South Carolina is an U.S. state, which is known for its shoreline of subtropical beaches beautiful coastline, gardens, and historic sites. Despite of natural beauty in abundance the state position in the health rankings is not pretty impressive and so the residents of this state certainly have room for improvement in terms of health. The vast majority of the state’s population does not have individual market coverage, because most of them either have employer-sponsored insurance or government provided coverage. State and the federal governments is the second major sources of health insurance for individuals, who jointly provide Medicaid for low-income individuals while the federal government sponsors Medicare for the elderly and disabled. Open enrollment for 2020 coverage in the individual major health insurance market both on- and off-exchange ended on December 15, 2019, like any other states that use HealthCare.gov. Average premiums in the South Carolina health exchange increased by 5.26 percent for 2019 coverage.
Highlight and Updates on South Carolina Health Insurance
- Open enrollment period for 2020 coverage has ended and now only residents with qualifying events can enroll or make changes in their plan.
- South Carolina uses federally facilitated health insurance exchange, so residents can enroll through HealthCare.gov.
- South Carolina is one of the nine states where there was increase in the enrollment rate compared to 2018.
- Short-term health plans are available in the state with initial plan terms of up to 11 months.
- For 2019 coverage, the approved average rate increase was of 5.26%.
- Currently there are three insurance carriers offering health plans through the exchange for 2020.
- Blue Cross Blue Shield of South Carolina allowed people to enroll in health plans outside the exchange until December 31, 2019. The coverage became effective from January 1, 2020.
- Most of the lawmakers of South Carolina are Republicans who opposed to the ACA.
Individuals & Family Health Insurance
All the qualified individuals and families plans available in South Carolina offer the ten standardized essential benefits mandated as per Affordable Care Act along with some additional benefits mandated by the South Carolina state. To easily compare costs and benefits of individual and families plans, ACA ensures that all qualifying plans should be of four metals, Platinum, Gold, Silver, and Bronze. In all the metal plans, insured have to share out-of-pocket charge and the Bronze plan have maximum out-of-pocket expenses whereas Platinum plans have least out-of-pocket amount. Types of health insurance plans available in South Carolina for individuals and families include:
PPO – PPO is a major healthcare plan of South Carolina offered by leading insurer carriers of the state, which is immensely popular in the individual and family market. Members of the PPO plans can visit any of the network physician or healthcare provider without requiring any referral from a primary care physician. To offer this plan insurance carriers contract with selected healthcare providers and hospitals to render services at a discounted rate to all the members of the plan. However, PPO members can seek healthcare services outside the network but they would have to pay a higher deductible or co-payment. A PPO plan is ideal for individual and families who wish to have freedom in choosing healthcare provider for seeking medical facility. In the PPO plans a part of out-of-network claims are covered by the insurance company and the members of the PPO plans do not have to obtain referrals before visiting a specialist.
HMO – HMO or Health Maintenance Organization plans provide several healthcare services through extensive network of providers who agree to render healthcare services to members of the plan. Members of the HMO plans in South Carolina are required to choose a primary care physician, who take care of their healthcare needs and also provide a referral before visiting a specialist. With HMO plans members are likely to receive a wide range of preventive healthcare services compared to any other individual plans. Members of the HMO plans have lower out-of-pocket healthcare expenses, as most of these plans have no deductibles and even minimal co-payments. The HMO plans have lower premiums and members won’t have to submit claims to their respective insurance company. However, members should keep in mind that they will likely have no coverage if they receive healthcare services from the out-of-network providers or even for healthcare services received without a proper referral from their Primary Care Physician.
HDHP with HSA – A HDHP is a health insurance plan that comes with lower monthly premiums and a higher deductible. Thus, South Carolina residents who wish to save money on their monthly premiums have the opportunity to open a health savings account and to open this account they need to have a high-deductible health plan. Members of HDHP have a deductible of $1400 in 2020 for an individual plan and $2800 for a family plan. The members of the plan need to first pay the deductible amount from their pocket for medical expenses before insurance companies pay anything. Therefore, individuals who can afford out-of-pocket expenses in a worst case scenario should opt for this plan, as this plan comes with minimum premium amount. Despite being annual contribution limits, HSA allows insured to roll over their balance from year to year and they can also contribute to this account on a pre-tax basis, which is a big advantage.
FSA – A Flexible Spending Account is a type of savings account that allows individuals to contribute a part of their regular earnings, which they can later use to pay for the qualified expenses related to medical and dental costs, including for dependents and spouses. Individuals can contribute in this account from their earnings before they are made subject to payroll taxes, thereby lowering their taxable income. With regular contributions to this account, individuals can significantly reduce their tax liability. However, the IRS has put a limit on the amount that can be contributed in this account per year. In 2020, the limit on deposited amount per individual is $2750. Individuals don’t need to pay taxes on the amount accumulated in the account.
Short-term Plans in South Carolina
South Carolina follows its own state regulations for short-term health plans, which are available for duration up to 11 months with total duration including renewals of up to 33 months. South Carolina has slightly shorter duration limits than ACA compliant plans which have one year term just to help residents understand that there is difference between both the plans. Short term plans are temporary plans that are designed especially to fill the coverage gap in situations when individuals have new jobs and they are waiting for benefits to start or when they missed open enrollment period or if they have just graduated or turned 26 and left their parents’ insurance plan. The major benefit of short-term plan is its affordability. The short-term plan benefits are related to emergency care and this plan works best for individuals who don;t require regular medical care like frequent visits to the doctor or expensive prescriptions. Though these plans do not offer benefits like major health plans but provide some coverage that is affordable for many people.
Dental Insurance Plan in South Carolina
Dental insurance plan in South Carolina works exactly in the same way as health insurance plan where insured have to pay a monthly premium in order to receive certain dental benefits like regular check ups, cleanings, x-rays along with other general dental care. Some of the dental plans also provide coverage for certain types of oral surgery, dental implants and orthodontia. Dental plans in South Carolina are categorized as follows:
Indemnity Care Dental Plan – With indemnity are plans insured have a broader selection of dental care providers. The insured are free to visit the dentist of their choice and they first need to pay up front and then later obtain reimbursement from their insurance carrier. The insurance carrier pays for covered dental services only after receiving the bill.
Managed Care Dental Plan – Managed care dental plans have in-network dentists who agree to render dental care services for patients at pre-negotiated rates. The in-network dentists then submit the claim to the dental insurance carrier on behalf of the patients. The plan members have less paper work in this plan and also have lower out-of-pocket costs.
Vision Insurance Plan in South Carolina
Vision insurance plans in South Carolina are designed to offer coverage for most comprehensive prevention, examination and prescription vision care services. The individual vision insurance plan in South Carolina will allow people save money on eye exams, eyeglass lenses, frames and contracts.
Insurance Carriers in South Carolina
South Carolina’s federally run health insurance exchange had just one insurer in 2018 offering plans in the exchange, Blue Cross Blue Shield of South Carolina but Ambetter (Absolute Total Care) and Molina also joined the exchange to provide coverage for 2019 and Bright Health has joined to offer health plans for the year 2020.