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.
The open enrollment period for individual/family health coverage runs from November 1 to January 15 in South Carolina. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
In South Carolina, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). More than 90% of consumers who enrolled in 2022 coverage through HealthCare.gov received premium subsidies.
South Carolinians may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in South Carolina.
Short-term health insurance is also a lower-cost coverage option in South Carolina, where five insurers offer short-term plans.
Five insurers offer marketplace coverage in South Carolina for 2023, up from four in 2022. Bright Health will no longer offer coverage after the end of 2022, but Cigna and Select Health have joined South Carolina’s market for 2023.
The following insurers offer plans in South Carolina’s exchange for 2023:
- Ambetter/Absolute Total Care
- Blue Cross Blue Shield of South Carolina
- Molina
- Cigna (new for 2023)
- Select Health (new for 2023)
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 insurer participation has grown significantly since then.
According to the South Carolina Department of Insurance, the weighted average rate change for 2023 amounts to a 7.1% increase for the three insurers that are continuing to offer plans for 2023 (there are two new insurers as well, but they don’t have applicable rate changes). If we include BlueChoice, which only offers plans outside the exchange, the weighted average rate increase is 7.33%.
But most exchange enrollees receive premium subsidies, which means that their actual (net) rate change can be very different from the full-price rate change that applies to their plan. And of course, people also have the option to switch to a different plan during open enrollment, resulting in a different premium.
Premiums for existing medical insurance plans changed very little from 2019 to 2020. For 2021, three of the four exchange insurers implemented small average rate decreases, ranging from 0.04 percent to 3.6 percent. Ambetter (Absolute Total Care) increased average premiums by about 8.5% for 2021, but their plans covered fewer than 7,400 enrollees in 2020.
For 2022, two of South Carolina’s exchange insurers (Absolute Total Care and Bright Health) proposed overall average rate decreases, while the other two insurers (BCBSSC and Molina) proposed fairly modest single-digit rate increases.
Read our full overview of the South Carolina health insurance marketplace.
During the open enrollment period for 2022 coverage, 300,392 people enrolled in plans through South Carolina’s exchange. This was by far a record high, and was an increase of 30% over South Carolina’s 2021’s enrollment.
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 2022, there were only three remaining CO-OPs offering plans in five states.
According to U.S. Census data, the uninsured rate in South Carolina was 15.8 percent in 2013, and 10.5% in 2018 (although it had been lower – at 10% – as of 2016; the national average uninsured rate 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 above the poverty level. More than 281,000 South Carolina residents qualified for premium subsidies in 2022 that amounted to an average of $512/month – covering the large majority of the average total monthly premium, which was $585. And more than 110,000 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 2022. The GOP has both Senate seats, and six of the seven U.S. representatives are Republican. Rep. Jim Clyburn, who represents the 6th District and supports the ACA, is the lone Democrat.
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. 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 eligibility under the ACA. But the state did increase the income limit for parent/caretaker Medicaid eligibility (from 67% of the poverty level to 100%), and it also opted to extend postpartum Medicaid coverage to 12 months.
But South Carolina has no pending plans to expand Medicaid coverage as called for in the ACA, 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% 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 fairly strict eligibility guidelines: Non-disabled adults without dependent children are ineligible regardless of income, although parents with dependent children are now eligible if their household income doesn’t exceed 100% of poverty (this limit used to be 67%, but a waiver proposal that was approved in 2019 increased the income limit for parent/caretakers to qualify for Medicaid in South Carolina).
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 mid-2022, there were 1,152,783 South Carolina residents enrolled in Medicare. About 40% of them were covered by private Medicare plans (Medicare Advantage) and the rest were enrolled in Original Medicare. Most South Carolina Medicare beneficiaries are eligible due to age, but almost 14% are under the age of 65 and are eligible for Medicare due to a disability.
Read more about Medicare enrollment in South Carolina, including details about Medicare Advantage and Medicare Part D, as well as state rules for Medigap plans.
- South Carolina Department of Insurance – Oversees, regulates, and licenses health insurance companies, agents, and brokers.
- South Carolina Department on Aging – Information and assistance programs for Medicare beneficiaries
- South Carolina Primary Health Care Association — the federally funded Navigator organization in South Carolina.
