South Carolina Health Insurance: Find Affordable Plans

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.

• Marketplace plans: In South Carolina, you can purchase health insurance through the Health Insurance Marketplace at HealthCare.gov or directly from plans purchased via the Health Insurance Marketplace have guaranteed protections and minimums in terms of coverage.
• Enrollment periods: In 2022, open enrollment for North Carolina health insurance plans runs from November 1, 2021 through January 15, 2022. If you don’t 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.
• 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 insurance 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.

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, and your income. You’ll also need this information for any member of your family you wish to register. After you register, you can get affordable 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’s one plan available off-exchange that offers ACA-compliant plans:

• BlueChoice Health Plan

Small businesses can find plans on the Health Insurance Marketplace. 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 (FPL). It also qualifies you for cost-sharing reductions (CSR) if you select a silver plan.

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. 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 (PCP), 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 (POS) plan offers a middle ground between an HMO plan and 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 insurance 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 cost-sharing reduction (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.

Plans sold on the Health Insurance Marketplace 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 2022, the cost of these health insurance plans has decreased in South Carolina:

• Bronze plans feature low monthly premiums but high deductibles. There’s 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.
• 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 $438 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 at only 20% for gold and 10% for platinum. You’ll pay quite a bit more in a monthly premium for these plans. The lowest-priced Gold plan in South Carolina costs $583 a month.

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 hasn’t 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’re pregnant or believe yourself to be pregnant
• If you have a child 18 years or younger
• If you’re 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’re blind
• If you’re disabled
• If you need nursing home care
• If you’re 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.

If you’re 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 doesn’t 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 (PFFS) plans, and Special Needs Plans (SNPs), 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 (Medigap). It covers many deductibles, including copays and coinsurance. It doesn’t cover long-term health care, dental, or hearing. Many Medicare Supplement Insurance plans will provide you with coverage if you travel outside the U.S. These plans won’t work with a Medicare Advantage Plan.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

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.

South Carolina has specific requirements for short-term health insurance plans, which are not ACA compliant. A short-term health insurance 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.

• Benefits.gov | South Carolina Medicaid | Last accessed December 2021
• CMS.gov | Medicare Open Enrollment | Last accessed December 2021
• Health and Human Services | Can I get coverage if I have a pre-existing condition? | Last accessed December 2021
• Healthcare.gov | Catastrophic Health Plans | Last accessed December 2021
• Healthcare.gov | Cost-Sharing Reduction | Last accessed December 2021
• HealthCare.gov | Deductible | Last accessed December 2021
• HealthCare.gov | Health Maintenance Organization (HMO) | Last accessed December 2021
• HealthCare.gov | Preferred Provider Organization (PPO) | Last accessed December 2021
• Healthcare.gov | Premium Tax Credit | Last accessed December 2021
• HealthCare.gov | Point of Service (POS) Plans | Last accessed December 2021
• HealthCare.gov | The ‘metal’ categories: Bronze, Silver, Gold & Platinum | Last accessed December 2021
• KFF | Average Marketplace Premiums by Metal Tier, 2018-2021 | Last accessed December 2021
• KFF | Health Insurance Coverage of the Total Population | Last accessed December 2021
• Medicare.gov | Part A & Part B sign up periods | Last accessed December 2021
• National Academy for State Health Policy | South Carolina CHIP Fact Sheet | Last accessed December 2021
• South Carolina Department of Aging | State Health Insurance Assistance Program | Last accessed December 2021