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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.
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:
There’s one plan available off-exchange that offers ACA-compliant plans:
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:
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:
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:
|Average premiums in South Carolina||2018||2019||2020||2021||2022|
|Most affordable Bronze plan||$365||$373||$351||$328||$339|
|Most affordable Silver plan||$521||$550||$496||$469||$438|
|Most affordable Gold plan||$547||$560||$529||$513||$483|
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.
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:
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 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.
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.
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).
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:
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.
The ACA mandates that everyone must have health insurance or pay a tax penalty. The Supreme Court negated the tax penalty in 2019. South Carolina isn’t one of the states that have mandated a health insurance requirement.
Several insurance companies sell direct plans in South Carolina, including several that sell short-term insurance. You’ll need to go through the marketplace to use a subsidy or qualify for cost-sharing. Short-term plans don’t provide all of the benefits that a plan on the Health Insurance Marketplace does.
The most popular form of cost-sharing health plans in South Carolina are faith-based, although most don’t have religious requirements to buy a plan. These plans aren’t regulated at the state or federal because the plans aren’t considered health insurance. Unlike ACA-compliant plans, health shares don’t 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.
In most cases, yes. It’s unlikely that you would save enough money using a health savings account (HSA) or flexible savings account (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.
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’sn’t 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.
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.
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.