Frequently asked questions about health insurance
coverage options in South Carolina
South Carolina’s health insurance marketplace/exchange is run by the federal government, so residents use HealthCare.gov to shop for individual and family health plans. The marketplace provides health insurance to people who need to buy their own coverage, including early retirees, the self-employed, and people who are employed by small businesses that don’t offer health benefits.
Enrollment and plan changes for individual/family coverage are normally only available during open enrollment in the fall, or during a special enrollment period triggered by a specific qualifying event. But in 2021, an enrollment window runs through August 15. South Carolina residents can enroll or make a plan change during this window, without needing to experience a qualifying event.
This window gives uninsured South Carolina residents a chance to obtain coverage, and it also gives current enrollees or off-exchange enrollees an opportunity to switch plans in order to take advantage of the additional premium subsidies offered by the American Rescue Plan.
After August 15, 2021, South Carolina residents will again need a qualifying event in order to enroll in coverage for 2021 or make a change to their existing 2021 coverage.
Open enrollment for 2022 South Carolina health insurance plans will begin November 1, 2021, for coverage effective January 1, 2022. Open enrollment is an opportunity for South Carolina residents to make a change to their individual/family health plan, update their income information that the exchange has on file, renew their existing coverage, or newly enroll in individual market coverage. The enrollment window applies both on-exchange and off-exchange (ie, coverage purchased directly from a health insurer).
Learn more in our comprehensive guide to the open enrollment period for 2021 health plans.
Unfortunately, South Carolina does not have any federally-funded navigator organizations that can help people enroll in coverage through the exchange, but there are numerous brokers who are licensed by the state and certified by the exchange to provide information and assistance with the enrollment process.
The November 1 – December 15 open enrollment period applies to individual market health insurance, so it does not affect people who get their health coverage from an employer or from the government, via Medicare, Medicaid, or CHIP.
Medicaid/CHIP enrollment continues year-round for people who are eligible. South Carolina has not expanded Medicaid coverage under the Affordable Care Act, which means the state’s pre-ACA eligibility guidelines still apply.
Four insurers offer marketplace coverage in South Carolina. South Carolina’s health insurance marketplace had just one insurer – Blue Cross Blue Shield of South Carolina – offering plans in the exchange in 2018. But Ambetter (Absolute Total Care) joined the exchange for 2019 and Bright Health and Molina started 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 have proposed small average rate decreases, ranging from 0.1 percent to 3.6 percent. Ambetter (Absolute Total Care) has proposed an average rate increase of nearly 17 percent, but it would only apply to fewer than 7,400 enrollees.
Read our full overview of the South Carolina health insurance marketplace.
In 2014 and 2015, South Carolina residents could buy health insurance through Consumers Choice, the state’s Consumer Oriented and Operated Plan (CO-OP). The CO-OP was funded under the ACA with a grant from the federal government.
Nationwide, about $2 billion was awarded to CO-OPs in 22 states. In South Carolina, Consumers’ Choice Health Plan (CCHPSC) received about $87.6 million. However, by November 2015, officials had announced its closure, and CO-OP members needed to select coverage from another insurer for 2016.
As of 2020, there were only four remaining CO-OPs offering plans in five states, and one of them, New Mexico Health Connections, is closing at the end of 2020.
According to U.S. Census data, the uninsured rate in South Carolina was 15.8 percent in 2013, and 10.5 percent in 2018 (although it had been lower – at 10 percent – as of 2016; the national average uninsured rate has crept back up during the Trump administration).
South Carolina leadership’s opposition to the ACA means the state has thus far refused to expand Medicaid coverage, so a cornerstone of the law’s ability to reduce the uninsured rate is not being utilized.
But the ACA has made comprehensive individual market coverage more affordable for South Carolina families with income between the poverty level and 400 percent of the poverty level. Nearly 186,000 South Carolina residents were receiving premium subsidies in 2020 that amounted to an average of $539/month – covering the large majority of the average total monthly premium, which was $610. And nearly 87,000 enrollees were receiving cost-sharing reductions, which help to keep out-of-pocket costs affordable when a person has a medical claim (ie, lower deductible, copays, and coinsurance).
And everyone enrolled in individual and small-group health plans in South Carolina (with effective dates of 2014 or later) has coverage for the ACA’s essential health benefits, without lifetime or annual caps on the benefits.
South Carolina’s U.S. congressional delegation is comprised almost entirely of Republicans as of 2020. The GOP has both Senate seats, and five of the seven U.S. representatives are Republican. Rep. Jim Clyburn, from the 6th District, and Rep. Joe Cunningham, from the 1st District, are the lone Democrats.
Cunningham and Clyburn support the ACA, and Cunningham campaigned on additional health care reform proposals, including lowering the Medicare eligibility age to 55, allowing Medicare to negotiate with drug manufacturers, and limiting skimpy policies like short-term health insurance.
Lindsay Graham, South Carolina’s senior Senator, was instrumental in Senate Republicans’ last-ditch effort to repeal the ACA in September 2017 via the Graham-Cassidy Amendment. But Graham noted after the effort failed that he had essentially no understanding of health policy, saying “Well, I’ve been doing [healthcare reform policy] for about a month. I thought everybody 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 chambers of the state legislature.
South Carolina is currently one of 12 states that have not yet expanded Medicaid coverage or begun the process of doing so. (Expansion takes 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 on the part of consumer advocates. The ACA would have expanded Medicaid coverage for all legal residents with incomes up to 138 percent of poverty. In 2012, the Supreme Court ruled that states could opt out of Medicaid expansion, and South Carolina has been steadfast in its rejection of federal funding to expand Medicaid coverage. Because the state 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.
Roughly 214,000 additional people would be eligible to enroll in Medicaid plans if the state were to expand coverage guidelines. But instead, enrollment is still contingent on South Carolina’s strict eligibility guidelines: Non-disabled adults without dependent children are ineligible regardless of income, and parents with dependent children are only eligible if their household income doesn’t exceed 62 percent of poverty (a little over $1000/month for a family of three).
South Carolina officials have said that instead of expanding Medicaid coverage, they are focusing on their Healthy Outcomes program, which helps chronically ill people without health insurance get access to treatment through free clinics and hospital charity programs. Unfortunately, the program can only assist about 8,500 people – a tiny fraction of the people who are in the coverage gap in South Carolina.
Read more about Medicaid expansion in South Carolina.
South Carolina has its own state regulations regarding short-term health insurance plans. Short-term health insurance plans in South Carolina are currently prohibited from offering coverage which exceeds 11 months, with a total duration of 33 months of short-term health insurance coverage (including renewals).
Read more about short-term health insurance 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 plans (Medicare Advantage) and two-thirds were enrolled in Original Medicare. Most South Carolina Medicare beneficiaries are eligible due to age, but 17 percent are under the age of 65 and are eligible for Medicare due to a disability.