Last Updated on May 12, 2024 by Edward Harris
Affordable individual health insurance rates in South Carolina are available. The SC Exchange provides low cost coverage for many individuals, families, and small businesses that are not currently covered, or are eligible for federal subsidies. Consumers covered under private plans or through an employer may also be able to lower their rates by purchasing a Marketplace or SHOP plan. Senior Supplement, Advantage, and Part D prescription drug plans are offered to applicants that have reached age 65 and are eligible for Medicare.
We offer direct free online quotes so that you can quickly view the best healthcare prices in South Carolina, and also apply for benefits without paying any fees. You do not have to answer medical questions, pre-existing conditions are covered, and you can not be denied for underwriting reasons. We make it easy to compare multiple policies, calculate your federal subsidy, and apply online in 15-25 minutes. Applicants under age 65 can receive financial assistance based on projected household income. Lower-income households may be eligible for Medicaid.
SC Senior Medigap plans are also available from many of the top-rated carriers. Medicare Supplement options provide 11 different contracts (including a high-deductible F plan) that can eliminate many out-of-pocket expenses, including Parts A and B coinsurance, Parts A and B deductible, skilled nursing facility coinsurance, and three pints of blood. “Advantage” contracts replace original Medicare benefits and provide a low-cost alternative that often includes drug prescription coverage. NOTE: The Senior Open Enrollment period starts on October 15th and ends on December 7th. However, there is a seven-month Medicare eligibility when you reach age 65.
South Carolina Obamacare Plans
Under The Affordable Care Act legislation (also referred to as “Obamacare”), each state has established an “Exchange” that serves as a marketplace for all of the different policies that are offered in 2024 and 2025, the tenth year of coverage. Because of the complexity of the operation and all of the recent legislative changes, trusted authorities like us help consumers find and compare the best options. Actual Open Enrollment begins on November 1 and ends on January 15th.
South Carolina is one of many states that allows the federal government to operate its Exchange. It’s a big undertaking, considering the large number of persons that typically need help applying for coverage before the end of Open Enrollment. A federal tax penalty of $695 per adult and $347.50 per child, or 2.5% of total household income (whichever is higher) is no longer assessed to anyone that does not purchase “qualified” health insurance, or is not covered under another Group plan. The household maximum penalty (shared responsibility payment) of $2,085 has been eliminated.
One of the biggest challenges is always contacting families in lower-income areas that may not understand that a subsidized policy may cost much less than anticipated. In thousands of situations, families can obtain free or near-free benefits by being Medicaid-eligible or qualifying for financial aid that pays the entire premium. It is also possible to be eligible for Medicaid and Medicare (Dual-Eligible).
What If I Waited Too Long For Open Enrollment Period?
You can qualify for a “special” exemption (SEP) which allows you to purchase coverage at any time of the year with or without government assistance. There are many approved exceptions including substantial changes in income, loss of existing qualified benefits, moving outside of your service area, divorce, reaching age 26, and no longer being incarcerated!
You can also purchase an inexpensive temporary contract that will provide coverage up to $1 million for 12 months. Since it is not considered an approved Obamacare policy, existing medical conditions will likely not be covered and chronic conditions and non-generic medications may not be sufficiently covered. Several medium-sized carriers offer a temporary plan that can be approved within 48 hours. An initial payment is required along with a small application fee ($20-$50).
This type of policy is not designed to be kept for longer than 6-12 months, since ongoing chronic treatment will be limited or excluded when the policy is renewed. But it serves as an ideal stopgap plan if you are waiting for other benefits to begin. Depending upon the carrier, network benefits may extend to neighboring states including North Carolina, Georgia, Tennessee, Kentucky, and Alabama.
Which Companies Can I Choose From?
Companies that do business in the state must be approved by the SC Department of Insurance, Not all licensed carriers necessarily offer plans on the Exchange. There are also companies that offer short-term/temporary plans, but not long-term coverage. Since UnitedHealthcare, Cigna, and Aetna no longer offer “on-Exchange” coverage, the only companies licensed for offering Marketplace plans are Blue Cross Blue Shield of South Carolina (BCBS), Molina, Bright Health, and Absolute Total Care (Ambetter).
BCBS offers plans in all 46 counties while Absolute Total Care also offers plans in 46 counties. Molina offers plans in 45 counties. Anderson and Pickens Counties are new for Molina in 2024. Select Health of South Carolina offers plans in the following 17 counties: Anderson, Berkeley, Calhoun, Charleston, Chester, Dillon, Dorchester, Fairfield, Georgetown, Greenville, Horry, Kershaw, Lancaster, Laurens, Marion, Pickens, and Richland. UnitedHealthcare offers plans in 23 counties. Additional companies may offer qualified plans within two years, depending upon future legislation.
Average rate request changes for 2024 are shown below:
Absolute Total Care – 1.48% increase (Ambetter, Ambetter Virtual Access, and Ambetter + Vision + Adult Dental
BCBS Of South Carolina – 6.01% increase (BCBS BlueEssentials, BCBS BlueExtend, BCBS BlueEssentials Standard, Blue VirtuConnect, and BlueEssentials Catastrophic)
Blue Choice Health Plan – 2.09% increase (MyChoice Advantage)
Cigna – 10.53% increase (HMO State Design Basic)
Molina – 6.37% increase (Molina and Molina + Vision)
SC 2023 Small Business rate change requests
Aetna Health – 6.94% increase
Aetna Life – 1.04% decrease
BCBS Of South Carolina – 6.21% increase
Blue Choice Health Plan – 4.99% increase
UnitedHealthcare Of River Valley – 17.24% increase
UnitedHealthcare Of South Carolina – 15.01% decrease
UnitedHealthcare – 12.73% increase
BCBS offers plans in the Catastrophic, Bronze, Silver, and Gold tiers. “Blue CareOnDemand” is available with all policies at no cost. This free service provides access to physicians through video consultations. Designed to effectively treat minor medical conditions with small copays, a computer or smartphone can be utilized for rapid responses. The flu, fevers, rashes, ear infections, and migraines are several common treatable ailments. Medications can also be prescribed to be picked up at a local pharmacy. For families with several young children, the savings in copays and travel time can be significant.
The following carriers are licensed and authorized to offer Group plans or coverage that is considered off-Exchange:
Aetna
BCBS
BlueChoice HealthPlan
UnitedHealthcare
Will The Government Pay For My Policy?
Probably not all of your premium, but it’s possible a large portion might be paid by a federal subsidy. Here’s how it works: Assuming you are not currently covered by Medicaid or Medicare, financial assistance is based on your individual or family household income. If your income is between 100% and 400% of the FPR (Federal Poverty Level), you are eligible for the subsidy.
All “Metal” plans are eligible for financial assistance. However, “catastrophic” policies do not qualify for subsidies, since not all applicants can purchase this type of contract. For example, you must be under age 30 or be able to show poof of financial hardship. There are many specific exemptions that are allowed. Since catastrophic contracts often cost more than Bronze contracts, they are not especially popular. The number of provided office visits that are only subject to a copay, are often limited on catastrophic plans.
No Medical Questions During Open Enrollment
Your income is likely to be different each year and the FDR also changes annually, so your eligibility (and amount) will have to be re-calculated each year. Single persons (Age 45 with no dependents) making under $71,000, a couple (Ages 50) with income under $175,000 and a family with one child (Ages 40, 40, and 10) making under $165,000 will likely receive benefits.
Of course, the lower the income, the higher the amount funded by the government. NOTE: Since your household MAGI (Modified Adjusted Gross Income) can change, it’s important to re-calculate your subsidy each year so you are not liable for a large tax penalty the following year.
Sample Premiums
Below, view estimated monthly rates for several of the most popular plans in the Charleston area. Additional options are available in other counties. For this example, we are showing prices for a family of four (Ages 50, 50, 20, and 18) with household income of $85,000. The federal subsidy has automatically reduced the premium, and lowered deductibles, copays, and out-of-pocket expenses on Silver-tier plans. This “cost-sharing” is only offered in the Silver tier. Premiums are approved by the South Carolina DOI.
Bronze Tier
$16 – Ambetter Standard Expanded Bronze – $50 and $100 office visit copays with $75 copay for Urgent Care. $7,500 deductible with $9,400 maximum out-of-pocket expenses. Tier 1 drugs subject to $25 copay and Tier 2 and Tier 3 drugs subject to $50 and $100 copays. Tier 1 drugs not subject to deductible.
$43 – BCBS of South Carolina Blue Cooper Standard Expanded Bronze – $50 and $100 office visit copays with $75 copay for Urgent Care. $7,500 deductible with $9,400 maximum out-of-pocket expenses. Tier 1 drugs subject to $25 copay and Tier 2 and Tier 3 drugs subject to $50 and $100 copays. Tier 1 drugs not subject to deductible.
$46 – Ambetter Everyday Bronze – $40 and $90 office visit copays with $50 copay for Urgent Care. $8,450 deductible with $9,250 maximum out-of-pocket expenses. Preferred generic and generic drug copays are $3 and $30. $50 copay for lab and professional services.
$58 – BCBS of South Carolina Blue Cooper Blue Cooper Bronze 1 – $48 and $96 office visit copays with $60 copay for Urgent Care. $7,900 deductible with $8,850 maximum out-of-pocket expenses. Tier 1 and Tier 2 drugs subject to $29 copay ($41 mail order).
$123 – Ambetter Virtual Access Bronze – $65 (no deductible) and $100 office visit copays with $60 copay for Urgent Care. $7,000 deductible with $8,550 maximum out-of-pocket expenses. Tier 1 drugs subject to $3 copay and Tier 2 drugs subject to $30 copay. Tier 3 and Tier 4 drugs subject to deductible. $75 copay for lab and professional services.
$128 – UHC Bronze Essential – $40 and $75 office visit copays with $75 copay for Urgent Care. $6,350 deductible with $9,450 maximum out-of-pocket expenses. Tier 1 and Tier 2 drugs subject to $0 and $3 copays. $50 copay for Tier 3 drugs.
$132 – First Choice Next Bronze Classic 9450 – . $9,450 deductible with $9,450 maximum out-of-pocket expenses and 0% coinsurance.
$137 – UHC Bronze Value – $75 copay for Urgent Care. $8,250 deductible with $9,450 maximum out-of-pocket expenses. Tier 1 and Tier 2 drugs subject to $0 and $3 copays. $50 copay for Tier 3 drugs. Lab test copay is $20 at free standing office and $75 at hospital.
$142 – UHC Bronze Standard – $50 and $100 office visit copays with $75 copay for Urgent Care. $7,500 deductible with $9,400 maximum out-of-pocket expenses. Tier 1 and Tier 2 drugs subject to $0 and $25 copays. $50 copay (subject to deductible) for Tier 3 drugs.
$195 – UHC Bronze Copay Focus $0 Indiv Med Ded – $40 and $150 office visit copays with $100 copay for Urgent Care. $0 deductible with $9,450 maximum out-of-pocket expenses. Tier 1 drugs subject to $0 copay and Tier 2 drugs subject to $15 copay. Tier 3 drug copay s $55. $20 and $100 copays for lab tests and x-rays at free standing facility.
$225 – BCBS of South Carolina Blue VirtuConnect Bronze 1 – $50 and $100 office visit copays with $75 copay for Urgent Care. $7,500 deductible with $9,400 maximum out-of-pocket expenses. Tier 1 drugs subject to $25 copay ($35 mail order). Tier 2 and Tier 3 drug copays (subject to deductible) are $50 and $100 ($135 and $270 mail order).
$235 – BCBS of South Carolina Blue Essentials Standard Expanded Bronze – $50 and $100 office visit copays with $75 copay for Urgent Care. $7,500 deductible with $9,400 maximum out-of-pocket expenses. Tier 1 drugs subject to $25 copay ($35 mail order). Tier 2 and Tier 3 drug copays (subject to deductible) are $50 and $100 ($135 and $270 mail order).
Silver Tier
$396 – Ambetter Virtual Access Silver – $40 and $100 office visit copays with $60 copay for Urgent Care. $5,700 deductible with $7,400 maximum out-of-pocket expenses and 50% coinsurance. Preferred generic and generic drug copays are $5 and $25. Preferred brand drug copay is $75.
$418 – Ambetter CMS Standard Silver – $40 and $80 office visit copays with $60 copay for Urgent Care. $5,800 deductible with $8,900 maximum out-of-pocket expenses and 40% coinsurance. Preferred generic and generic drug copays are $20. Preferred brand drug copay is $40.
$419 – Ambetter Clear Silver – $5,400 deductible with $5,400 maximum out-of-pocket expenses and 0% coinsurance.
$421 – Molina Constant Care 8 250 – $40 and $80 office visit copays with $60 copay for Urgent Care. $5,800 deductible with $8,900 maximum out-of-pocket expenses and 40% coinsurance. Generic and preferred brand drug copays are $20 and $40.
$437 – Ambetter Focused Silver – $45 and $100 office visit copays with $60 copay for Urgent Care. $6,100 deductible with $7,500 maximum out-of-pocket expenses and 50% coinsurance. Tier 1 drugs subject to $5 and $25 (preferred generic and generic) copay and Tier 2 drugs subject to $75 copay. $50 copay for lab and professional services.
$443 – Ambetter Enhanced Silver – $35 and $65 office visit copays with $60 copay for Urgent Care. $3,850 deductible with $8,600 maximum out-of-pocket expenses and 40% coinsurance. Tier 1 drugs subject to $5 and $20 (preferred generic and generic) copay and Tier 2 drugs subject to $65 copay. $40 copay for lab and professional services.
$445 – Ambetter Every Day Silver – $35 and $70 office visit copays with $55 copay for Urgent Care. $6,500 deductible with $8,400 maximum out-of-pocket expenses and 40% coinsurance. Tier 1 drugs subject to $5 and $25 (preferred generic and generic) copay and Tier 2 drugs subject to $60 copay. $35 copay for lab and professional services.
$453 – Molina Constant Care Silver 1 250 – $30 and $60 office visit copays with $30 copay for Urgent Care. $2,500 deductible with $9,100 maximum out-of-pocket expenses and 50% coinsurance. Tier 1 drugs subject to $29 copay and Tier 2 drugs subject to $60 copay. $95 copay for x-rays and $60 copay for blood work.
$614 – BCBS of South Carolina BlueExclusive Cooper Silver 2 – $30 and $55 office visit copays with $55 copay for Urgent Care. $7,900 deductible with $8,900 maximum out-of-pocket expenses and 50% coinsurance. Tier 1 drugs subject to $20 copay and Tier 2 drugs subject to $20 copay. Tier 3 and Tier 4 drug copays are $50 and $150.
$630 – BCBS of South Carolina BlueExclusive Cooper Silver 1 – $25 and $60 office visit copays with $60 copay for Urgent Care. $7,500 deductible with $8,500 maximum out-of-pocket expenses and 50% coinsurance. Tier 1 drugs subject to $25 copay and Tier 2 drugs subject to $20 copay. Tier 3 and Tier 4 drug copays are $60 and $150.
$662 – Cigna Connect 0B – $50 and $100 office visit copays with $65 copay for Urgent Care. $0 deductible with $9,100 maximum out-of-pocket expenses and 50% coinsurance. Preferred generic and generic drug copays are $5 and $30 ($12.50 and $75 mail order). $45 copay for diagnostic tests.
$683 – Cigna Connect 7500 – $8 and $60 office visit copays with $40 copay for Urgent Care. $7,500 deductible with $9,100 maximum out-of-pocket expenses and 50% coinsurance. Preferred generic and generic drug copays are $2 and $10 ($5 and $25 mail order).
Gold Tier
$487 – Ambetter Secure Care 20 – $35 and $55 office visit copays with $35 copay for Urgent Care. $7500 deductible with $7,500 maximum out-of-pocket expenses and 35% coinsurance. Tier 1 drugs subject to $5 and $15 (preferred generic and generic) copay and Tier 2 drugs subject to $60 copay. $35 copay for lab and professional services.
$567 – BCBS Of South Carolina BlueExclusive Cooper Gold 1 – $40 and $90 office visit copays with $90 copay for Urgent Care. $0 deductible with $8,700 maximum out-of-pocket expenses and 50% coinsurance. Tiers 1 and 2 drug copays are $10 and $40 ($14 and $56 mail order).
$609 – Ambetter Secure Care 5 – $15 and $35 office visit copays with $35 copay for Urgent Care. $1,450 deductible with $6,300 maximum out-of-pocket expenses and 20% coinsurance. Tier 1 drugs subject to $5 and $15 (preferred generic and generic) copay and Tier 2 drugs subject to $30 copay. $15 copay for lab and professional services.
$638 – Molina Confident Care Gold 1 – $10 and $50 office visit copays with $10 copay for Urgent Care. $2,100 deductible with $8,550 maximum out-of-pocket expenses and 20% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $50 copays ($20 and $100 mail order). Tier 3 and Tier 4 drugs subject to deductible and coinsurance.
$813 – BCBS of South Carolina BlueEssentials Gold 5 – $40 and $90 pcp and specialist office visit copays with $90 Urgent Care copay. $250 deductible with $8,700 maximum out-of-pocket expenses and 50% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $40 copays ($14 and $56 mail order). Tier 3 and Tier 4 drugs subject to coinsurance.
$865 – BCBS of South Carolina BlueEssentials Gold 4 – $30 and $55 pcp and specialist office visit copays. $55 Urgent Care copay. $3,000 deductible with $7,000 maximum out-of-pocket expenses and 35% coinsurance. Tier 1 and Tier 2 drugs subject to $10 and $40 copays ($14 and $108 mail order). The Tier 3 drug copay is $100 ($270 mail order).
$916 – BCBS of South Carolina BlueEssentials Gold 2 – $25 and $50 pcp and specialist office visit copays. $50 Urgent Care copay. $2,500 deductible with $6,000 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 drugs subject to $25 and $50 copays ($35 and $135 mail order). The Tier 3 drug copay is $100 ($270 mail order).
$933 – BCBS of South Carolina BlueEssentials HD Gold 3 – $3,400 deductible with $3,400 maximum out-of-pocket expenses and 0% coinsurance. HSA-eligible.
$1,003 – BCBS of South Carolina BlueEssentials Gold 1 – $20 and $40 pcp and specialist office visit copays with $50 Urgent Care copay. $2,000 deductible with $4,500 maximum out-of-pocket expenses and 25% coinsurance. Tier 1 and Tier 2 drugs subject to $12 and $40 copays ($17 and $108 mail order). The Tier 3 drug copay is $100 ($270 mail order).
Monthly Health Insurance Rates In Columbia (35 Year-Old Male With Income Of $40,000)
$24 – BCBS BlueEssentials Bronze 2
$24 – BCBS BlueEssentials Bronze 1
$27 – BCBS BlueEssentials Bronze 4
$40 – BCBS BlueEssentials Bronze 3
$40 – BCBS BlueEssentials Bronze 5
$207 – Molina Constant Care Silver 4 250
$211 – BCBS BlueEssentials Silver 14
Monthly Health Insurance Rates In Mount Pleasant (45 Year-Old Married Couple With Income Of $60,000)
$55 – BCBS BlueExclusive Cooper Bronze 1
$86 – Molina Core Care Bronze 2
$93 – Molina Core Care Bronze 1
$105 – Molina Core Care Bronze 5
$125 – Molina Core Care Bronze 4
$350 – Molina Constant Care Silver 4 250
$360 – Molina Constant Care Silver 2 250
Monthly Health Insurance Rates In Greenville (50 Year-Old Married Couple With Two Children (4 Persons) And Income Of $90,000)
$0 – Molina Core Care Bronze 2
$0 – BCBS BlueEssentials Bronze 4
$9 – Molina Core Care Bronze 1
$30 – Molina Core Care Bronze 5
$33 – BCBS BlueExclusive Bronze 1
$470 – Molina Constant Care Silver 4 250
$489 – Molina Constant Care Silver 2 250
Monthly Health Insurance Rates In Rock Hill (60 Year-Old Married Couple With Income Of $70,000)
$0 – BCBS BlueEssentials Bronze 1
$0 – BCBS BlueEssentials Bronze 4
$0 – BCBS BlueEssentials Bronze 5
$0 – BCBS BlueEssentials Bronze 2
$0 – Ambetter Essential Care 10
$475 – Ambetter Balanced Care 29
$496 – Ambetter Balanced Care 12
Charleston Healthcare Rates Are Very Affordable
Are Rates In Charleston The Same As Other Cities?
Prices vary, depending upon where you live (see above). So yes, rates in Columbia, Charleston, Rock Hill, Summerville and most other cities will be different. The cost of healthcare in your area along with the availability of facilities may impact what you pay. If there are more major hospitals within a 30-mile radius of where you live, you may be charged less than a rural area with limited options. Previously, when more companies offered private plans,more choices for consumers meant lower prices. It is hoped that by 2024, additional companies will return.
Other factors that could impact cost, include your age, amount of federal subsidy you receive (as previously discussed) and your smoking status. If you have used tobacco products within the last 12 months, there will be a modest surcharge. However, medical questions can not be asked, height and weight (BMI) will not be a factor, and pending or recent surgeries will not be considered. Also, there are no price differences between males and females.
Note: If you previously selected a plan from UnitedHealthcare, providers from the Carolina Healthcare System can no longer be used. This includes Roper St. Francis and affiliated physicians and hospitals. However, it is possible that an agreement will be reached in the future and network privileges will be reinstated. Also, Charleston hospitals (such as Trident and East Cooper) are not impacted.
What Is The Cheapest Policy I Can Purchase?
The least expensive plan will likely be a “Bronze” option, since you will potentially have the highest out-of-pocket expenses. The other three types of plans are Platinum, Gold and Silver. Costs are based on “actuarial value,” which is the cost that the owner of the policy is expected to pay, based on projected expenses. For example, the Bronze plan is based on paying 40%, while the Platinum option (the most expensive) is based on only 10%. The five least expensive BCBS plans are BlueEssentials Bronze 1, BlueEssentials Bronze 2, BlueEssentials Bronze 3, BlueEssentials Bronze 4, and BlueEssentials Bronze 5.
However, if your income is between 100% and 150% of the Federal Poverty Level, you can qualify for a policy with lower spending caps (maximums) without spending the money on a “Platinum” option. These are called “HSA Level” contracts and they are ideal if you have serious medical conditions that require multiple medications, treatments and specialty visits.
Income under 100% should qualify for Medicaid (SC) which is being expanded in many states. CHIP is also available to children of low-income families. “Healthy Connections” is the state plan which provides benefits to aged, blind or disabled (ABD), breast and cervical cancer victims and disabled children. It is possible to have children covered under CHIP, while the parents receive their benefits from a private plan.
SC Insurer Market Share (Accident And Health)
BCBS Of SC – 57.5%
UnitedHealthcare – 7.2%
Cigna – 3.3%
Aetna – 2.0%
Metropolitan Life – 1.5%
UnitedHealthcare Of The River Valley – 1.3%
American Family Life – 1.2%
Guardian Life – 1.0%
Genworth Life – 0.86%
Colonial Life – 0.76%
South Carolina Medigap Coverage For Seniors
Once you reach age 65, you will probably be eligible for Medicare. Benefits can be provided through original Medicare, and a Part D prescription drug plan can be purchased. Also available are Part D prescription drug plans. a Supplement contract can be added to pay for many of the out-of-pocket expenses (deductibles, copays, and coinsurance) not covered. Another option is enrolling in an “Advantage” plan that covers Parts A and B, and often Part D. Premiums are often fairly low. The Part A premium costs $227 per month for most persons. Part A and B deductibles are $1,316, and $183 respectively.
Carriers authorized to offer SC Medicare Supplement plans are listed below:
AARP (UnitedHealthcare)
American Continental
American Pioneer Life
American Republic
American Retirement
Americo Financial
Assured Life
Aetna
Bankers Life
BCBS Of South Carolina
Central Reserve Life
Central States
Cigna
Combined Insurance
Conseco
Constitution Life
Continental General
CSI Life
Everest
Family Life
Federal Life
First Health
Gerber
Globe
Great American
Guarantee Trust
Humana
Liberty National
Manhattan Life
Mutual Of Omaha
Oxford Life
PacifiCare
Pennsylvania Life
Physicians Mutual
Provident
Pyramid Life
Reserve National
Shenandoah Life
Standard Life And Accident
State Farm
State Mutual
Sterling Life
Transamerica
United American
USAA
United Teachers
United World
SC Medicare Supplement Rates
Prices can frequently change. However, we have posted below the most recent estimated monthly rates for several ages, plans, and counties. Some plans are not offered in all areas.
Greenville, MCcormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan A – Female Age 65
$66 – AARP-UnitedHealthcare
$82 – Accendo
$80 – Aetna
$85 – Cigna
$86 – Mutual Of Omaha
$87 – Aetna
$88 – Elips Life
$88 – Medico
$89 – SBLI USA Life
$90 – Philadelphia American
$92 – Manhattan Life
$96 – Great Southern Life
$96 – United States Fire
$98 – Capitol Life
$101 – National Health
$103 – Humana
$105 – United American
$106 – Union Security
$109 – AFLAC
$115 – Central States
$116 – Assured Life
$119 – GPM Health
$137 – Bankers Fidelity
$142 – Guarantee Trust Life
$177 – Oxford Life
Greenville, McCormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan F – Female Age 65
$100 – Accendo
$105 – Humana
$106 – Central States
$108 – Aetna
$109 – Great Southern Life
$110 – Capitol Life
$110 – United States Fire
$115 – Lumico Life
$116 – Assured Life
$117 – AARP-UnitedHealthcare
$120 – Cigna
$122 – Union Security
$130 – National Health
$132 – Philadelphia American
$183 – Medico
$198 – Oxford Life
Greenville, McCormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan F (HD) – Female Age 65
$26 – United American
$30 – Philadelphia American
$31 – Great Southern Life
$32 – Bankers Fidelity
$41 – National Health
$43 – Humana
Greenville, McCormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan G (HD) – Female Age 65
$26 – United American
$27 – Philadelphia American
$30 – Mutual Of Omaha
$34 – United States Fire
$34 – Humana
$40 – Aetna
Greenville, McCormick, Anderson, Pickens, Oconee, and Abbeville Counties Plan N – Female Age 65
$65 – Cigna
$66 – Accendo
$66 – Aetna
$66 – Capitol Life
$68 – Humana
$68 – Assured Life
$68 – Manhattan Life
$68 – Union Security
$69 – United States Fire
$70 – Philadelphia American
$70 – Great Southern Life
$70 – Assured Life
$72 – Humana
$75 – GPM Health
$75 – Central States
$76 – AARP-UnitedHealthcare
$88 – National Health
$103 – Medico
$136 – Oxford Life
Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan A Male Age-65
$77 – AARP-UnitedHealthcare
$87 – Accendo
$91 – Humana
$92 – Aetna
$95 – Cigna
$99 – Elips Life
$99 – Philadelphia American
$99 – Mutual Of Omaha
$100 – Medico
$105 – Manhattan Life
$106 – Capitol Life
$106 – United States Fire
$110 – Great Southern Life
$116 – National Health
$119 – GPM Health
$121 – United American
$123 – Central States
$142 – Bankers Fidelity
$199 – Oxford Life
Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan F Male Age-65
$113 – Medico
$115 – Accendo
$118 – Elips Life
$121 – Manhattan Life
$123 – Great Southern Life
$124 – Humana
$125 – Aetna
$125 – Mutual Of Omaha
$126 – United States Fire
$129 – Central States
$132 – Capitol Life
$134 – Assured Life
$145 – AARP-UnitedHealthcare
$147 – National Health
$168 – Bankers Fidelity
$173 – GPM Health
$174 – Guarantee Trust Life
$220 – United American
Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan F (HD) Male Age-65
$35 – Philadelphia American Life
#39 – Cigna
$40 – United World Life
$41 – Great Southern Life
$45 – Humana
$56 – Continental Life
Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan G Male Age-65
$90 – AARP-UnitedHealthcare
$103 – CSI Life
$104 – Assured Life
$104 – Lumico Life
$104 – Western United Life
$104 – Transamerica
$106 – Union Security
$107 – Philadelphia American
$109 – Cigna
$110 – Humana
$111 – Aetna
$111 – Continental Life
$112 – Greek Catholic Union
$114 – Thrivent
$115 – Great Southern Life
$125 – Oxford Life
$137 – Medico
Richland, Sumter, Orangeburg, Berkeley, and Fairfield Counties Plan N Male Age-65
$80 – AARP-UnitedHealthcare
$82 – Aetna
$83 – CSI Life
$85 – Union Security
$86 – Transamerica
$87 – Assured Life
$87 – Greek Catholic Union
$89 – Lumico Life
$89 – Humana
$90 – Cigna
$91 – United World Life
$93 – Thrivent
$94 – New Era Life
$92 – Liberty Bankers Life
$94 – New Era Life
$94 – Humana
$98 – Great Southern Life
$117 – Medico
$144 – Oxford Life
Charleston, Colleton, and Dorchester Counties Plan C Male Age 65
$140 – AARP-UnitedHealthcare
$146 – Western United Life
$170 – New Era Life
Charleston, Colleton, and Dorchester Counties Plan F (HD) Male Age 65
$38 – Philadelphia American Life
$42 – Cigna
$44 – United World Life
$45 – Great Southern Life
$47 – Humana
Charleston, Colleton, and Dorchester Counties Plan N Male Age 65
$89 – Aetna
$89 – AARP-UnitedHealthcare
$90 – Transamerica
$91 – Assured Life
$93 – Union Security
$96 – Philadelphia American
$96 – Lumico Life
$98 – CSI Life
$99 – Humana
$99 – United World Life
$100 – Guarantee Trust Life
$102 – Thrivent
$104 – Western United Life
$106 – Cigna
$109 – Great Southern Life
$125 – Medico
$158 – Oxford Life
SC Medicare Part D Prescription Drug Plans
SilverScript Choice – $53.20 monthly premium with $545 deductible. 3,505 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $2 (Tier 1), $7 (Tier 2), 16% (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $6 (Tier 1), $21 (Tier 2), 16% (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 29,713 statewide members.
SilverScript Plus – $106.40 monthly premium with $200 deductible. 3,553 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 30% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 6,577 statewide members.
SilverScript SmartSaver – $13.40 monthly premium with $280 deductible. 3,634 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $5 (Tier 2), 24% (Tier 3), 50% (Tier 4), and 29% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $15 (Tier 2), 24% (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 31,229 statewide members.
Humana Walmart Value Rx Plan – $40 monthly premium with $505 deductible. 3,178 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $2 (Tier 2), 17% (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $6 (Tier 2), 17% (Tier 3), 46% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 21,659 statewide members.
Humana Premier Rx Plan – $91.70 monthly premium with $300 deductible. 3,244 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 49% (Tier 4), and 28% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $12 (Tier 2), $135 (Tier 3), 49% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 13,213 statewide members.
Humana Basic Rx Plan – $53.20 monthly premium with $505 deductible. 3,135 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $1 (Tier 2), 24% (Tier 3), 49% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $18 (Tier 2), $114 (Tier 3), 41% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 6,338 statewide members.
WellCare Classic– $32.20 monthly premium with $505 deductible. 3,088 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $6 (Tier 2), $38 (Tier 3), 41% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $18 (Tier 2), $114 (Tier 3), 41% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 16,525 statewide members.
WellCare Value Script– $10.70 monthly premium with $505 deductible. 3,446 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $5 (Tier 2), $44 (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $15 (Tier 2), $132 (Tier 3), 47% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 50,232 statewide members.
WellCare Medicare Rx Value Plus– $71.40 monthly premium with $0 deductible. 3,457 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $4 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $12 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0 Summary Star Rating. 7,919 statewide members.
BlueCross Rx Plus– $205.30 monthly premium with $0 deductible. 3,436 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $3 (Tier 2), $20 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $9 (Tier 2), $60 (Tier 3), 40% (Tier 4), and 33% (Tier 5).
BlueCross Rx Value– $86.20 monthly premium with $300 deductible. 3,436 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $5 (Tier 1), $20 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 27% (Tier 5). 90-day supply preferred pharmacy cost sharing – $15 (Tier 1), $60 (Tier 2), $141 (Tier 3), 50% (Tier 4), and 27% (Tier 5).
Cigna Secure-Essential Rx– $24.00 monthly premium with $445 deductible. 3,193 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $2 (Tier 2), 18% (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $6 (Tier 2), 18% (Tier 3), 47% (Tier 4), and n/a (Tier 5).
Cigna Secure Rx – $20.40 monthly premium with $445 deductible. 3,233 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $3 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $9 (Tier 2), $126 (Tier 3), 50% (Tier 4), and n/a (Tier 5).
Mutual Of Omaha Rx Value – $28.30 monthly premium with $435 deductible. 2,931 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $2 (Tier 2), $27 (Tier 3), 48% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $6 (Tier 2), $81 (Tier 3), n/a (Tier 4), and n/a (Tier 5).
Mutual Of Omaha Rx Plus – $59.10 monthly premium with $435 deductible. 3,286 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $11 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $33 (Tier 2), $126 (Tier 3), n/a (Tier 4), and n/a (Tier 5).
AARP MedicareRx Walgreens – $37.00 monthly premium with $435 deductible. 3,051 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 32% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 32% (Tier 4), and 25% (Tier 5).
AARP MedicareRx Saver Plus – $39.90 monthly premium with $435 deductible. 2,954 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $1 (Tier 1), $8 (Tier 2), $31 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply preferred pharmacy cost sharing – $3 (Tier 1), $24 (Tier 2), $93 (Tier 3), 35% (Tier 4), and 25% (Tier 5).
AARP MedicareRx Preferred – $84.60 monthly premium with $435 deductible. 3,529 formulary drugs offered. 30-day supply preferred pharmacy cost sharing – $5 (Tier 1), $10 (Tier 2), $45 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day supply preferred pharmacy cost sharing – $15 (Tier 1), $30 (Tier 2), $135 (Tier 3), 40% (Tier 4), and 33% (Tier 5).
SC Medicare Advantage Plans (Cost And Availability Can Vary By County)
AARP Medicare Advantage Patriot – $0 monthly premium, and $4,500 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for first 6 days, and outpatient hospital copay is $0-$295. Primary-care physician and specialist office visit copays are $0 and $30. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0-$110 copay (in-network). Prescription drug benefits not included.
AARP Medicare Advantage Choice Plan 1 – $95 deductible, $0 monthly premium, and $5,900 maximum out-of-pocket expenses. Inpatient hospital copay is $335 for first 5 days, and outpatient hospital copay is $0-$335. Primary-care physician and specialist office visit copays are $0 and $35. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0- $110 copay (in-network). 30-day supply prescription drug copays are $0 (Tier 1), $14 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 31% (Tier 5).
AARP Medicare Advantage Choice Plan 2 – $395 deductible, $29 monthly premium, and $6,900 maximum out-of-pocket expenses. Inpatient hospital copay is $325 for first 5 days, and outpatient hospital copay is $0-$325. Primary-care physician and specialist office visit copays are $0 and $35. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0- $110 copay (in-network). 30-day supply prescription drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 26% (Tier 5).
AARP Medicare Advantage Plan 1 – $0 deductible, $0 monthly premium, and $5,900 maximum out-of-pocket expenses. Inpatient hospital copay is $325 for first 6 days, and outpatient hospital copay is $0-$325. Primary-care physician and specialist office visit copays are $0 and $45. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0-$120 copay (in-network). 30-day supply prescription drug copays are $0 (Tier 1), $14 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).
AARP Medicare Advantage Plan 2 – $0 deductible, $24 monthly premium, and $4,500 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for first 6 days, and outpatient hospital copay is $0-$295. Primary-care physician and specialist office visit copays are $0 and $30. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0-$120 copay (in-network). 30-day supply prescription drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).
AARP Medicare Advantage Walgreens – $95 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $350 for first 5 days, and outpatient hospital copay is $0-$350. Primary-care physician and specialist office visit copays are $0 and $35. Urgent Care and Emergency Room visit copays are $40 and $90. Diagnostic radiology services (MRIs) are covered with are subject to a $0-$115 copay (in-network). 30-day supply prescription drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 31% (Tier 5).
Aetna Medicare Premier – $150 deductible, $0 monthly premium, and $7,500 maximum out-of-pocket expenses. Inpatient hospital copay is $365 for first 4 days, and outpatient hospital copay is $0-$350. Primary-care physician and specialist office visit copays are $0 and $30. Urgent Care and Emergency Room visit copays are $0-$30 and $90. Foot, dental, vision, and hearing exams are covered with $0-$30 copays. 30-day supply prescription drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 30% (Tier 5).
Aetna Medicare Premier Plus – $0 deductible, $0 monthly premium, and $7,500 maximum out-of-pocket expenses. Inpatient hospital copay is $365 for first 4 days, and outpatient hospital copay is $0-$350. Primary-care physician and specialist office visit copays are $0 and $30. Urgent Care and Emergency Room visit copays are $0-$30 and $90. Foot, dental, vision, and hearing exams are covered with $0-$30 copays. 30-day supply prescription drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).
Aetna Medicare Value Plus – $250 deductible, $21 monthly premium, and $6,900 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 5 days, and outpatient hospital copay is $0-$300. Primary-care physician and specialist office visit copays are $0 and $25. Urgent Care and Emergency Room visit copays are $0-$25 and $90. Foot, dental, vision, and hearing exams are covered with $0-$25 copays. 30-day supply prescription drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5).
AFC Care Rx – $0 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $325 for first 5 days, and outpatient hospital copay is $250. Primary-care physician and specialist office visit copays are $10 and $45. Urgent Care and Emergency Room visit copays are $10 and $75. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $45 (Tier 2), $95 (Tier 3), 33% (Tier 4), and n/a (Tier 5).
Allwell Medicare – $0 deductible, $0 monthly premium, and $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $360 for first 5 days, and outpatient hospital copay is $275. Primary-care physician and specialist office visit copays are $0 and $40. Urgent Care and Emergency Room visit copays are $40 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $8 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).
BlueCross Total – $70 deductible, $19 monthly premium, and $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $400 for first 4 days, and outpatient hospital copay is $0-$325. Primary-care physician and specialist office visit copays are $10 and $30. Urgent Care and Emergency Room visit copays are $45 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $3 (Tier 1), $15 (Tier 2), $37 (Tier 3), 45% (Tier 4), and 31% (Tier 5).
Cigna-HealthSpring Preferred – $300 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for first 6 days, and outpatient hospital copay is $0-295. Primary-care physician and specialist office visit copays are $0 and $40. Urgent Care and Emergency Room visit copays are $55 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $2 (Tier 1), $10 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 27% (Tier 5).
EON Select – $150 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 5 days, and outpatient hospital copay is $225. Primary-care physician and specialist office visit copays are $10 and $50. Urgent Care and Emergency Room visit copays are $50 and $80. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $2 (Tier 1), $10 (Tier 2), $45 (Tier 3), $95 (Tier 4), and 28% (Tier 5).
Humana Gold Plus – $0 deductible, $0 monthly premium, and $5,900 maximum out-of-pocket expenses. Inpatient hospital copay is $290 for first 7 days, and outpatient hospital copay is $290. Primary-care physician and specialist office visit copays are $0 and $40. Urgent Care and Emergency Room visit copays are $0-$40 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $4 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5).
HumanaChoice – $400 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $450 for first 4 days, and outpatient hospital copay is $450. Primary-care physician and specialist office visit copays are $20 and $50. Urgent Care and Emergency Room visit copays are $20-$50 and $90. Foot, dental, and hearing exams are covered with copays. 30-day supply prescription drug copays are $5 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 25% (Tier 5).
WellCare Premier – $50 deductible, $0 monthly premium, and $6,000 maximum out-of-pocket expenses. Inpatient hospital copay is $300 for first 6 days, and outpatient hospital copay is $450. Primary-care physician and specialist office visit copays are $5 and $40. Urgent Care and Emergency Room visit copays are $30 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), 35% (Tier 4), and 32% (Tier 5).
WellCare Value – $0 deductible, $0 monthly premium, and $6,700 maximum out-of-pocket expenses. Inpatient hospital copay is $372 for first 5 days, and outpatient hospital copay is $200-$300. Primary-care physician and specialist office visit copays are $5 and $45. Urgent Care and Emergency Room visit copays are $30 and $90. Foot, dental, vision, and hearing exams are covered with copays. 30-day supply prescription drug copays are $0 (Tier 1), $20 (Tier 2), $47 (Tier 3), 35% (Tier 4), and 33% (Tier 5).
Note: Plans shown above offer prescription drug benefits for Spartanburg County. Additional plans are offered in all other counties, although rates, availability, and deductibles and copays may differ.
Can A Navigator Tell Me To Purchase A Specific Plan In The Exchange?
No, a “navigator” can not recommend a specific plan or provide advice regarding which policy to purchase. They are also prohibited from discussing the federal subsidy tax implication and calculating what amount you may be eligible for. The best way to obtain coverage is through our website, the .gov website or through a licensed agent.
So…What can a navigator do and what is their purpose? Through community outreach programs, they can meet people (also go door-to-door) and discuss basic elements of the enrollment process. Persons that don’t have computers will be greatly helped by them, especially the elderly or persons without transportation.
HIEC
The Health Insurance Education Cooperative (HIEC) received more than a half million dollars from the federal government to assist consumers. Educating persons that may not fully comprehend the process will be one of their primary tasks. With 20% of South Carolina’s population currently uninsured, plenty of help will be needed. However, websites (like ours) and reputable and licensed agents will also be used for enrollment and education.
Grocery stores, hospitals and churches may be places where you may see DECO Recovery Management talking about enrollment. They are one of the groups that received federal aid. They also plan on targeting libraries and community centers. Right now, medical facilities in Greenville, Aiken and Clarendon counties are training their employees to be navigators.
Buying a South Carolina Health Insurance Exchange plan with the help of a federal subsidy is now possible. Since there are no medical questions required during Open Enrollment, the free quotes you view may save you a significant amount of premium dollars.
SC Short-Term Medical Coverage
Temporary plans provide inexpensive medical coverage for up to 12 months. Rates are low, but pre-existing conditions are not covered, preventative benefits are not always fully covered, and maximum annual or lifetime limits are typically between $250,000 and $2 million, instead of unlimited. Persons that missed Open Enrollment or prefer an Obamacare alternative can consider these types of plans. Sample monthly rates in several areas are shown below:
35-Year-Old Male Residing In Columbia (Richland County)
$65 – $10,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$81 – $5,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$97 – $5,000 deductible with $1 million policy maximum benefit (Everest Flex)
$101 – $2,500 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$136 – $1,000 deductible with $1 million policy maximum benefit (Everest Flex)
45-Year-Old Female Residing In Greenville (Greenville County)
$109 – $10,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$134 – $5,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select
$168 – $2,500 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$197 – $2,500 deductible with $1 million policy maximum benefit (Everest Flex)
$241 – $1,000 deductible with $1 million policy maximum benefit (Everest Flex)
55-Year-Old Male Residing In Charleston (Greenville County)
$185 – $10,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$227 – $5,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select
$284 – $2,500 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
$342 – $2,500 deductible with $1 million policy maximum benefit (UnitedHealthcare Medical Plus Select)
$437 – $1,000 deductible with $2 million policy maximum benefit (UnitedHealthcare Medical Value Select)
SC Peba Plans
The South Carolina Public Employee Benefit Authority manages retirement benefits for more than 500,000 state workers. Programs are offered to employees, employers, and retirees. The State Health Plan is the largest program and is self-funded. Prescription, dental, vision, life insurance, and long term disability coverage is also available.
Employees that are eligible must work for a higher education institution, the state of South Carolina, or a public school district. During the Open Enrollment period (October 1-31), new plans are issued, and existing plans can be changed.
Health Plans
Standard Plan – $490 deductible (maximum two per family) with 20% coinsurance. $14 office visit copay (physician’s office and Blue CareOnDemand) with $105 and $175 copays for outpatient services and emergency care. Inpatient hospital charges must be paid in full until the deductible is met. Prescription drug copays (30 day and 90 day) are $9 and $22 (generic), $42 and $105 (preferred brand), and $70 and $175 (non-preferred brand). After $3,000 of drug copays, there is $0 out-of-pocket expense. The monthly costs are $97.68 (employee), $253.36 (employee and spouse), $143.86 (employee and children), and $306.56 (family).
PAST UPDATES
Aetna has contacted about 3,500 policyholders in the state, informing them that their policies will not be renewed. However, new policies will be offered (probably at a higher rate) that include mandatory benefits, such as maternity and pediatric dental and vision benefits. If the household income meets Federal Poverty Level guidelines, the subsidy may pay for some (or all) of the premium increase.
Also, the navigator program, which received millions of dollars in federal funding, has not been a factor in educating or assisting consumers. “The Cooperative Ministry,” one of the largest organizations to receive money, have had no correspondence from residents that received information in the mail. Perhaps when all of the glitches are sorted out, more consumers will contact them. Of course, websites (like ours) and experienced brokers are probably much more helpful.
Christian Soura has been appointed by Governor Nikki Haley to run the SC Department of Health And Human Services. Current director Tony Keck is leaving the office next month to accept a position with Mountain States Health Alliance, in Johnson City (Tennessee). The State Medicaid program cost more than $7 billion annual to run. About half of its recipients are children living in poorer counties of the state.
More than 200,000 persons enrolled for SC plans for 2015, about double from last year. The vast majority of applicants received federal subsidies with the average amount at about $300. With the extension recently announced, more eligible persons will be able to apply for plans through April 15 if they meet certain criteria.
Get ready for new rates. Although not all plan prices are rising, some carriers have requested hefty premium increases. The SC Department of Insurance will determine the final price on all offered plans. Below, you can view projected increases from several popular Marketplace plans.
53.2% – Time Individual Medical
33.6% – Aetna POS-PD
19.6% – UnitedHealthcare Off Exchange
18.5% – Consumer’s Choice CC PPO Individual
14.4% – Coventry Carolinas SC Group PPO
With Obamacare in a “death spiral,” (according to many healthcare experts), one of the biggest unknowns is when Trump Administration plan changes will be effective, and of course, the details and costs of the new policies. We expect South Carolina consumers to be offered more choices and lower rates. However, the full implementation may take another 12-24 months.