Getting health insurance for 2020 doesn’t need to be a long or stressful process. Use our quick guide on everything you need to know about the best health insurance plans in South Carolina before you choose a health insurance provider.
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The Best Health Insurance in SC
- Best Overall: Blue Cross and Blue Shield of South Carolina
- Most Affordable: BlueChoice Health Plans
- Best Customer Service: UnitedHealthcare
- Best for Claims: Absolute Total Care
- Best for Younger Individuals: Aetna
- The Best Health Insurance in SC
- What is Health Insurance?
- Compare Plans
- Average Cost of Health Insurance in South Carolina
- Types of Health Coverage
- What does Health Insurance Cover?
- What Does Health Insurance not Cover?
- Best Health Insurance Providers in SC
- It’s Time to Get Covered
- Frequently Asked Questions
What is Health Insurance?
How do you get health insurance for the upcoming decade? First, let’s go over how health insurance works and the total amount you’ll pay for coverage.
Health insurance is a type of protection that safeguards your finances against the rising cost of health care. If you don’t have health insurance and you get into a car accident, you might be responsible for paying tens of thousands of dollars in hospital bills. But if you have health insurance, your insurance will cover the bulk of your expenses. Health insurance is an absolute must-have because an accident can happen at any time to anyone.
Most Americans get their health insurance through their employer or through the government’s Medicare program if they’re over 65 years old. However, if you’re self-employed or an independent contractor, you can still buy an independent plan through the Affordable Care Act (ACA) marketplace. Create an account on Healthcare.gov to be directed to the marketplace and explore your choices.
When you compare plans, you might have trouble understanding what exactly you’ll pay for each plan. Let’s go over the total cost of individual health insurance.
First, you’ll get a premium. Your premium is the amount of money you pay to your insurance company every month to keep your coverage current. You must pay your premium every month even if you don’t use your benefits during a specific month. If you do need to use your health insurance, you’ll pay 100% of your health care costs until you reach your deductible. Your plan deductible can range from $0 to a few thousand dollars, depending on your plan provider.
Once you reach your deductible, you pay coinsurance. Your coinsurance is a percentage of your care costs you pay after you meet your deductible. Your insurance covers whatever’s left over. For example, let’s say you go to the doctor and receive a bill for $100. If you have a 20% coinsurance rate, you’ll pay $20 — your insurance will pay the remaining 80%.
This continues until you hit your annual out-of-pocket maximum. Your out-of-pocket maximum is the maximum amount that you’ll pay for your health care costs in a single year. Once you reach your maximum, your insurance covers 100% of your health care costs after that point. Once the new year arrives, all of these numbers reset and you must reach your deductible again.
Average Cost of Health Insurance in South Carolina
The average adult with an individual health insurance plan in South Carolina pays about $527 each month for his or her health insurance. You may qualify for subsidies through the Marketplace if you have very low income. Begin by creating an account on Healthcare.gov to see which subsidies you may qualify for.
Types of Health Coverage
When you start shopping for health insurance, you’ll likely see multiple types of plans offered by a single insurance company. Understand each acronym to help ensure that you choose the best plan for your needs. These are the 3 most common plan types you’ll see in the ACA Marketplace:
- Health maintenance organizations (HMOs): HMO plans are usually the most affordable health insurance options you’ll see on the Marketplace. However, they’re also the most limited. You must see doctors and specialists within your HMO network to use your benefits. You may also need a referral from your doctor before you can see a specialist.
- Preferred provider organizations (PPOs): PPO plans are almost always more costly than HMO plans. However, they give you more freedom to use your insurance. On a PPO plan, you can see any doctor or specialist you want, regardless of the network. You also usually don’t need a referral to see a specialist.
- Point-of-service (POS) plans: POS plans allow you to see any doctor or specialist, similar to a PPO plan. However, your POS plan will usually require you to get a referral from your primary care provider before you can see a specialist. POS plans are designed as a mix between an HMO and a PPO and typically fall in the middle of the pricing spectrum.
What does Health Insurance Cover?
The ACA introduced a set of essential benefits that every long-term insurance provider must offer with each of its plans. Every plan on the Marketplace covers at least these required services:
- Ambulatory patient services: This includes care that you get outside of a hospital or emergency room.
- Emergency services: Your insurance provider needs to cover emergency care at any hospital, regardless of your plan type. In a true emergency, you should always seek care from the hospital closest to you. It’s against the law for your insurance provider to deny you coverage because you sought emergency care at a hospital out of your network.
- Hospitalization: Your insurance plan must cover hospital stays and the costs of medically-necessary surgeries.
- Maternal care: Your insurance plan must include coverage for breastfeeding support and newborn care. This benefit must apply both before and after you give birth.
- Mental health and substance abuse disorder treatment: ACA-compliant plans must include coverage for mental health disorders and addiction treatment. Your plan must cover things like counseling, inpatient rehabilitative services and psychotherapy. It’s against the law for your insurance provider to institute a limit on mental health care that’s more restrictive than the rest of your plan. For example, this means that your insurance plan can’t charge you a larger coinsurance percentage for counseling than you’d pay for prescription drugs.
- Prescription drugs: Your insurance must cover prescription drugs. However, this doesn’t mean that plans are required to cover the cost of all brand-name drugs. Your insurance provider may require you to try a generic treatment before moving onto higher-tier drugs.
- Rehabilitative services and mobility devices: This includes devices like wheelchairs and services like occupational therapy.
- Laboratory services: Your insurance must cover order laboratory tests like X-rays.
- Preventive and wellness screenings: Your insurance must cover preventive treatments and screenings. Annual physicals and blood work are 2 examples of preventive care covered by ACA-compliant plans.
- Pediatric services: All of the above services must be included for children under the age of 18 on your plan. Your plan must also include dental and vision coverage for minors.
Your plan must also cover FDA-approved birth control if you’re a woman. This coverage extends from birth control pills to Plan B. You may not have access to this benefit if you get your insurance through your employer and you work for a religious institution or nonprofit.
What Does Health Insurance not Cover?
By law, your insurance provider must only offer coverage for the essential benefits listed above. This means that most insurance providers don’t extend their coverage beyond these benefits. Here are some exclusions you’ll likely see on your insurance plan.
- Non-essential surgeries: No insurance plan will cover non-necessary services, like breast augmentation or Botox.
- Weight-loss surgery: There is no federal requirement that forces insurance providers to cover bariatric surgery, even if it’s medically necessary.
- Dental, vision and hearing coverage: The ACA requires that these services be covered for children on your plan only. If you want adult coverage, you’ll need to buy a separate plan with its own set of limits and deductibles.
- Travel vaccinations: Your insurance provider must cover general health vaccines. However, vaccines that aren’t considered routine in the United States (like typhoid or yellow fever vaccinations) aren’t considered medically necessary. You’ll need to cover the costs of these vaccinations out-of-pocket, even if they’re required before you travel abroad.
- Male birth control: Birth control benefits only apply to female contraceptives. Condoms and vasectomies aren’t covered by health insurance.
- Abortion services: Your insurance provider doesn’t need to offer coverage for physical or medicinal abortions. The Plan B pill isn’t the same thing as a medicinal abortion. Plan B is covered under the ACA, drugs intended to terminate an already viable pregnancy are not.
Best Health Insurance Providers in SC
Let’s take a closer look at some of the best insurance providers you’ll see on the Marketplace.
1. Blue Cross and Blue Shield of South Carolina
Blue Cross and Blue Shield of South Carolina is the only South Carolina-native company that offers health insurance to residents of the Palmetto State.
Blue Cross and Blue Shield prides itself on its selection of affordable individual policies. It has individual health insurance options and $0 premiums available, though these plans do include higher deductibles and coinsurance percentages. Blue Cross and Blue Shield also offers access to one of the largest South Carolina-specific state networks. No matter where you live, you’ll be able to find a doctor near you.
2. BlueChoice Health Plans
BlueChoice is another statewide health insurance provider in South Carolina. It offers plans in most ZIP codes. BlueChoice plan holders get access to a number of benefits and discounts for additional health services which range from local fitness centers to Jenny Craig weight-loss programs.
Its mobile app contains all the information you need to use your benefits on the go, and it even offers virtual consultation functionality. You can also sign up for text messages to remind you of upcoming visits, appointments and due dates.
UnitedHealthcare might be right for you if you’re looking for an insurance provider that offers a wide range of plan options. UnitedHealthcare offers ACA-compliant family and individual plans and group plans for business owners.
UnitedHealthcare also offers affordable short term health insurance plans, dental and vision coverage and Medicare supplement options. UnitedHealthcare offers a plan for everyone, from standard individual policies to supplemental policies for those with special needs.
4. Absolute Total Care
Absolute Total Care offers South Carolina residents a simpler way to get signed up for a plan and understand its benefits. Absolute Total Care’s plans include discounts for taking proactive steps to improve your health, like joining a gym or losing weight.
Its Ambetter Telehealth service allows you to chat with a doctor on the phone at any hour of the day or night and its online resources allow you to quickly see which prescription drugs are included on each plan. These 2 factors can be a huge benefit if you take a higher-tier prescription medication that isn’t covered under other insurance plans.
Aetna is another nationwide health insurance company that offers everything from individual ACA plans to Medicare supplemental options.
One of the biggest benefits of getting your insurance through Aetna is that you gain access to its useful and intuitive online health portal. You can search for prescription drugs, view doctors’ offices in your area that accept your insurance and manage your claims. Aetna’s website is also helpful if you’re new to the health insurance Marketplace. It offers plenty of information in easy-to-understand terms.
It’s Time to Get Covered
No matter which health insurance plan you choose, your journey begins with a trip to the ACA Marketplace. Begin by visiting Healthcare.gov and signing up for a Marketplace account. Just enter some information about your address, your income and your personal information and you’ll be matched up with plans that offer coverage in your area. Remember to leave yourself plenty of time to compare insurance options before you choose a plan — Open Enrollment for 2020 ends December 15.