – December 15. Enrollments completed in the initial enrollment will be effective January 1, 2016. The Health Exchange open enrollment will extend until January 31, 2016.
South Carolina Health Exchange Quotes – Federal Subsidies
Beginning October 1 2014, many South Carolina residents will be eligible to receive health insurance plan subsidies to reduce their South Carolina Health Exchange rates. South Carolina Health exchange plan subsidies will be available to South Carolina residents who earn between 100% – 400$ of the Federal Poverty Level. For an Individual, this means an income between $11, 490 – $45,960. In addition, South Carolina residents with incomes below 250% of the Federal Poverty Level may also qualify for cost sharing subsidies. Cost sharing subsidies will reduce out of pocket costs such as deductibles, coinsurance, and co-pays that South Carolina residents will have to pay to receive care. In order to receive cost sharing subsidies, it is necessary to enroll in the correct type of plan. If you qualify for South Carolina Health Exchange Subsidies, you may elect to receive your subsidies on a monthly or annual basis. If you choose to receive your health plan subsidy on a monthly basis, it will automatically reduce your monthly health plan premium. If you elect to receive your subsidy on an annual basis, you will receive your subsidy on your tax return. In addition, your subsidy may need to be adjusted during the year based on changes in income or family status. These changes make it very important to work with a licensed health insurance agent who can help advise you throughout the year.
Please feel free to CONTACT US TODAY – we can help assess your options at no cost to you.
Per a CMS news release today, we have learned that for 2015, switching plans resulted in significant savings for Marketplace consumers!
Full-year enrollees saved nearly $400 on premiums after tax credits for the same level of coverage in 2015
Health and Human Services Secretary Sylvia M. Burwell announced today the findings of a new report that shows that consumers who reenrolled in the Health Insurance Marketplace last year and who switched to a plan with the same level of coverage saved nearly $33 per month after tax credits, or almost $400 annually, relative to what they would have paid had they remained in the same plan as in 2014. Those who also switched issuers within the same level of coverage were able to save $41 per month, or over $490 annually after tax credits.
Today’s report shows Marketplace consumers were active shoppers last year, with about one third (31 percent) of re-enrollees from 2014 switching to a new plan for 2015.
During Open Enrollment in the Marketplace this coming year, if all consumers switched from their current plan to the lowest-cost premium plan in the same metal level, consumers could save an average of $610 annually before tax credits and the total savings – to consumers and taxpayers (in premiums and tax credits) – would be more than $4 billion. For 2016, more than 8 in 10 current Marketplace enrollees can find a lower premium plan in the same metal level before tax credits by returning to shop. Last year, HHS projected that if all returning consumers who bought a silver plan in 2014 switched to the lowest-cost silver plan in 2015, they would have saved an average of $492 annually. If all returning consumers had switched to the lowest-cost plan within their metal level, across all metal levels, the total savings in premiums would have been over $2 billion before tax credits.
“Our message to returning Marketplace customers is simple: Shopping may save you money,” Burwell said. “Consumers who visited HealthCare.gov last year to comparison shop for the best plan saved almost $400 a year in premiums for the same level of coverage, and we expect people to be able to find similar deals for 2016. Consumers can visit HealthCare.gov today to preview plans in their area before Open Enrollment begins on November 1.”
Today’s findings underscore that the Marketplace offers a competitive insurance market from which consumers can choose affordable health plans based on their specific needs and budget. It also shows that consumers using HealthCare.gov are smart shoppers, who pay close attention to plan costs when making selections.
According to the report, historical estimates of plan switching among enrollees in employer sponsored insurance (2.8 percent), the Federal Employee Health Benefits Program (12 percent) and Medicare Drug Plans (13 percent) are low compared to Marketplace consumers.
Today’s report also finds that more consumers switched issuers than metal level, suggesting they preferred to keep the same level of coverage. Specifically, 57 percent of switchers changed issuers in 2015, while only 38 percent changed metal level.
(Health insurance plans on the Marketplace are classified by metal level, which range from bronze, with the lowest premiums but the highest deductibles and co-pays, to platinum with the highest premiums and lowest deductibles and co-pays.)
HealthCare.gov offers detailed information about each health insurance plan sold in an area, including out-of-pocket costs, customer service and more. Consumers can visit the 2016 health insurance plans and prices tool on HealthCare.gov and use the new total yearly out-of-pocket cost estimator to learn more about their specific costs.
Finally, the report confirms the popularity of silver plans. Among reenrolling consumers with 2014 silver level plans, the majority (91 percent) stayed in silver plans in 2015. Enrollment in silver level plans is much higher than other metal level plans—69 percent of enrollees chose a silver plan in 2014. Silver plans appeal to many consumers because, generally, eligible consumers must enroll in a silver plan in order to apply their cost-sharing reduction (approximately 85 percent of silver enrollees in states using the HealthCare.gov platform received cost-sharing reductions in 2015).
The 10 states with the highest annual savings from switching were: Florida, Texas, North Carolina, New Jersey, Pennsylvania, Wisconsin, Louisiana, Arizona, Indiana and Georgia.
Open Enrollment in the Health Insurance Marketplace starts on November 1, 2015 and runs through January 31, 2016. Sign up by December 15 to have coverage that starts January 1. You can find help by calling SChealthconnector.org offices at 843-882-7062 or by visiting www.SChealthconnector.org
To read today’s report and to see state by state information on consumer choices visit:
It has been brought to our attention that Senator Al Franken (D-Minn.) has introduced a bill known as the Family Coverage Act. You can view the summary here.
What is the Family Coverage Act?
The Family Coverage Act intends to correct the “Family Glitch” which prohibits many families from obtaining affordable coverage under the new healthcare reform law. This issue mostly pertains to Americans who receive health benefits through there employer.
As the law is currently written, “affordable” health insurance coverage is only calculated on what the employee pays for single, or “employee only” coverage, regardless of the cost to add family members to the policy. Currently, most employers providing job based health insurance contribute 50% or more to the “employee only “cost. Due to the rising cost of health insurance, many employers do not contribute to the cost of family coverage. Currently, as long as the “employee only” coverage does not exceed 9.5% of the families combined income, the entire family is deemed ineligible for tax credits to help pay for health insurance on the health insurance exchange; healthcare.gov. This has left many families with the double whammy of unaffordable coverage and facing a tax penalty for not having coverage in 2014.
If the Family Coverage Act were to pass Congress and be signed into law, millions of American families could potentially be helped afford coverage and avoid tax penalties!
As your South Carolina Obamacare Agent, we will be closely monitoring the progress of this bill in the United States House & Senate. Stay tuned for updates!