As the individual states review their insurance regulations to come into compliance with the 2010 Patient Protection and Affordable Care Act, major changes are already in place regarding the handling of pre-existing conditions. Children may no longer be denied coverage on the basis of such a condition and may remain on their parents’ health policies up to age 26 even if they are no longer in school or if they have married. Adults with pre-existing conditions may currently seek coverage through temporary high-risk insurance pools that will be in place until January 1, 2014 when the federally mandated health care exchanges become fully functional.
General Insurance Regulations
Insurance policies in South Carolina must carry a guarantee of renewability, but policies may currently exclude for pre-existing conditions with a look-back period of 12 months. Health status can be used as a basis for policy refusal and for rate levels, but not as a basis of cancellation once the plan is in force.
Health Care Exchange
South Carolina is currently studying options for the creation of a health insurance exchange, although a planning committee has recommended that such an exchange not be created. If the governor decided to accept that recommendation, the federal government will take over the task of creating the exchange required under the Affordable Care Act.
Pre-Existing Condition Insurance
The U.S. Department of Health and Human Services administers the Pre-Existing Condition Insurance Plan in South Carolina to provide primary and specialty care, hospitalization, and prescription medications to qualified participants. The monthly premiums for the coverage depending on age and option run from $139 to $596. Deductibles range from $1000 to $3000 and there may be a separate drug deductible. Maximum yearly out-of-pocket expenses are capped at $7000.
Medicaid eligibility is figured by income level as a percentage of the Federal Poverty Level, which is the same measure applied to qualifications for Children’s CHIP-funded Medicaid Expansions. In South Carolina, all children from birth to age 19 qualify for Medicaid at 150% FPL and for CHIP funds at 200%.
Pregnant women my draw Medicaid benefits at 185% FPL, parents at 50%, and disabled Social Security recipients at 74%.
Additionally, the Partners for Healthy Children Program provides coverage for children under 19 years of age who do not have insurance and who cannot get Medicaid.
Some 16 percent of the population of South Carolina draws Medicare benefits, with more than 715,000 drawing on prescription drug coverage.
The South Carolina Department of Health and Environmental Control offers various Long Term and Nursing care options to Medicare recipients, and the South Carolina I-Care program supplies educational and counseling services to help Medicare beneficiaries with their health-care options.