How does health care in the Palmetto State compare to the rest of the nation? According to a study by U.S. News, South Carolina has the 41st best health care in the nation. That accounts for access, quality, and good public health.
Health insurance options in South Carolina
According to the SC Department of Insurance, residents can gain access to health care through several outlets.
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do South Carolina residents get health insurance?
|Individual or family
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population
10 percent of South Carolina residents are uninsured, just above the national average. That’s a positive sign for residents. Why? A high percentage of uninsured people lead to higher rates for insured people.
South Carolina health insurance companies
There are sparse options for health insurance companies in SC. These are the providers offering individual and family plans in the state:
- BlueCross BlueShield of South Carolina
- Ambeter/Absolute Total Care
South Carolina health insurance costs and rate factors
How much will you pay for health care in your state? South Carolina residents spend an average of $7,311 every year on health care expenditures. That’s less than the rest of the country.
There are several factors that insurance companies consider while pricing your policy, and they vary from person to person.
Marketplace plans come in metal tiers: bronze, silver, gold, and platinum. It’s no surprise that higher coverage levels come with higher monthly premiums.
So, what should you expect to pay in SC? These are the average monthly prices for each plan type for a middle-aged state resident in 2020:
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier
A gold plan will cost you about 50 percent more than a bronze plan. This price shift is because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent.
A catastrophic plan is the lowest level of coverage you can get in the marketplace. Catastrophic plans have low monthly premiums but a yearly deductible of $8,150. Investing in a bronze or silver plan may save you money when you need to use your insurance.
Body mass index
According to the CDC, a high body mass causes several serious health conditions. That’s why insurers analyze your BMI when determining your risk-level. People with higher BMIs pay more in monthly premiums.
In 2017, SC residents had a 34.3 percent obesity rate, the 14th highest in the country. Out of the many state residents who used QuoteWizard to compare health care policies, 37 percent have a BMI in the obese range.
Because of the numerous health conditions caused by smoking, tobacco users spend more on health insurance. About 18.8 percent of South Carolina residents are smokers, the 36th highest rate in the country.
Older people pay up to three times more for health insurance than younger people. SC residents who used QuoteWizard to shop for health insurance are, on average, 42 years old.
Every state has different rules, regulations, and providers surrounding its health care marketplace. A key factor in your health care costs is where you live.
Also, health insurers often rely on community ratings to price your policy. That means that rates account for the combined claims that everyone files. If your neighbor files an abnormally high number of claims, for example, your prices could rise.
The health of your state also plays a role. According to America’s Health Rankings, SC is the 44th healthiest state in the country.
South Carolina health insurance laws
The Affordable Care Act limits what insurance companies can use to determine your health care costs.
- Pre-existing conditions: The ACA mandates that you can’t be charged more for having a pre-existing condition. People with previous medical problems or lapses in insurance used to face steep premiums, if they could even get coverage.
- Gender: According to a study about health care costs, women historically pay more for health insurance. But the ACA limits health care companies from charging men and women different prices for the same plan.
- Insurance and medical history: Insurance companies used to analyze past insurance coverage and previous medical problems. They used these factors to boost prices, but the ACA limits them from doing that anymore.
Marketplace plans have a cap on how much you can pay out-of-pocket. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
SC state law requires insurance companies to offer at least some coverage for the following services:
- Maternity minimum stay
- Diabetes education and supplies
- Cancer screenings
- Mental health
- Autism spectrum disorders
- Emergency room service
Medicare and Medicaid in South Carolina
Medicare and Medicaid are both government-funded health care programs that aid certain Americans. Medicare helps seniors, and Medicaid assists low-income families and children.
Medicare exists to offer affordable health care to people 65 and older. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid (Healthy Connections) helps low-income families and children obtain affordable health care. These are the state’s Medicaid financial requirements:
|Maximum Yearly Income
South Carolina Office of the Insurance Commissioner
- Insurance Commissioner:
- Raymond G. Farmer
- Insurance Hotline:
- (803) 737– 6160
- Office Hours:
- Monday - Friday
8:30 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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