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 plans in South Carolina with effective dates of September 2024 or later are limited to total durations of no more than four months, including renewals.¹

Plans sold between late 2018 and August 2024 can’t last more than 11 months, with a total duration of 33 months (including renewals).²

Those limits changed for plans issued in September 2024 or later, under the terms of new federal rules that cap total duration at four months, including renewal.

From late 2018 through August 2024, Trump administration regulations allowed 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 were clear in noting that a state could impose stricter guidelines.

South Carolina imposes slightly shorter limits — which were used in the state during the years when the Trump administration’s federal rules were in effect — 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.

But now that federal rules are stricter than South Carolina’s rules, the federal rules are used instead. New short-term policies are limited to initial terms of no more than three months, and total duration of no more than four months, including renewals.

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.³ 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).⁴

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),³ 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. (Here’s more about understanding and possibly avoiding the coverage gap.) For some people in this situation, a short-term plan might be an affordable temporary solution. But as noted above, short-term policies issued in September 2024 or later can only have a duration of up to four months.

The South Carolina Department of Insurance published Bulletin 2024-13 in November 2024, to clarify that the new federal rules are in effect in South Carolina, limiting short-term health insurance policies to a total duration of no more than four months.

The South Carolina Department of Insurance had previously published Bulletin 2018-08 in August 2018, to clarify the state’s rules for short-term health insurance in South Carolina after the Trump administration’s federal rules took effect.

In an effort to differentiate short-term health coverage from ACA-compliant health plans between 2018 and August 2024, South Carolina limited 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 are now 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.”