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South Carolina health insurance marketplace: history and news of the state’s exchange

BCBSSC's average rate hike was less than 6% for 2019, and Ambetter has joined the exchange in Charleston County. Total enrollment in SC exchange grew for 2019.

Highlights and updates

South Carolina exchange overview

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

South Carolina is among the states that have done the least to preserve the Affordable Care Act’s gains.

South Carolina uses the federally run health insurance exchange, so residents enroll through HealthCare.gov. Open enrollment for 2019 coverage ended December 15, but residents with qualifying events can still shop for ACA-compliant plans. And Blue Cross Blue Shield of South Carolina is allowing people to purchase plans outside the exchange until December 31, 2018, with coverage effective January 1, 2019 (this is highly unusual, as off-exchange enrollment windows are typically aligned with on-exchange enrollment windows in every state except Nevada).

Blue Cross Blue Shield of South Carolina was the only insurer offering plans in the exchange in 2018, but Ambetter (Absolute Total Care) has joined the exchange in Charleston County for 2019.

Open enrollment ended December 15, but BCBSSC has extended enrollment — outside the exchange — until December 31

In all states that use HealthCare.gov, including South Carolina, open enrollment for 2019 plans ended on December 15, 2018. But Blue Cross Blue Shield of South Carolina is allowing people to enroll in their plans, outside the exchange, until December 31, 2018. No financial assistance is available when people enroll outside the exchange. Blue Choice, which only offers plans outside the exchange, is also allowing people additional time to enroll in plans for 2019.

This is quite unusual. Insurers in the individual markets nationwide tend to align open enrollment with the schedule used by the exchange, and it’s rare to see insurers offer people additional time to enroll in off-exchange plans.

2019 enrollment: One of only nine states where enrollment grew for 2019

216,889 people had enrolled in plans through South Carolina’s exchange by December 15, when open enrollment for 2019 plans ended. This was slightly higher than enrollment the prior year (for 2018 coverage). South Carolina was one of only nine states where enrollment was higher during the enrollment period for 2019 plans than it had been for 2018 plans.

Approved average rate increase in SC exchange: 5.26 percent increase, plus a new insurer in Charleston County

Although there were several insurers in South Carolina’s on- and off-exchange markets prior to 2017, Blue Cross Blue Shield of South Carolina was the state’s only on-exchange insurer in 2017 and 2018. Blue Cross Blue Shield of South Carolina is continuing to offer on-exchange plans statewide in South Carolina for 2019. But in Charleston County, Ambetter by Absolute Total Care is also offering plans in the exchange for 2019, so South Carolina’s exchange now has two participating insurers (albeit only in Charleston County; the rest of the state just has one on-exchange insurer).

BlueChoice, which began offering only off-exchange plans as of 2017, is continuing to sell off-exchange plans in 2019.

Blue Cross Blue Shield of South Carolina had 203,000 enrollees in the individual market in 2018, and initially proposed an average rate increase of 9.3 percent. In their filing documents, the first two justifications for the higher rates are the impending elimination of the individual mandate penalty, and the fact that short-term health plans and association health plans are being expanded, both of which will “likely siphon better risks from the ACA market.”

Once rates were finalized in South Carolina, Blue Cross Blue Shield of South Carolina’s average rate increase was 5.26 percent. In SERFF, it notes that the filing was “approved as amended.” So although the details of the amended filing (dated August 20) are redacted, presumably BCBSSC updated their filing with a rate increase that was smaller than they initially proposed.

Since Ambetter (Absolute Total Care) is new to the state for 2019, they do not have any applicable rate change.

Outside the exchange, BlueChoice initially proposed an average rate increase of 6.93 percent, but the final approved average rate increase was 3.22 percent.

2018 enrollment 6% lower than 2017 during open enrollment

215,983 people enrolled in 2018 coverage in the South Carolina exchange during open enrollment. That was about a 6 percent decrease from 2017, when 230,211 people enrolled. The decrease in enrollment has to be considered in light of the fact that open enrollment was much shorter for 2018 than it was in prior years. Open enrollment for 2018 coverage began on November 1, 2017, and ended December 15, 2017, with all plan selections effective January 1, 2018. In addition to a shorter open enrollment period, federal funding for advertising and enrollment assistance was drastically reduced.

197,699 people had effectuated coverage in South Carolina’s exchange as of February 2018.

2018 rate changes: Nearly 3/4 of the average rate increase was due to lack of CSR funding

Blue Cross Blue Shield of South Carolina is the only insurer offering plans in the exchange for 2018, as was the case in 2017. The average approved rate increase for 2018 was 31.33 percent. But nearly three-quarters of the total average rate increase was due to the fact that the federal government is no longer funding cost-sharing reductions (CSR).

The cost of CSR was added to on-exchange silver plans in South Carolina. BCBSSC’s rate filing indicated that they are offering separate off-exchange-only silver plans that don’t have the cost of CSR added to the premiums, and all of their non-silver plans (on and off-exchange) are also being sold without the cost of CSR added to the premiums.

South Carolina’s approach protects most enrollees, makes non-silver plans particularly appealing

Adding the cost of CSR to on-exchange silver plans while also making off-exchange silver plans available without the cost of CSR added to the premiums is the approach that protects the greatest number of consumers: people who get premium subsidies receive larger subsidies than usual, and people who don’t get premium subsidies have multiple options for plans that don’t have the cost of CSR added to their premiums.

With the cost of CSR added to premiums for silver plans, premium subsidies are larger than they would otherwise be, since the subsidies are based on the cost of the second-lowest-cost silver plan, and grow to keep pace with the increase in silver plan premiums. Due to the larger premium subsidies, bronze plans became very inexpensive starting in 2018, and gold plans are also comparatively less expensive than they were in prior years.

As an example, a 45-year-old in Charleston who earns $25,000 could choose from several 2018 bronze plans with after-subsidy premiums of less than two dollars per month. These plans had bronze-level out-of-pocket exposure, which means that the enrollee would be on the hook for several thousand dollars in out-of-pocket costs in the event of a large claim. But the availability of these nearly free (or for some enrollees, entirely free) bronze plans makes getting insured — as opposed to remaining uninsured — the obvious choice (note that with an income of $25,000, the applicant would be eligible for CSR benefits if he or she were to pick a silver plan instead — for $138/month in premiums — but CSR benefits are weak for people at that income level, and a nearly free bronze plan might make more sense).

If that 45-year-old earns $30,000/year, he could get a bronze plan for as little as $34/month for 2018, whereas his least expensive option would have been $175/month in 2017. The much lower premiums for 2018 are due to the cost of CSR being added to silver plan premiums, and the resulting increase in premium subsidies. This continues to be the case in 2019: A 45-year-old earning $30,000 in Charleston County in 2019 can get a bronze plan for as little as $32/month.

People who aren’t eligible for premium subsidies can purchase plans at other metal levels, or an off-exchange silver plan (people ineligible for a premium subsidy includes those impacted by the Medicaid coverage gap or the family glitch, as well as anyone earning above 400 percent of the poverty level: $48,560 for a single individual, or $100,400 for a family of four in 2019).

So although the bulk of the overall rate increase in South Carolina in 2018 was due to the elimination of federal funding for CSR, the only people who had to bear that cost themselves were on-exchange silver plan enrollees who don’t get premium subsidies, and who chose to keep their silver plan for 2018 instead of switching to an off-exchange plan or switching to a plan at a different metal level.

Despite the fact that the Trump Administration cut off funding for CSR, the benefits of CSR are still available to all eligible enrollees. If your income is between 100 percent and 250 percent of the poverty level ($12,140 and $30,350 for a single individual) and you selected a silver plan in the South Carolina exchange for 2019, your coverage includes cost-sharing reductions that lower your out-of-pocket costs. The benefits are strongest for those with income below 200 percent of the poverty level ($24,280 for a single individual).

Although there were countless headlines about CSR starting in the fall of 2017, eligibility and benefits remained unchanged for 2018, and that continues to be the case for 2019. All that has changed is that the cost of CSR is now being added to premiums (in most states, to silver plan premiums), rather than funded directly by the federal government. But because the cost has been added to silver plan premiums in most states, the added premiums are mostly covered by the federal government anyway, in the form of larger premium subsidies for all enrollees who qualify for premium subsidies.

Off-exchange: 3 insurers, one of which only offers off-exchange coverage

The off-exchange individual market was more robust in South Carolina in 2017 than the exchange market, with six carriers offering individual and family plans outside the exchange. However, for 2018, only two insurers offered individual market plans outside the exchange: Blue Cross Blue Shield of South Carolina, and  Blue Choice Health Plan.

For 2019, Ambetter by Absolute Total Care has joined the individual market in South Carolina, offering plans in Charleston County (on- and off-exchange). So there are three insurers now offering plans outside the exchange in South Carolina.

It’s noteworthy that Blue Choice Health Plan — which only sells off-exchange plans, and thus doen’t have to add the cost of CSR to premiums, since CSR isn’t available outside the exchange — had an average rate increase of just 10 percent for 2018, while BCBSSC’s average rate increase was more than 31 percent. Judging from the rate filing that BCBSSC submitted, their average rate increase for 2018 would also have been around 10 percent if the federal government had continued to fund CSR.

Premium subsidies and CSR are not available outside the exchange. HHS estimated that there were 21,000 people with off-exchange plans in South Carolina in 2016 who would be eligible for subsidies if they switched to exchange plans. But on the other hand, if you had a silver exchange plan in 2017 and were absolutely certain that you wouldn’t qualify for premium subsidies in 2018, an off-exchange silver plan might have been a better option than keeping your on-exchange silver plan. Keep in mind, however, that you can’t change your mind mid-year and switch to an on-exchange plan if your income changes, unless you experience a qualifying event — and a change in income is not a qualifying event unless you’re already enrolled in the exchange.

2017 enrollment

230,211 people enrolled in qualified health plans through the South Carolina exchange during the 2017 open enrollment period, which ran from November 1, 2016 through January 31, 2017. That was just slightly lower than the 231,849 enrollment total from the year before.

Across all the states that use HealthCare.gov, enrollment declined by an average of almost 5 percent from 2016 to 2017, likely due to increasing premiums, uncertainty about the future of the ACA, and the Trump Administration’s decision to curtail advertising and outreach for HealthCare.gov in the final week of open enrollment. But South Carolina’s enrollment decline was smaller than average, at only 0.7 percent.

One carrier in 2017, average rates increased 28%

91 percent of South Carolina’s exchange enrollees received premium subsidies in 2016. Those subsidies are substantially larger in 2017, as the average benchmark (second-lowest-cost silver plan) premium in South Carolina is 29 percent higher in 2017 than it was in 2016, and subsidies are tied to the cost of the benchmark plan.

UnitedHealthcare exited the entire individual market — on and off-exchange — in South Carolina at the end of 2016. This was also the case in most of the other states where United currently offered exchange plans in 2016.

Coventry (Aetna) also offered plans in the South Carolina exchange in 2016, and had originally filed an average rate increase of 27.17 percent for 2017. But in August 2016, Aetna announced that they would exit the South Carolina exchange altogether at the end of 2016.

And in October 2016, the South Carolina Department of Insurance confirmed that BlueChoice, a subsidiary of Blue Cross and Blue Shield of South Carolina, would no longer offer plans in the exchange in 2017, with the parent company choosing instead to only offer Blue Cross and Blue Shield of South Carolina plans. They are the only carrier offering plans in the exchange in 2017.

And although Blue Cross and Blue Shield of South Carolina had filed a proposed average rate increase of 14.74 percent for 2017, the approved rate increase ended up being an average of 27.8 percent.

But that’s before any subsidies are applied, and the majority of South Carolina exchange enrollees receive subsidies that offset a significant portion of their premiums. Those subsidies increased for 2017 to shield subsidy-eligible consumers from the brunt of the rate hikes.

BCBS of South Carolina offered plans in the exchange state-wide in 2016, and so did Blue Choice. But the other two exiting carriers had much smaller coverage areas: Coventry offered plans in 15 of the state’s 46 counties, and insured only 8,000 of the more than 200,000 people who had coverage in the South Carolina Exchange in 2016. UnitedHealthcare only offered plans in five counties in South Carolina, and did not offer either of the two lowest-priced silver plans in any of those counties.

In South Carolina, the state guaranty fund had to pay $48 million in outstanding claims for Consumers Choice CO-OP members when the CO-OP ceased operations at the end of 2015 (details below). This was a larger outlay than the state had expected. Health insurance carriers contribute to the guarantee fund, and they were allowed to incorporate those fees into their premiums.

2016 enrollment: 10% higher than 2015

During the 2016 open enrollment period, enrollment in private plans through the South Carolina totaled 231,849, including new enrollees and renewals (as of mid-2015, there were 165,276 people with in-force coverage through the exchange, and many of them renewed their coverage for 2016). The enrollment total as of February 1 was 10 percent higher than 2015’s open enrollment total of 210,331.

By March 31, 2016, effectuated enrollment stood at 204,846. Of those enrollees, 91 percent were receiving premium subsidies that averaged $312 per month.

Open enrollment for 2016 ended at the end of January, but coverage is still available throughout the year for applicants who experience a qualifying event. Native Americans can enroll year-round through the exchange, and Medicaid/CHIP enrollment also continue year-round.

Consumers Choice CO-OP closed at the end of 2015

On October 22, 2015 The South Carolina Department of Insurance announced that Consumers Choice – an ACA-created CO-OP – would wind down its operations by year-end, and would not participate in the 2016 open enrollment period that began November 1. Consumers Choice was the ninth CO-OP to fail, and the fifth in October alone.

The significant shortfall in risk corridors payments was blamed for the CO-OP’s demise, as was the case for all of the CO-OPs that failed since the beginning of October. HHS announced on October 1 that carriers would get just 12.6 percent of the 2014 risk corridors payments that they were owed, leaving many smaller carriers well into the red. One of the other four CO-OPs that closed as a result of the risk corridor shortfall – Community Health Alliance in Tennessee – was also run by Consumers Choice CEO Jerry Burgess.

67,000 Consumers Choice members had to secure new coverage for 2016. The Department of Insurance put together a series of FAQs for impacted plan members. One concern for patients with chronic conditions was the network coverage of the remaining health insurers. None of them include the Medical University of South Carolina in their networks, despite the fact that MUSC is the only place where some patients are able to access specialists for their conditions. MUSC eventually accepted an offer from Blue Cross Blue Shield of South Carolina to cover specialty care for patients who had previously been insured with Consumers Choice, but the agreement had not yet been finalized as of December 29 – just three days before the CO-OP members were to be transitioned to their new plans.

2016 rates in the exchange

Statewide, the average benchmark premium in South Carolina was 10.8 percent more expensive in 2016 than it was in 2015. That means subsidies were higher on average across the state in 2016, offsetting some of the rate increases that insureds would otherwise have had to pay. But benchmark plans are just the second-lowest-cost silver plan in each area; they aren’t necessarily the same plan from one year to the next, and that change in benchmark premiums doesn’t always give a good picture of how overall rates are changing.

For that, we need to see how rates changed for each carrier in the exchange. In early October 2015, South Carolina regulators released approved rate changes for 2016. The weighted average rate increase at that point was about 15.9 percent (slightly lower in the exchange, slightly higher when off-exchange plans are included). In the exchange, the highest rate increases were for Coventry (Aetna) and Consumer’s Choice. Since Consumers Choice ultimately ended up not offering plans for 2016, the overall weighted average rate increase was lower, since Consumers Choice plans were going to see an average rate increase of 22 percent:

  • Coventry (Aetna) proposed rate increases averaging 31.8 percent across all of their ACA-compliant (on and off exchange) plans. Regulators approved the Coventry/Aetna rates as proposed, and the average rate increase for their plans was 31.8 percent for 2016. Including both on and off-exchange plans, Coventry’s enrollment stood at 34,000 members as of spring 2015.
  • Consumers Choice (CO-OP – shut down at the end of 2015, so rate changes never took effect in 2016) had proposed an average rate increase of 18.4 percent, but regulators increased the rate increase to 22 percent. Including on and off-exchange plans, Consumers Choice enrollment stood at 70,398 members as of April 2015. As of October 22 – when regulators announced that Consumers Choice would not offer plans for 2016 – membership stood at about 67,000 people.

Two additional carriers in the South Carolina exchange – BlueChoice Health Plan and BlueCross BlueShield of South Carolina – both had rate decreases for 2015. And their rate increases for 2016 were single digit:

  • BlueChoice Health Plan: 8.89 percent rate increase approved.
  • BlueCross BlueShield of South Carolina: 8.66 percent rate increase approved.

Time Insurance, which offered on-exchange plans in South Carolina in 2015, initially requested the steepest rate hike (53 percent), but their parent company, Assurant, subsequently announced that they would exit the individual market nationwide; Time products are no longer for sale in any state.

UnitedHealthcare joined the South Carolina exchange for 2016 in five counties; their products had previously only been available outside the exchange. UnitedHealthcare began offering off-exchange individual plans in South Carolina in 2015, and they had 4,109 enrollees (all off-exchange) as of when they filed 2016 rates in the spring of 2015. They proposed an average rate increase of 19.6 percent on those plans for 2016, although regulators reduced the approved rate increase down to 17.1 percent. United’s participation ended up being for just one year; the carrier is exiting the exchange (and the individual market off-exchange) at the end of 2016.

As of 2013, BCBS covered 59 percent of the individual market in South Carolina. And unlike Blues plans in many other states that raised rates substantially for 2016, the Blues plans in South Carolina both had average rate increases of less than nine percent for 2016. They requested larger rate hikes for 2017—close to 15 percent—but those proposed rate hikes were still lower than the national average for 2017.

Very small 2016 rate increases for small groups

In the small group market, the average rate increase for plans sold through the SHOP exchange in South Carolina is just 1.02 percent for 2016. Market-wide, including off-exchange small group plans, the average rate increase is still less than two percent.

2015 enrollment

By the end of the 2015 open enrollment period, a total of 210,331 people in South Carolina had finalized their private plan selections in the exchange.  88,749 of them already had exchange coverage in 2014, and the rest (58 percent of the total) were new to the exchange for 2015.  Total enrollment for 2015 was 177 percent of the enrollment total at the end of the 2014 open enrollment period last spring.

HHS had predicted 150,000 private plan enrollees in South Carolina’s exchange during the 2015 open enrollment period, and the exchange ended up at 140 percent of that target.

But effectuated enrollment is always lower than initial enrollment numbers, because some enrollees don’t pay their premiums and others opt to cancel their coverage mid-year.  As of June 2015, in-force enrollment in private plans through the South Carolina exchange stood at 165,276 people.  88.7 percent were receiving premium subsidies, and 62.7 percent are receiving cost-sharing reductions on silver plans.

Between November 15 and February 22, another 21,106 exchange enrollees were found to be eligible for Medicaid under the state’s existing guidelines, despite the fact that South Carolina has not yet expanded Medicaid.

2015 South Carolina Rates and carriers

Assurant joined the South Carolina exchange for 2015, bringing the total number of carriers in the exchange to five.  Assurant joined the four companies that were already offering health insurance through the federally-run marketplace in South Carolina: Blue Choice Health Plan, Blue Cross Blue Shield of South Carolina, Consumers’ Choice Health Plan and Coventry Health Care of the Carolinas. (this page has more information about the participating carriers).  There were a total of 52 plans available in the state, although not all of them were available in all areas.

A preliminary report released by the U.S. Department of Health and Human Services (HHS) found premiums in South Carolina to be higher than the national average in 2014. In South Carolina, the average cost for the least-expensive bronze plan in 2014 was $267 a month before tax credits or subsidies. The national average for the lowest cost bronze plans was $249 a month.

But things were a lot better in 2015.  Across the entire individual market — including on and off-exchange — PricewaterhouseCooper LLC calculated a weighted average rate increase of just 4.3 percent for 2015. The Commonwealth Fund found that average premiums in the South Carolina exchange increased by 10 percent for 2015, but for silver plans, it was much more muted at just 3 percent.  And the South Carolina Department of Insurance found that the weighted average rate increase in the exchange was just 0.93 percent for 2015, and 0.95 percent for the entire individual market.

In South Carolina, some people who had the benchmark plan (second lowest-cost silver plan) in 2014 and who switched to the new benchmark plan for 2015 experienced rate decreases for 2015, particularly in the western portion of the state.  In the Greenville area, the benchmark plan as well as the lowest-cost bronze and silver plans were all being offered by a different carrier in 2015 compared with 2014.  And this was the case in much of the rest of the state as well.

2014 enrollment numbers

By April 19, 118,324 South Carolina residents had completed their private plan Obamacare enrollments in the exchange.  In addition, 28,359 exchange applicants had enrolled in Medicaid, qualifying under the state’s existing guidelines (South Carolina has not expanded Medicaid under the ACA).

HHS released a report in June detailing average after-subsidy premiums in the federally facilitate marketplaces, and South Carolina is very much in line with the national averages:  87% of enrollees in the SC exchange received a subsidy, the same as the overall percentage across the 36 HHS-run exchanges.  And the average after-subsidy premium in SC is $84, just two dollars higher than the average across all 36 states

No Medicaid expansion

US Rep. James Clyburn (D – SC) views the ACA as the “Civil Rights Act of the 21st century” and has long called on South Carolina to embrace the law (including Medicaid expansion, which SC lawmakers have thus far resisted) and all that it can offer to the state and its residents.

In his article, Rep. Clyburn noted that SC ranks 43rd in the US in terms of overall health, and points out the myriad ways that the ACA can help to improve residents’ health.

And on the 2016 presidential campaign trail, Ohio Governor John Kasich, a contender for the GOP nomination, called on South Carolina to accept federal funding to expand Medicaid.

In large part because of the state’s failure to expand Medicaid, the uninsured rate in South Carolina is still higher than the national average. According to US Census data, the uninsured rate was still 11 percent in 2017 in South Carolina. That was down from 15.8 percent in 2013, but it was still significantly higher than the 8.7 percent national average as of 2017.

And hospitals in South Carolina – particularly in rural areas of the state – are facing closure as a result of a lack of funding – a problem that hospital administrators believe could be addressed by accepting federal funding to expand Medicaid.

Although South Carolina has made no progress so far in terms of expanding Medicaid eligibility, there is one small sliver of good news in the South Carolina Medicaid program: starting in December 2014, adults covered by Medicaid in South Carolina gained coverage for preventive dental coverage, fillings, and extractions with up to $750 in services available for each member per year.

Leadership’s ongoing opposition to ACA

Despite the fact that nearly 20% of the population in South Carolina is uninsured, the state made headlines in 2014 thanks to anti-ACA legislation.  They started with a bill that would have effectively prohibited the implementation of the the ACA in the state.  

The curiously-named South Carolina Freedom of Health Care Protection Act (H3101) would have blocked state employees from participating in the exchange and would have reimbursed residents facing an IRS penalty for not complying with the ACA’s individual mandate.  The bill passed the SC House in the spring of 2013, and then-Governor Nikki Haley supported the legislation. However, it failed a second reading in the Senate on March 19. 

Republican lawmakers in SC haven’t giving up on their efforts to nullify the ACA – Senate Republican Tom Davis introduced an amendment to the bill in 2014 in an effort to continue to fight against the law in a state that desperately needs the ACA.  But the SC Senate voted 23 – 19 to table the amendment. Davis believed that Senate Republicans (with a majority) “didn’t deliver”, but uninsured and underinsured South Carolina residents probably see things a little differently.

And then in December 2014, South Carolina Representative Bill Chumley introduced H3020, which would have essentially remove the state’s ability to operate an exchange, expand Medicaid, or even assist in enrolling people in the exchange. It would also have prohibited the state from participation in any sort of enforcement of the individual or employer mandates. The bill was referred to the Committee on Labor, Commerce, and Industry as soon as the legislative session began on January 13, but did not advance.

The “Freedom of Choice in Health Care Act” was reintroduced in the 2015 legislative session with S103, but did not advance out of committee.

Grandmothered plans

South Carolina was quick to accept President Obama’s policy cancellation compromise that allowed carriers to extend existing plans that had been scheduled to terminate at the end of 2013.  And when HHS extended that proposal in early 2014, South Carolina was once again among the majority of states that opted to allow grandmothered plans to renew into 2015.

These plans, described as grandmothered or transitional, are allowed to remain in force until the end of 2019, under the terms of the latest federal extension, issued in 2018. South Carolina has agreed to allow carriers to keep grandmothered plans in force until the end of 2019, at the carriers’ discretion.

It has been left up to each carrier to determine whether they wanted to allow their pre-2014 plans to continue to be eligible for renewal. This gives many people — who had individual coverage prior to 2014 — another alternative to compare with the options available in the exchange, but some critics contend that it keeps healthy people out of the new ACA-compliant insurance pools.

Outreach

Three federally funded groups launched training programs and outreach campaigns in 2013 to help consumers understand their options. DECO Recovery Management, Cooperative Ministry, and the Beaufort County Black Chamber of Commerce all received grants to hire “navigators.” Navigators provide unbiased information about the options available through the marketplace and help consumers through the enrollment process, but cannot be directly or indirectly paid by insurance companies.

South Carolina was among the states that received the least amount of federal funding in the initial planning grants – the state got $1 million.  This is a thousand times less than the $1 billion that California received (and several other states got hundreds of millions), but is predicated on the state’s refusal to promote the ACA – the money wouldn’t have been utilized by the South Carolina government.

Prior to the 2016 open enrollment period, two navigator organizations in South Carolina received federal grant funding: the Beaufort County Black Chamber of Commerce ($456,102) and the Palmetto Project ($1,123,916).

Navigator funding was sharply reduced by the Trump Administration in 2017 and again in 2018. Heading into the open enrollment period for 2019 coverage (in the fall of 2018), only one organization — DECO Recovery Management — received navigator funding in South Carolina, totaling $300,000.

South Carolina health insurance exchange links

State Exchange Profile: South Carolina
The Henry J. Kaiser Family Foundation overview of South Carolina’s progress toward creating a state health insurance exchange.

South Carolina Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 768-3467  /consumers@doi.sc.gov


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.