Home to a variety of cultural, historical and geographical attractions, South Carolina has a blend of all types of interests. Whether you prefer a golf outing on Hilton Head Island, a trip to Myrtle Beach, or hiking in the mountains, South Carolina has much to offer. In addition to the relaxed nature of most of the state, Columbia, the capital, and other major cities have a variety of activities to pursue involving the arts, museums, professional sports, and universities.
The residents of South Carolina have a number of health insurance options, with companies like Aetna, Celtic, Cigna, Humana, Coventry and UnitedHealth Care to choose between. Since there is such a wide variety of options, feel free to call one of our licensed South Carolina agents at 888.803.5917 for extra assistance. To get a quote and compare prices and availability in your area on your own, enter your zip code below.
The health of South Carolina as a whole could use some big improvements. There is a large population of overweight/obese adults, which has increased from 22% to 32% over the past decade. Also, the number of adults with diabetes has climbed from 7.1% to 10.7% in the past ten years. If the overall intake of healthy foods and participation in physical activity was implemented and taken more seriously the levels of poor health could see some changes. An upside is that there are low numbers of binge drinking in South Carolina.
Though there is high immunization coverage in South Carolina, the number of uninsured individuals has increased to above the average of most other states in the U.S. to almost 19% of the population. Tobacco use is declining in the state, though 21% of adults still smoke cigarettes. There are many wellness programs provided through health insurance plans, as well as public programs for those who cannot afford insurance. Making use of these services in addition to keeping up with medical needs could drastically improve the health of South Carolinians.
Health Insurance Plans
- PPO plans are available in South Carolina through Aetna in Value and Individual PPO options. Some of these plans have additional benefit options such as unlimited primary care visits and dental coverage. PPOs give you access to discounts through Aetna’s Preferred network of providers, or the choice to see a non-network provider. Both types offer preventive care benefits from the start date of your plan, including immunizations, check-ups and well-baby care. There are a variety of deductibles to choose from, as well as different levels of coinsurance. Value plans give a basic level of coverage, and Individual PPOs offer a more comprehensive set of benefits.
- PPO High Deductible plans are qualified high deductible policies with the ability to pair it with a health savings account (HSA). High deductible plans offer a very comprehensive level of coverage, with no charge for doctor’s office visits, prescription drugs, and inpatient and outpatient hospital care after the deductible is met. HSA funds can be saved for the future or withdrawn tax-free for specified medical costs (like deductibles and coinsurance). Preventive care is offered immediately for no cost when using in-network doctors.
- CeltiCare Preferred plans are PPOs that come in either Select, “Any Doc” or Managed Indemnity options. Each type provides 80/20 coinsurance after you meet your deductible on services such as physician office visits (specialist and non-specialist), lab work and X-rays, and hospital care. From the day your plan starts, you can receive in-network preventive care for no cost, as well as prescriptions and your first two doctor’s office visits for a small copay. Deductible choices are $2,500, $5,000, and $10,000 for individuals.
- Celtic Basic plans are also PPOs, with a choice between 70/30 or 80/20 coinsurance. The first two physician’s office visits for non-preventive care are $30, and prescriptions are available for a copay as well (generics are $15). Preventive care is available through in-network providers at 100% coverage, which includes immunizations, physical exams, GYN exams, well-child care and more. A variety of services can be used before the deductible is met for a set amount of cost sharing determined by your plan.
- Open Access PPO plans from Cigna in South Carolina have some of the company’s lowest premiums, with high deductibles and a fairly rich set of benefits. Physician visits to specialists and non-specialists in-network are available for a copay as soon as your plan starts. Preventive care is covered at 100% immediately, including physical exams, well-child care, immunizations and more. Prescription drugs are available for a copay, $10 for generic, and $35 for brand names. After your deductible is met, you will pay your chosen level of coinsurance for inpatient and outpatient care, lab work, and other services.
- Health Savings plans are high deductible plans qualified for use with a health savings account. These plans offer 100% coverage after deductible on most medical care such as emergency room care, urgent care, doctor’s office visits, and inpatient and outpatient hospital services. These also have a moderate amount of coverage for inpatient and outpatient mental health care. With an HSA, you can use the funds to meet your deductible sooner, or pay for various medical costs specified by your insurer.
- Copay (WellPath Select) plans from CoventryOne are available in various levels of coverage, with different deductibles and coinsurance options to choose from, but all provide a simple copay for doctor’s office visits and prescriptions. CoventryOne plans are POS plans, which act similarly to a PPO in that you can choose in or out-of-network providers based on your preference. In-network will be less expensive, and is free of charge for preventive care such as mammograms, colorectal cancer screening, child well-care and immunizations. These plans come in Traditional, Value, and Extra Value options.
- QHDHP(WellPath Select) plans offer a high level of coverage for a high deductible. These plans also are HSA compatible, which gives you control over your health care expenses and payments. These plans are also POS, with 100% coverage on most medical services after deductible when using in-network, and 70% for out-of-network. Services include physician office visits, prescription medications, diagnostic services, anesthesia, and other inpatient and outpatient hospital care. There are a range of deductibles to choose from, between $1,500 – $5,000 for individuals in-network.
- Monogram plans in South Carolina connect you with HumanaOne’s PPO network for discounts on various types of health care services. Once your plan starts, you can receive in-network preventive care at no cost, and after you have met your deductible, there is no charge for doctor’s office visits, diagnostic testing, outpatient surgery, inpatient hospital care and more. There are a range of deductibles to choose from, all of which include prescription drug coverage at a copay of $15 for generics and $40 for brand name drugs. You can also seek out-of-network care for a lower level of coverage after deductible.
- Autograph plans from HumanaOne also utilize the preferred network, with high deductibles and the ability to open a health savings account. Choosing to pair your plan with an HSA gives you control over your medical care costs, and grow tax-advantaged funds to pay for deductibles, coinsurance, and copays. These plans are very comprehensive, covering 100% of your physician’s visits, hospital care, emergency and urgent care, and lab work when using network providers after deductible. From the start of your plan, you can get immunizations, routine physicals, GYN exams, and other preventive care for no cost with in-network doctors.
- Portrait plans are also PPOs with primary care doctor visits available for a copay of $35 and specialists visits for $50 from the day your plan starts. Other immediately accessible benefits include a copay on prescription drugs, and in-network preventive care covered in full. After you have met your deductible, office visits are covered at 100%, inpatient and outpatient physician and hospital services are covered at 80%, and mental health care is covered at 50%. You also can choose out-of-network services, and a prescription drugs deductible.
- High Deductible plans are available throughout South Carolina (and most of the country) in the following options: Plan 100, Plan 80 and Saver 80. With Plan 100, you will not be charged any coinsurance for most in-network medical services after you meet the deductible. Plan 80 and Saver 80 require 20% coinsurance paid at the time of service, though their premiums are lower than Plan 100. All of these high deductible plans cover preventive care at 100% with in-network providers, and give you the option of using non-network providers as well.
- Copay plans are simple to use, and will be familiar to anyone who has has employer-sponsored health insurance. There is a set copay on physician’s office visits ($35) and the various tiers of prescription drugs. You can choose between 70/30, 80/20 or 100% coinsurance coverage after deductible, as well as a broad selection of deductibles. The convenience of paying a flat fee makes Copay plans appealing to those who prefer a predictable cost for health care. Preventive care is no cost to those who use in-network doctors.
- HSA plans are qualified high deductible plans that can be set up with a health savings account for a higher level of control over your medical expenses. You have the benefit of lower monthly premiums and using your HSA funds on deductibles, coinsurance, and other eligible health care costs – or just saving for the future. These plans come with either 100% of 70/30 coverage after you meet the deductible. Preventive care is covered at 100% immediately, including routine physical exams, vaccinations, well-baby and well-child care, cancer screenings and more.
Public Health Options
South Carolinians have a variety of state-funded health care options to fit their needs, whether it be one of many Health Connections (Medicaid) plans, or a program specific to a health condition. While the South Carolina Department of Health and Environmental Control specializes in prevention services and testing, they also offer the Women, Infants & Children (WIC) program for nutritional assistance and family planning. For a full list of their services, visit the SCDHEC website. The South Carolina Medicaid plan, Healthy Connections, is administered by the Department of Health & Human Services, and provides health plans to the financially and medically needy. The following is a list of highlighted programs that help millions of South Carolina residents every year.
- Healthy Connections: medical care coverage under a managed care organization or network for low-income families, children, pregnant women, elderly, disabled, and other individuals in need of medical assistance.
- Women, Infants & Children (WIC): a program providing education and financial help to low-income women with young children to ensure safety and health.
- Best Chance Network: a breast and cervical cancer screening program for low-income women between ages 47 -64 in South Carolina.
- South Carolina AIDS Drug Assistance Program (SC ADAP): a program for individuals infected with HIV/AIDS who need assistance paying for medications proven to help their condition.
- Home Health Services: skilled nursing, aides, and therapies including physical, occupational and speech, and disease management programs for those who need medical assistance in the home.
Health Insurance Laws
Regulations on health insurance in South Carolina are currently more helpful for health insurance companies, who have the right to deny individuals a health plan based on their medical status. Pre-existing conditions are defined by the insurer in South Carolina by the prudent person standard. This broadens the category to anyone who has, or should have but did not, receive care or medical advice for a condition before enrolling in a health plan. These conditions can range from acne and anxiety to cancer and diabetes, so insurers are very open to considering any risk an expensive individual to take on. For health insurance applicants who have pre-existing conditions, insurers can neglect to give them a policy, or can increase premiums.
Insurance companies in South Carolina are also legally permitted to opt out of paying for treatment related to the condition deemed pre-existing for up to 24 months of an exclusion period. They can also attach an elimination rider to a plan, which makes sure they never have to pay for that certain condition as long as you are insured by them, though you may receive other covered services. For those who have experienced this, or if you feel you are a high-risk individual, there is an option called the Pre-Existing Condition Insurance Plan (PCIP).
PCIP is a health plan funded and operated by the U.S. Department of Health & Human Services, which was set up as a temporary means to an end until 2014. According to health care reform, at the start of 2014, all adults who have been regarded as having a pre-existing condition will no longer be allowed to be rejected for plans in the private market. The law in the Affordable Care Act was upheld that insurance companies cannot issue exclusion periods or elimination riders, and must not charge these individuals more than another adult. In the meantime, those who have such conditions in South Carolina should consider the PCIP plan. To compare PCIP plans in your area, fill out a quote, and select PCIP from companies.
Another law that is important in the health insurance market is HIPAA, which includes the guaranteed renewability provision. This law ensures that once someone has insurance, they keep it regardless of their health declining suddenly after enrollment. Health insurers also are required to ask the insured if they want to renew the same plan at the end of their term. This is all true under the condition that the insured has paid their premiums, not acted fraudulently, or violated the terms of their policy.