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South Carolina Health Insurance

South Carolina Medical Insurance Overview

The state of South Carolina exhibits a low number of strengths and quite a few weaknesses overall.  In 2014, the United Health Foundation ranked the state in the 42nd position with regard to the general health of people residing in this state.

The Governor of the state, Nikki Haley vehemently opposed the Affordable Care Act and vowed to fight the healthcare legislation at every turn.  With the large presence of Republicans in office in South Carolina, her efforts have proven to be quite successful.  Since the enactment of the ACA, the state has opted to allow the federal government to implement and manage the state’s benefits exchange.  In addition, the Governor opposed the expansion of the Medicaid program.

Because of the opposition to the Affordable Care Act, the legislation’s ability to reduce the uninsured population of this state has largely been thwarted.  When enrollment was upon the residents of South Carolina, many took advantage of the opportunity for health insurance, but the state still has a long way to go in the bigger picture.

South Carolina’s Health Care Issues
Because the state of South Carolina sat in the 42nd position when its health status was collectively compared to other states in the country, the state still has quite a ways to go to see some improvements.  It has progressed on a small scale, but the state is far apart from where it needs to be to see a great deal of benefits.

Some of the strengths and weaknesses of the health of South Carolina’s population include:


  • High immunization coverage among children
  • Low prevalence of excessive drinking
  • Small disparity in health status by education level


  • Low immunization coverage among adolescents
  • High prevalence of smoking
  • High violent crime rate

Understanding South Carolina’s Uninsured Population
The uninsured population of South Carolina is quite large as of 2014.  The Kaiser Family Foundation estimates that 13% of the state’s non-elderly population was without insurance of any kind.  In 2014 alone, the number of uninsured residents peaked at 614,100.  Still, this number is a great deal less than the numbers presented for 2013.  This signifies that residents are using the federally facilitated exchange in order to purchase insurance coverage.

Seven percent of the non-elderly uninsured population is comprised of children who are under 18 years of age.  The population of residents without insurance who are between 19 and 64 years of age is represented by 18%, while 6% of those earning incomes of over 400% of the Federal Poverty Level are not insured.

Group Health Plans
The regulatory body responsible for overseeing private insurance providers in the state of South Carolina is the Department of Insurance.  In this state, many large companies offer group level coverage to workers, but the plans are based on the amount of workers covered and the policy that is purchased.  Healthcare efforts aim to lower the costs of group health coverage, but there are still many companies operating in the state of South Carolina who don’t offer any coverage to their roster of employees.

With regard to the monthly premiums, through a group plan, the company usually chips in to pay a portion of the associated costs.  Smaller companies may not be able to afford such benefits packages for their workers.  Also, many employees don’t obtain coverage through the workplace because of the expense involved.  Still, if the company you work for offers a benefits package, you should take this under consideration because it may be the cheapest method of buying insurance in the state.
Signing Up
Joining your employer’s group benefits package is usually done during times of open enrollment.  Through your company’s Human Resources Department, you can learn when this period of time is scheduled so that you can plan ahead and research the benefits offered.

You can usually have a few choices to pick from when considering group benefits through your workplace, so it is important to determine the level of coverage that you will require in the future along with each plan’s affordability.  You should also learn what is covered by the plan and what is excluded from coverage.

Before making the commitment to sign up for health insurance coverage, you should consider the premiums and whether or not they are budget friendly.  In addition, you should ensure that the policy you are interested in covers your dependents if this coverage is applicable to your situation.

Also, ask whether or not the plan offers coverage for pre-existing medical conditions.  If this applies to you, you want to be sure that you can obtain medical services throughout the coming policy period.  If there is pre-existing condition coverage, what is the length of time dedicated to the exclusion period?  Lastly, ask when the affiliation period begins and how long you will have to wait before making your monthly premiums and enjoying coverage.

Following the probationary period, newly hired employees can usually get insurance coverage under the company’s group plan right away.  If you opt out of the benefits package through your workplace and later change your mind, you will only be allowed to sign up during the next open enrollment period.  These periods of time are usually held once a year, but if you miss the deadline for registering for coverage, you will have to wait.  For information on enrolling into the company’s group plan, obtain all of the relevant information from the company’s Human Resources department.

Continuation Coverage
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives those persons who have lost insurance coverage for any reason the ability to obtain continuation coverage.  Qualifying events for COBRA coverage include job loss, divorce, transition between jobs, death or reduction in hours worked.  In order to get coverage, the company previously offering the group coverage must have over 20 employees.  You will have to pay the entire insurance premium along with an extra two percent for administrative costs.

COBRA coverage is available on a temporary basis for up to 18 months and offers the same basic coverage that was previously available under the original group plan.

Conversion plans are available to those covered individuals who wish to maintain the group coverage, but have it converted to an individual insurance plan.  In this scenario, you are able to retain the same insurance company.
Individual Health Plans
Individual health insurance plans are available to people based on a number of criteria and are typically purchased by people who cannot obtain group coverage or participation in a state-sponsored program.

Individual policies can be the best possible solution for the needs of individuals and families covered under this type of plan.  Under a policy of this type, you are able to obtain comprehensive coverage, but it can also prove to be an expensive option.  Costs associated with coverage under an individual insurance policy depend on your age, location within the state and the amount of coverage chosen under the plan.

It is estimated that a young, healthy non-smoker residing in South Carolina may obtain coverage of this type for around $50 every month.  However, for such a low cost, you may not receive comprehensive coverage or low deductibles.  Many different options exist for this type of insurance policy and the best one depends on your situation and medical needs.

Individual insurance policies are subject to a great deal of medical underwriting in order for the insurance company to determine your eligibility.  For insurance coverage under a plan of this nature, you may be forced to wait out a two year long exclusionary period if you have a pre-existing medical condition before enrolling into an individual plan.  Health Maintenance Organizations (HMOs) can look back into your medical records for a period of a year in order to determine whether or not you have a pre-existing condition.  In the event that such a condition exists, if the coverage is through an HMO, the exclusionary period can only last for twelve months before your insurance coverage can be used.

South Carolina Health Benefit Exchange
Under the terms of the Patient Protection and Affordable Care Act, every state in the country was required to create and implement a health insurance marketplace.  In such a marketplace, residents of each state would be able to secure insurance coverage and compare the plan options for the available policies.  However, the state of South Carolina opted to leave the benefits exchange to be a federally facilitated marketplace.  Governor Nikki Haley opposed the legislation and signed a law that prohibits state exchange plans from covering abortions with few exceptions.

Using, residents in the state of South Carolina can look at their options, apply for coverage and learn their state-funded program options if they earn a low income.

More information on the history of the South Carolina health benefits exchange using the Henry J. Kaiser Family Foundation’s official website.

South Carolina State Insurance Programs
South Carolina has a myriad of options for those individuals and families earning low or moderate level incomes.  Eligibility for these program options is dependent on age, gender, health condition and income level.

Below is a list of the various state-funded programs available in this state along with descriptions for each.

South Carolina Health Insurance Pool (SCHIP)
SCHIP was created to offer coverage to South Carolina residents who cannot obtain insurance because of a medical condition or due to the premiums exceeding 150% of the pool rate.  You can apply for SCHIP by filling out the application located on the Department of Insurance’s website.

SCHIP can be expensive, ranging in costs from $326 to over $4,000 with deductibles ranging between $500-$1,500 which is dependent on the plan selected, your age, gender and any requirements for co-insurance.

Pre-Existing Condition Insurance Plan (PCIP)
PCIP is available to residents in the state of South Carolina who have been turned down for coverage because of a medical condition.  To be eligible, you must be a U.S. citizen, have gone without insurance coverage for six months prior to enrollment and have a qualifying medical condition.  Coverage for residents can range in costs from $301 to $642 dependent on age.  The plan has a deductible amount of $2,500 and an out of pocket limit of $5,950 annually.

Under PCIP, you can obtain services such as prescription drug coverage, doctor’s visits, emergency services and more.

Adult Sickle Cell Program
For adults with inherited blood disorders is the Adult Sickle Cell Program.  This program offers various treatment options for any conditions related to sickle cell disease.  Nursing, nutrition, and outpatient services are offered along with coverage for supplies, equipment and prescription medications.  South Carolina residents must be a United States citizen and over the age of 18-years-old to qualify for coverage.  In addition, your income must be under 200% of the Federal Poverty Level.  There is typically no cost for services under this program.

Healthy Connections (Medicaid)
Using Medicaid, participants can receive a variety of covered services.  Medicaid is a program that is run on a federal level and provides insurance coverage to millions of Americans.  Among those covered are pregnant women, parents, children, people with disabilities and seniors.

In order to qualify for coverage under the Medicaid program, you must meet certain income requirements.  To apply, you must visit the Healthy Connections online portal.
Partners for Healthy Children (PHC)
This program offers coverage to children whose families earn at or under 208% of the Federal Poverty Level.  To qualify, you must be under the age of 19, be a South Carolina resident, a U.S. citizen or resident alien, have a Social Security number or can prove that you have applied for one.  You can apply for this coverage at the online portal for PHC.  Costs associated with coverage are typically zero for participants, but if premiums are charged, they are minimal.

Children’s Rehabilitative Services (CRS)
For CRS eligibility, applicants must be a legal U.S. resident living in the state of South Carolina.  In addition, you have to be under the age of 18 and diagnosed with a developmental delay, chronic illness or disability with a combined household income of 250% of the poverty level.

Under CRS, you can obtain hospital care services, braces, hearing aid, various therapies, prescriptions and children’s summer camp.

Best Chance Network (BCN)
For women between the ages of 47-64 years old in South Carolina who earn a significantly low income and have no insurance, medical services can be obtained for breast exams and other early detection methods.  This covers mammograms, pap smears, pelvic exams and more.  Your income may not go over 200% of the federal poverty line in order for you to be eligible for services.

Women-Infants-Children (WIC)
WIC is a program that offers breastfeeding and infant care services and support to pregnant women and new mothers.  WIC is focused on providing needy mothers and children with supplemental food products and educational resources to aid in healthiness of the participants covered.  WIC is typically offered to women who earn low wages annually.

This program is funded and regulated through the Individuals with Disabilities Education Act and is an early intervention system for children from birth to three years of age.  Those persons able to participate must have a medical condition that is associated or will result in developmental delays.  More information can be gleaned from the SC First Steps website.

Medicare and the State Health Insurance Program (SHIP)
For seniors, people with end stage renal disease and individuals who are disabled, the Medicare program offers a variety of benefits.  If you wish to be covered, you must be disabled or suffering from renal disease or be a senior over 65 years of age.

There are four parts to the Medicare program, each with varying levels of coverage.  If you want more information on your coverage options, you can use the SHIP program as a counseling service for Medicare benefits.

In order to be eligible to apply for Medicare, you or your spouse must have worked in a job that was covered by Medicare for the span of over ten years.

VA Medical Benefits Package
All veterans in any branch of the United States military are able to receive comprehensive medical coverage through this program.  Qualifying vets must have completed their active duty requirement or 24 consecutive months of service and be in receipt of an honorable discharge.  There is no cost for this program and veterans are guaranteed coverage if the above requirements are met.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance is a free, nationwide program that helps consumers get financial assistance for helping pay the costs for medications.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a volunteer network in which the mentally ill can use to talk to someone about their mental illness.  In addition, this program helps those living with the mentally ill.  Along with informational guidance, callers can receive their options for treatment, but this is not a replacement for medical care or advice from a doctor.

The Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act first governed the use and transmission of private medical records among medical providers.  With the addition of the Affordable Care Act, the law now works to offer protections for consumers against health insurance companies.

HIPAA governs the length of time that insurance providers can deem necessary for exclusionary and affiliation periods.  In addition, it prohibits group health plan providers from discriminating against consumers due to the presence of a health condition prior to enrollment.

Under HIPAA, however, individual health insurance providers can deny coverage to you if you have a pre-existing medical condition.  Additionally, HIPAA does not offer those persons who are self-employed to benefit from HIPAA guidelines set forth for group health insurance plans.

Regardless, the legislation is a step in the right direction for consumers.