South Carolina Health Insurance

 Health insurance in South Carolina

● Open enrollment for 2021 health insurance plans is from November 1 to December 15, 2020. Residents with qualifying events can register or make changes to their coverage outside of open enrollment.

● Four insurance companies offer health plans in the South Carolina health insurance market.

● Short-term health insurance plans are available in South Carolina with initial plan terms of up to 11 months.

● The uninsured rate was 10.5% in 2018, compared to a national average of 8.9%.

● Most South Carolina lawmakers are Republicans opposed to the ACA.

● South Carolina has not expanded Medicaid, leaving 101,000 people in a coverage gap.

● More than a million people - 20% of South Carolinians - are enrolled in Medicare.

This page is dedicated to helping consumers quickly find health insurance resources in the state of South Carolina. Here you will find information about the many types of health insurance coverage available. You can find the basics of south Carolina's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in South Carolina; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for South Carolina residents.

South Carolina's health insurance market

The South Carolina health insurance market/exchange is run by the federal government, so residents use HealthCare.gov to purchase individual and family health plans. The market provides health insurance to people who have to purchase their coverage, including early retirees, the self-employed and people who are employed by small businesses that do not offer health benefits.

214,030 people enrolled in individual private market health plans through the South Carolina health insurance market during the open enrollment period for 2020 coverage.

South Carolina's health insurance market had only one insurer - South Carolina's Blue Cross Blue Shield - that offered stock market plans in 2018. But Ambetter (Absolute Total Care) joined the exchange for 2019 and Bright Health and Molina began offering plans for 2020. Premiums for existing medical insurance plans changed very little from 2019 to 2020.

For 2021, three of the four exchange insurers proposed small average rate reductions, ranging from 0.1% to 3.6%. Ambetter (Absolute Total Care) has proposed an average rate increase of almost 17%, but would only apply to fewer than 7,400 subscribers.

South Carolina opens enrollment period for 2021 health plans

Open enrollment for South Carolina 2021 health insurance plans is November 1, 2020 through December 15, 2020. This window is an opportunity for South Carolina residents to make a change to their individual/family health plan, update the income information the exchange has on file, renew existing coverage, or recently enroll in individual market coverage. The registration window applies both on the stock exchange and off-exchange (for example, coverage purchased directly from a health insurer).

Unfortunately, South Carolina doesn't have federally funded navigator organizations that can help people sign up for coverage through the exchange, but there are numerous brokers that are state-authorized and certified by the exchange to provide information and assistance with the enrollment process.

Outside of the open enrollment period, South Carolina residents can sign up or make changes to their coverage if they have a qualifying event.

The enrollment period open from November 1 to December 15 applies to individual market health insurance, so it doesn't affect people who get their health coverage from an employer or government, through Medicare, Medicaid, or CHIP.

Medicaid/CHIP enrollment continues year-round for eligible people. South Carolina has not expanded Medicaid coverage under the Affordable Care Act, meaning the state's pre-ACA eligibility guidelines are still applicable.

South Carolina goes bad in general health ratings

South Carolina ranked 41st among the 50 states and the District of Columbia by the Commonwealth Fund's Scorecard on state health care system performance in 2019.

The 2019 edition of America's Health Rankings also placed South Carolina in the bottom quartile, ranked 42nd among the 50 states in terms of overall health.

How did Obamacare help SC?

According to US census data, the uninsured rate in South Carolina was 15.8% in 2013 and 10.5% in 2018 (although it had been lower - at 10 percent - than in 2016; the average uninsured national rate rose during the Trump administration).

South Carolina leadership opposition to the ACA means the state has so far refused to expand Medicaid coverage, so a cornerstone of the law's ability to reduce the uninsured rate is not being used.

But the ACA has made full coverage of the individual market more affordable for South Carolina families with incomes between poverty levels and 400% poverty levels. Nearly 186,000 South Carolina residents received premium subsidies in 2020 that averaged $539/month, covering the vast majority of the average total monthly premium, which was $610. And nearly 87,000 subscribers were receiving cost-sharing reductions, which help keep out-of-pocket costs accessible when a person has a medical complaint (for example, lower deductible, copays, and coinsurance).

And everyone who has enrolled in individual and small-group health plans in South Carolina (with actual dates in 2014 or later) has coverage for the ACA's essential health benefits, with no life limits or annual benefits.

South Carolina and the Affordable Care Act

South Carolina's U.S. Congressional delegation is made up almost entirely of Republicans in December 2020. The GOP has both senate seats, and five of the seven U.S. representatives are Republicans. Jim Clyburn, of the 6th District, and Representative Joe Cunningham, of the 1st District, are the lone Democrats. Cunningham and Clyburn support the ACA, and Cunningham is campaigning on further health reform proposals, including lowering Medicare's eligibility age to 55, allowing Medicare to negotiate with drug, and limiting contemptuous policies like short-term health insurance.

Lindsay Graham, a senior senator from South Carolina, was instrumental in senate Republicans' latest attempt to repeal the ACA in September 2017 through the Graham-Cassidy Amendment. But Graham noted after the effort failed that he essentially had no understanding of health policy, saying "Well, I've been doing [health reform policy] for about a month. I thought everyone else knew what the hell they were talking about, but apparently not.

Henry McMaster is the current governor of South Carolina and won his re-election campaign in 2018. McMaster was attorney general in South Carolina before becoming lieutenant governor and then governor. During his time as AG, McMaster organized a legal challenge against the ACA.

South Carolina also has a strong Republican majority in both houses of the state legislature.

Medicaid expansion in South Carolina

South Carolina is currently one of 12 states that have not yet expanded Medicaid coverage or begun the process of doing so. [The expansion took effect in Nebraska in October 2020 and in Oklahoma and Missouri in mid-2021.]

South Carolina has no pending plans to expand Medicaid coverage, despite tireless work by consumer advocates. The ACA would expand Medicaid coverage for all legal residents with incomes of up to 138% of poverty. In 2012, the Supreme Court ruled that states could give up Medicaid expansion, and South Carolina was firm in its rejection of federal funding to expand Medicaid coverage. Because the state has refused to expand Medicaid plans, South Carolina has 101,000 people in the coverage gap, with no access to financial assistance with their medical insurance.

About 214,000 additional people would be eligible to enroll in Medicaid plans if the state expanded coverage guidelines. But instead, enrollment is still subordinated to South Carolina's strict eligibility guidelines: Non-disabled adults without dependent children are not eligible regardless of income, and parents with dependent children are only entitled if their family income does not exceed 62% of poverty (just over $1000/month for a family of three).

South Carolina officials said that instead of expanding Medicaid coverage, they are focusing on their Healthy Outcomes program, which helps chronically ill people without health insurance access care through free clinics and hospital charities. Unfortunately, the program can only help about 8,500 people -- a small fraction of the people who are in the coverage gap in South Carolina.

South Carolina Co-Op

In 2014 and 2015, South Carolina residents could purchase health insurance through Consumers Choice, the state's consumer-oriented and managed plan (CO-OP). The CO-OP was funded under the ACA with a grant from the federal government.

Nationally, about $2 billion has been allocated to CO-POs in 22 states. In South Carolina, consumers' choice health plan (CCHPSC) received about $87.6 million. However, in November 2015, officials had announced its closure and CO-OP members had to select coverage from another insurer for 2016.

As of December 2020, there were only four remaining CO-Po's offering plans in five states, and one of them, New Mexico Health Connections, is closing in late 2020.

Short-term health insurance in South Carolina

South Carolina has its own state regulations on short-term health insurance plans.  Short-term health insurance plans in South Carolina are currently prohibited from offering coverage that exceeds 11 months, with a total duration of 33 months of short-term health insurance coverage (including renewals).

Does South Carolina have a high-risk pool?

Prior to 2014, individual health insurance was underwritten in nearly every state, including South Carolina. This meant that pre-existing conditions could prevent an applicant from getting coverage or result in significantly higher premiums or policy exclusions.

The South Carolina Health Insurance Pool was created in 1989 to offer people an alternative if they were unable to obtain individual health insurance because of their medical history.

The implementation of the ACA and a guaranteed individual issuance market has made high-risk pools largely obsolete, but South Carolina's health insurance pool is still operational. This is in part due to the pool providing Medicare Supplement coverage to Medicare beneficiaries who are unable to qualify for Medigap plans signed by the doctor (this includes any Medicare beneficiary who is disabled and under the age of 65, since federal rules do not provide any kind of Medigap guaranteed emission supply for this population).

Medicare coverage and enrollment in South Carolina

As of August 2020, there were 1,100,624 South Carolina residents enrolled in Medicare. About a third of them were covered by private Medicare (Medicare Advantage) plans, and two-thirds were enrolled in Original Medicare. Most South Carolina Medicare beneficiaries are eligible for age, but 17% are under the age of 65 and are eligible for Medicare because of a disability.

South Carolina Health Insurance Resources

● South Carolina Department of Insurance - Oversees, regulates, and licenses health insurance companies, agents, and brokers.

● South Carolina Department of Aging — Information and assistance programs for Medicare beneficiaries