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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

South Carolina residents can obtain insurance from a variety of sources. Whether you get employer-sponsored health insurance, shop through the marketplace, or qualify for government insurance programs, you have options. Read this guide to understand how you can get affordable health insurance in South Carolina.

What to know about insurance in South Carolina

  • Marketplace plans: In South Carolina, you can purchase health care through the Health Insurance Marketplace at Healthcare.gov or directly from an Plans purchased via the Health Insurance Marketplace have guaranteed protections and minimums in terms of coverage.
  • Enrollment periods: Normally, enrollment in the Health Insurance Marketplace lasts from November 1 to December 15. If you do not enroll during this time, you can only enroll if you have a qualifying event, such as having a baby, getting married, losing a job, or moving. As a result of COVID-19, the federal government and South Carolina have extended the enrollment date in marketplace plans until August 15, 2021.
  • South Carolina health insurance companies: Several companies offer plans on the Healthcare.gov exchange for South Carolina. Some of these plans cover the entire state, while others only cover certain regions.
  • Off-exchange health insurance plans: An off-exchange plan conforms to Affordable Care Act (ACA)-compliant guidelines but cannot be purchased on the Healthcare.gov m South Carolina only has one of these plans: the BlueChoice Health Plan. There are six other health plans offered by insurance companies, but plans may not conform to ACA-compliant guidelines.
  • Coverage types: South Carolinians get health care in a variety of ways. The most popular way is through an employer (45.4%). Next is Medicaid (18.8%) and then Medicare (16.8%). Nongroup insurance (6.1%) and the military (2.2%) comprise the final two groups. Currently, 10.8% of the residents of South Carolina are uninsured.

How do I enroll in South Carolina’s health insurance marketplace?

If you would like to enroll in an ACA-compliant plan in South Carolina, you can use Healthcare.gov. When you register, you’ll be asked for personal information such as your Social Security number, where you live, your income, etc. You’ll also need this information for any member of your family you wish to register. After you register, you can get health insurance quotes and compare as many as three plans at once for premiums, copays, coinsurance, and deductibles. This will make it easier to find a plan that suits you or your family. There are four plans available on the South Carolina Health Insurance Marketplace. Only one of those plans is available in the entire state. The other plans are available in some areas of South Carolina. These plans are:

  • Absolute Care
  • Blue Cross Blue Shield of South Carolina (available in all counties)
  • Bright Health Company of South Carolina
  • Molina Healthcare of South Carolina

There is one plan available off-exchange that offers ACA-compliant plans:

  • BlueChoice Health Plan

Small businesses can find plans on the Health InsuranceMarketplace. If you run a business and employ between one and 50 people, you can buy health insurance through the Small Business Health Options Program (SHOP). If you select certain ACA plans, you can earn premium tax credits that lower your premiums if your family’s income is between 100% to 400% of the Federal Poverty Level. It also qualifies you for cost-sharing reductions (CSR) if you select a silver plan.

How do I enroll in South Carolina individual and family insurance?

You can purchase insurance for yourself or your family through the marketplace or an insurance company in South Carolina. Whether you’re choosing insurance for yourself or your family, you’ll need to ask yourself important questions:

  • How healthy am I?
  • How healthy is my family?
  • How much can I afford to pay for a monthly premium?
  • Will my income allow me to qualify for any subsidies on the ACA marketplace?
  • How much can I afford to pay in out-of-pocket costs?

Insurance for individuals in South Carolina

You’ll have more flexibility when you’re selecting a plan for yourself. If you’re healthy, you want to select a plan with a low monthly premium and a higher deductible. However, if you have a chronic illness or condition, you’ll want a plan with a higher monthly premium and a lower deductible, which will help keep out-of-pocket costs to a minimum.

  • Selecting a Health Maintenance Organization plan (HMO) is probably your best choice if you’re in good shape. This is the plan for you if you want fewer out-of-pocket costs. But you’ll have less flexibility in an HMO plan. You’ll be restricted to the insurance company’s in-network medical providers, need to pick a primary care physician, and when you want to see a specialist, you’ll need to obtain a referral.
  • A Preferred Provider Organization (PPO) plan is a better choice if you have a chronic illness. A PPO has a higher monthly premium but lower deductibles. You’ll also have more flexibility. You can venture out-of-network for treatment, you won’t need a primary care doctor, and you don’t need referrals to see specialists.
  • A Point of Service Plan (POS) offers a middle ground between an HMO plan and a PPO plan. You’ll still need a referral to see a specialist but aren’t limited to in-network medical providers.

Insurance for families in South Carolina

The answers to the questions above become a bit more complicated when you’re selecting family health care coverage rather than just for yourself. You may be healthy, but your spouse may have a chronic condition, or your child may suffer from asthma or allergies. Selecting the right plan becomes more of a balancing act. When you select an ACA-compliant plan from the marketplace, you may be eligible for a subsidy and CSR plan. Even when selecting insurance directly from an insurance company, all ACA-compliant health plans sold in the United States offer essential health coverage and must cover all pre-existing conditions and not charge you extra if you have one.

How much does health insurance cost in South Carolina?

Plans sold on the Health InsuranceMarketplace in South Carolina follow the metal tier structure: bronze, silver, gold, and platinum. The different levels have nothing to do with the quality of care. Instead, the tiers signify the differences in what you’ll pay for monthly premiums and out-of-pocket expenses. Overall, in 2021, the cost of these health care plans has decreased in South Carolina.

 

Average premiums in South Carolina 2018 2019 2020 2021
Most affordable bronze plan $365 $373 $351 $328
Most affordable silver plan $521 $550 $496 $469
Most affordable gold plan $547 $560 $529 $513

  • Bronze plans feature low monthly premiums but high deductibles. There is also a 40% coinsurance payment each time you seek medical treatment. A bronze plan is appropriate if you don’t have many health care needs. The most affordable bronze plan in South Carolina has a monthly premium of $328.
  • Premiums for a silver plan are higher than bronze, but you’ll pay less in deductibles. The coinsurance fee is also lower at just 30%. Silver plans offer the most potential benefits, including cost-sharing reductions. The most affordable silver plan (before any potential savings) in South Carolina is $469 a month.
  • If you or a family member have chronic health problems and you need to make numerous health care visits, a gold or a platinum plan might be your best choice. These plans have the lowest deductibles and coinsurance payments (only 20% for gold and 10% for platinum). However, you will pay quite a bit more in a monthly premium for these plans. The lowest-priced gold plan in South Carolina costs $513 a month.

What kind of low-income health insurance is available in South Carolina?

Residents of South Carolina with low or very low income levels can qualify for Medicaid, and children may be eligible for the Children’s Health Insurance Program (CHIP). South Carolina has not enacted the Medicaid expansion offered by the ACA, which means if you’re an adult 18 to 64, you can’t qualify for Medicaid unless you meet certain specific health conditions.

Medicaid in South Carolina

As of January 2021, there are 1,126,621 people enrolled in Medicaid in South Carolina. In South Carolina, Medicaid’s yearly income limit for an individual is $12,880 per year and for a household of three people is $21,960. If you have more than eight people in your household, you can add $4,540 per person. Resources (assets) cannot exceed more than $2,000 for an individual and $4,000 for a couple. You may also qualify for Medicaid:

  • If you are pregnant or believe yourself to be pregnant
  • If you have a child 18 years or younger
  • If you are a child 18 years or younger
  • If you or your child is adopted or in foster care
  • If you have been diagnosed with cervical or breast cancer
  • If you are blind
  • If you are disabled
  • If you need nursing home care
  • If you are over 65

You can apply online for Medicaid in South Carolina at apply.scdhhs.gov. You can also call Healthy Connections at (888) 549-0820 to request a paper application by mail or apply in person at your local county office.

CHIP in South Carolina

CHIP in South Carolina provides free or low-cost health coverage for eligible children. Coverage includes routine checkups, dental care, immunizations, and treatment of illnesses or conditions. Family income limits for CHIP are 208% of the FPL.

What are South Carolina’s Medicare options for seniors and people with disabilities?

If you are at least 65 or you’re disabled, you’re eligible for Medicare, the federal government’s health insurance plan.

  • Original Medicare is the basic Medicare program. It includes Part A (hospital insurance) and Part B (medical insurance). Original Medicare has no out-of-pocket limits. It does not cover prescription drug costs. You’ll need to purchase a Medicare Part D plan if you require prescription coverage.
  • Medicare Part C is also known as Medicare Advantage. There are four different types of Medicare Advantage Plans: HMOs, PPOs, Private Fee-For-Service Plans, and Special Needs Plans, each with different premiums, out-of-pocket costs, and medical coverage. Plans provide vision, dental, and hearing coverage, and some cover fitness memberships and prescription drugs. In South Carolina, there were 59 Medicare Advantage Plans available in 2019.

If you’re worried about out-of-pocket costs with Original Medicare, consider a Medicare Supplement Insurance plan. It covers many deductibles, including copays and coinsurance. It does not cover long-term health care, dental, or hearing. Many Medicare Supplement Insurance plans will provide you with coverage if you travel outside the United States. However, these plans will not work with a Medicare Advantage Plan.

Eligibility and Enrollment
Eligibility For Medicare enrollment, you need to be:

  • A U.S. citizen or a permanent resident
  • At least 65 or disabled for 24 months under the Social Security Disability Insurance program
  • Ill with a disease such as Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD).
Enrollment
  • Initial Enrollment begins three months before you turn 65, the month of your birthday, and three months after you turn 65.
  • Open Enrollment takes place between October 15 and December 7. You can move from Original Medicare to a Medicare Advantage Plan, return to Original Medicare from a Medicare Advantage Plan or switch between Medicare Advantage Plans. You can also make changes to Part D and Medicare Supplement Insurance plans.
  • If you move out of your county in South Carolina, you are eligible for a Special Enrollment Period, and you can sign up for a new plan.

Medicare Resources

You can get free, one-on-one counseling about your Medicare options from a trained counselor of the State Health Insurance Assistance Program (SHIP) in South Carolina. Their advice is free, unbiased, and confidential, and none of the volunteers work for a health company or will ever try to sell you a plan.

Are there short-term health insurance plan options in South Carolina?

Yes. However, South Carolina has specific requirements for short-term health insurance plans, which are not ACA compliant. A short-term health care plan in South Carolina is limited to 11 months and cannot be renewed for longer than 33 months. ACA-compliant plans last a year. Short-term health insurance plans can help if you’ve lost your job, are transitioning between jobs, or are in between enrollment in an ACA-compliant plan. With a short-term plan, you won’t get the same protection as major health care plans on the marketplace or through an insurance company’s ACA-compliant plans. Six insurance companies offer short-term coverage in South Carolina:

  • BlueChoice
  • BlueCross BlueShield of South Carolina
  • Everest Reinsurance
  • Independence American Insurance Company
  • National General
  • United Healthcare (Golden Rule)

Health Insurance in South Carolina FAQ

Is health care required in South Carolina?

The ACA mandates that everyone must have health care or pay a tax penalty. However, the Supreme Court negated the tax penalty in 2019. South Carolina is not one of the states that have mandated a health care requirement.

Do I have to use the Health InsuranceMarketplace in South Carolina?

No. Several insurance companies sell direct plans in South Carolina, including several that sell short-term insurance. However, you’ll need to go through the marketplace to use a subsidy or qualify for cost sharing. And short-term plans don’t provide all of the benefits that a plan on the Health Insurance Marketplace does.

What types of alternative health insurance plans (like cost-sharing plans) are available in South Carolina?

The most popular form of cost-sharing health plans in South Carolina are faith-based, though most don’t have religious requirements to buy a plan. These plans are not regulated at the state or federal because the plans are not considered health insurance. Unlike ACA-compliant plans, health shares do not have to provide coverage for every health care issue and can refuse coverage of pre-existing conditions. If you consider purchasing such a cost-sharing plan, verify it covers your health concerns.

Do I need health insurance if I have HSA/FSA?

In most cases, yes. It is unlikely that you would save enough money using an HSA or an FSA plan to pay for a serious medical condition or injury. If you want to pay for deductibles, copays, or coinsurance, these are good plans but not for major medical expenses.

Do I need short-term disability coverage in South Carolina if I have health insurance?

Whether you need short-term disability coverage depends upon your risk factors. Short-term disability coverage is intended to pay for household expenses, such as groceries or utility bills, while you cannot work. It is not intended to pay for major medical costs. If you have a job where an injury is a possibility, a short-term disability plan is a good idea.

Do I need long-term disability coverage in South Carolina if I have health insurance?

Long-term disability coverage is meant to deal with the same financial issues as short-term disability coverage, only over a longer period. If you have major risk factors, such as working in a job where serious injury is a possibility, then a long-term disability plan is a good idea.

What does CHIP in South Carolina cover?

CHIP in South Carolina provides free or low-cost health coverage for eligible children. Coverage includes routine checkups, dental care, immunizations, and treatment of illnesses or conditions.

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