South Carolina Health Insurance: 2021 Coverage Guide

Fran Majidi
August 24, 2020

South Carolina Affordable Healthcare Insurance

People in South Carolina have a few options when it comes to picking a health insurance plan so it’s wise to compare rates carefully. Whether you’re an individual or you’re buying coverage for a family, you can compare prices for different coverage options with SmartFinancial. This way, you’ll know you’re getting the best value. Keep in mind that you may only enroll in a health plan during open enrollment. Some people are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in South Carolina?

November 1, 2020 - December 15, 2020. Coverage begins January 1, 2021.

How to Get Health Insurance in South Carolina

You can estimate how much you need in terms of coverage by taking a look at the previous year. This information will help you decide which health plan is right for you, and which coverage tier will be most economical. A higher premium sometimes means savings, especially if you see care providers regularly. Compare health insurance companies and health insurance quotes before you buy. After you submit a form you’ll get several rates from competing health insurance companies. We’ll then connect you with an agent so you can buy coverage or ask questions about the plans you’re considering.

What Types of Health Insurance Are Available in South Carolina?

HMOs, EPOs, PPOs and POS plans, which are all managed very differently, are available in South Carolina. You can also choose different levels of coverage, which are categorized in this order, from least coverage to most: catastrophic, bronze, expanded bronze, silver and gold. While higher levels of coverage cost more monthly, they usually carry little out of pocket expenses like copays and coinsurance. Deductibles will differ too, so if you’re buying a PPO plan at a higher tier, your deductible will be much lower but you’ll pay more in premiums.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • If you lost or quit a job. You may have lost a job, changed jobs or even started your own business. If so, you qualify for the special enrollment period. If you are not offered health insurance at your new job, you qualify to buy health insurance after the enrollment period.
  • If you turned 26. Once you turn 26, you can no longer be on your parents’ health insurance plan but you can enroll in an individual health plan.
  • If you move to another state or out of an HMO coverage area. If you had health plan that was only valid in one area but you moved to another after the enrollment period, you are able to enroll in a new health plan.
  • If your Cobra coverage ended. Cobra extends health care coverage from a previous job and has a deadline. When you reach it, you can enroll in a new health plan.
  • If you divorced. If you were married and shared a health plan with your spouse but you divorced, you may enroll in a new individual health plan.
  • If you got married. If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
  • If you gave birth or adopted a child. If you had a baby outside the open enrollment date, you can buy health insurance for your baby.
  • If a spouse or partner died. If you were covered under your spouse or partner’s health plan but that person passed away, you qualify to buy an individual plan during the special enrollment period.
  • If your spouse or partner lost coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in South Carolina?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in South Carolina?

The average cost of health insurance in South Carolina for a 40 year old is about $501 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in South Carolina

The best way to save on health insurance in South Carolina is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

Medicare in South Carolina

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in South Carolina?

21% of the population of South Carolina is on Medicare.

How Much Is Medicare in South Carolina?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in South Carolina

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in South Carolina?

Sign up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

South Carolina State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2019 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the South Carolina Health System is listed below:

  • South Carolina: Overall State Ranking: 41 of 50
  • South Carolina: Overall Performance: Below Average
  • South Carolina: Access & Affordability: 41
  • South Carolina: Prevention & Treatment: 42
  • South Carolina: Avoidable Hospital Use & Cost: 25
  • South Carolina: Healthy Lives: 40
  • South Carolina: Health Care Disparities: 47
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South Carolina Health Insurance Coverage

The people of South Carolina have different kinds of health insurance while some South Carolina residents are not insured at all. See the breakdown below:

  • Private coverage: 47%
  • Medicaid: 19%
  • Medicare: 21%
  • Uninsured: 13%

Report: America's Health Insurance Plans

South Carolina Health Insurance Companies

The following carriers offer health insurance and/or medicare in South Carolina.

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