Availability of short-term health insurance in South Carolina

Yes. As of 2024, at least five insurers were offering short-term health insurance in South Carolina.

Short-term health insurance in South Carolina can’t last more than 11 months, with a total duration of 33 months (including renewals).¹

Those limits will change in 2024 under new Biden administration rules for short-term health plans. Short-term plans issued or sold on or after September 1, 2024 will be limited to total durations of no more than four months, including renewal.

Until then, the Trump administration’s regulations that took effect in late 2018 allow a short-term health insurance plan to have an initial term of up to 364 days and a total plan duration of up to 36 months. But the federal rules are clear in noting that a state can impose stricter guidelines.

South Carolina imposes slightly shorter limits because ACA-compliant plans have one-year terms (if they’re purchased during open enrollment and take effect on January 1), and the 11-month limit on short-term plans was intended to help consumers understand that short-term coverage and ACA-compliant plans are not interchangeable.

Short-term health insurance in South Carolina can be purchased by residents who can meet the underwriting guidelines of insurers.

In general, people can qualify for short-term health plans if they’re under 65 years old (some insurers will only issue plans to people who are under 64 years of age) and do not have any of the short list of medical conditions that will result in a declined application.² But the specific requirements vary from one insurance company to another.

Short-term health insurance plans usually include blanket exclusions for pre-existing conditions, and they often use post-claims underwriting (meaning that they will go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition).³

Short-term health plans also generally exclude coverage for some of the ACA’s essential health benefits (most commonly, maternity care, prescription drugs, and mental health care),² and impose dollar limits on the coverage they do provide. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.

Before purchasing a short-term health insurance plan, you should check to see if open enrollment is underway for ACA-compliant health plans (this runs from November 1 to January 15 in South Carolina). If not, you should check to see if you’re eligible for a special enrollment period that would allow you to enroll in an ACA-compliant (ie, Obamacare) individual major medical plan through the South Carolina exchange (Marketplace). A variety of qualifying life events will trigger a special enrollment period, and premium subsidies are available depending on your household income.

You can enroll in a Marketplace plan even if you’re only going to need it for a short time. These insurance plans are purchased on a month-to-month basis, so you can cancel your coverage after just a few months if you become eligible for health coverage elsewhere (from a new employer, for example, or Medicare).

Depending on the circumstances, there could be times when a short-term health plan might be the only realistic option, for example:

• If you missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.
• If you’ve recently become employed and the health plan your employer offers has a waiting period before benefits take effect (assuming you don’t also have a qualifying event that would allow you to enroll in an Obamacare plan while you wait for your employer’s plan to take effect).
• You’ll soon be eligible for Medicare and need just-in-case coverage until you reach age 65 and your Medicare coverage takes effect (note that Medigap insurers can impose a pre-existing condition waiting period if you don’t have coverage for your pre-existing conditions prior to enrolling in Medicare).
• If you’re not eligible for Medicaid or a premium subsidy in the marketplace (exchange), the monthly premiums for an ACA-compliant plan might be unaffordable. South Carolina does have a coverage gap due to the state’s refusal to expand Medicaid under the ACA, which means adults with income below the poverty level are ineligible for any financial assistance with their health coverage. For some people in this situation, a short-term plan might be an affordable temporary solution. (Here’s more about understanding and possibly avoiding the coverage gap.)

The South Carolina Department of Insurance published Bulletin 2018-08 in August 2018, to clarify the state’s rules for short-term health insurance in South Carolina.

In an effort to differentiate short-term health coverage from ACA-compliant health plans, South Carolina limits the initial term of a short-term plan to no more than 11 months, and total duration, including renewals, to no more than 33 months. (As noted above, much stricter federal rules will be in effect for policies sold or issued starting in September 2024.)

Although the South Carolina Department of Insurance lists short-term medical coverage as an option for people who lose their employer-sponsored coverage, they do clarify that it “does not provide the same protections as major medical coverage.” The Department of Insurance also notes that short-term healthcare plans “are designed to have lower monthly premiums (than ACA-compliant plans or employer-sponsored plans). As a result, they have less coverage and consumer protections than major medical plans.”