Medicaid Costs and Coverage in South Carolina

Determining how much is Medicaid in South Carolina requires a closer look at our state’s Medicaid program, coverage options and services provided. Medicaid coverage is administered our state’s Medicaid program, Healthy Connections, and pays for medical treatment for qualifying applicants who do not have sufficient income to pay for health care.

How much does Medicaid cost in South Carolina? Medicaid cost estimates depend largely on the type of insurance plan that you enroll in and the services you seek out. In South Carolina, there are two primary types of Medicaid insurance: managed care organizations (MCOs) and fee-per-service Medicaid. With both plans, you may have to pay a small co-pay in exchange for medical treatment and prescriptions.

To learn more about Medicaid costs and services, download our guide to the South Carolina Healthy Connections program. In addition to what services are covered by Medicaid, our Healthy Connections guide breaks down the different types of Medicaid insurance and explains the different costs associated with each.

Download our helpful guide to Medicaid to learn more about eligibility requirements and the documents you will need to apply.

Understanding Medicaid Coverage in South Carolina

Medicaid coverage in South Carolina is provided by Healthy Connections, our state’s Medicaid program operated by the South Carolina Department of Health and Human Services (SCDHHS). Healthy Connections handles the different types of Medicaid insurance within our state in accordance with federal Medicaid guidelines.

Through Medicaid health coverage, Healthy Connections pays the medical bills for treatment and prescriptions for qualifying families with low income and special health care needs. In South Carolina, Medicaid health insurance is paid for by taxes collected by the state and federal government. Find out more about Medicaid coverage in South Carolina by learning more about the Healthy Connections program and the SCDHHS.

Types of Medicaid Coverage in South Carolina

There are two primary types of Medicaid insurance in South Carolina and understanding what they offer will help you determine how to apply. The first type of Medicaid coverage and the most popular is known as a managed care organization (MCO). An MCO is a network of doctors, clinics and other health care providers in South Carolina who collaborate to coordinate services and programs to create comprehensive, quality health plans. In this state, many MCO plans include extra benefits, such as unlimited physician visits, health management programs and 24/7 nurse help lines. With this type of Medicaid insurance plan, the South Carolina Department of Health and Human Services pays the MCO for all the services included in the plan, as opposed to paying individually for each individual service.

There are five primary MCO Medicaid insurance plans in South Carolina, including Absolute Total Care, BlueChoice HealthPlan Medicaid, First Choice by Select Health of South Carolina, Molina Healthcare of South Carolina, and WellCare.

The second type of Medicaid insurance is known as “fee-for-service” or “regular” Medicaid. With this type of Medicaid plan, the SCDHHS pays medical providers for each treatment or service you receive.

In your Medicaid insurance enrollment letter, you will be informed whether you are required to sign up for an MCO. If enrollment in an MCO Medicaid insurance plan is not required of you, you typically may choose between an MCO or fee-for-service plan. Choosing the right plan for you and your family’s needs requires you to assess the benefits of each as well as any chronic medical conditions.

How Much Does Medicaid Cost in South Carolina?

Medicaid cost estimates in SC, through South Carolina Healthy Connections may depend on the type of coverage or MCO plan you choose. As a South Carolina Medicaid insurance plan member, you may be charged a small copayment for covered services. Medicaid payment is typically no more than a few dollars and paid at the time you receive the service. In addition to fixed copayments, you may have to pay for Medicaid services that go over your plan limit and services that are not covered through your plan.

Medicaid cost estimates in South Carolina may vary depending on the type of insurance or MCO you are enrolled in. Depending on your MCO Medicaid plan, you may be able to receive certain treatments and extra services–such as disease management and family planning–for free.

What Services Are Covered by Medicaid in South Carolina?

In South Carolina, benefits and services covered by Medicaid may depend on the type of Medicaid insurance or MCO you select. However, all types of Medicaid insurance and MCO plans cover the same basic services, including (among others):

  • Doctor and dentist office trips
  • Hospital outpatient, inpatient and emergency center visits
  • Prescriptions for select types of medications
  • Mental health care and inpatient psychiatric treatment
  • Alcohol and substance abuse counseling and services

All Medicaid health coverage plans in South Carolina cover a certain number of routine physical checkups for children and adults. Many South Carolina MCO Medicaid coverage plans include additional free services and rewards, such as unlimited physician visits, free natal program enrollment, free glasses and more.

Once you understand what services are covered by Medicaid with your unique type of insurance or MCO plan you can budget to receive the services you need much more affordably.

What Does Medicaid Not Cover in South Carolina?

Depending on your Medicaid coverage type or MCO, certain medical treatments and services may not be covered under your health plan. If you need services not covered by Medicaid, you may be required to pay full-price or use a third-party health insurance provider to pay. Examples of what does Medicaid not cover may include:

  • Over-the-counter medications, nutritional supplements or vitamins that were not prescribed by a physician
  • Cosmetic surgery and costs associated with cosmetic surgery
  • Non-emergency treatments and services provided outside of the U.S.
  • Custodial care provided in a patient’s home
  • Select foot-care services and products, such flatfoot treatment or orthopedic shoes

Discover services covered by Medicaid in addition to those not covered in our expert Healthy Connections guide. In our guide to Medicaid coverage in South Carolina, you will find program costs, services, tips on choosing an MCO plan and more.

Download our comprehensive guide to affordable health coverage including how to determine your potential costs and the methods you can use to apply.