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South Carolina’s Medicaid program is Healthy Connections, which provides various types of healthcare coverage to low-income South Carolina residents and their families. Healthy Connections, or Medicaid SC, offers coverage for doctors’ appointments, prescription drugs, and much more to help people get more well-rounded healthcare coverage at reduced costs.
South Carolina residents who meet the income and health eligibility requirements can enroll in this state program. As of June 2023, 1,313,651 South Carolinians were enrolled in the program.
If you live in South Carolina and are looking for a way to get more healthcare coverage without paying for expensive health insurance plans, consider applying for the Healthy Connections Medicaid program. South Carolina Medicaid can provide coverage for routine doctors’ visits, prescription medications, and more.
This guide covers everything you need to know about applying for and maintaining coverage while keeping healthcare costs low.
You can extend your benefits by enrolling in a policy with a third-party insurance company for even more well-rounded coverage. Medicaid covers a lot, but it doesn’t cover everything and can limit you to a small network of doctors. Extending your coverage allows you to enjoy a wider provider network, lower costs, and additional benefits. To prevent shouldering the debt of unexpected medical expenses, many South Carolinians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Every state has its own Medicaid program, and South Carolina’s is Healthy Connections. As a Medicaid program, it receives funding from the state of South Carolina and the federal government. Healthy Connections is available to low-income individuals or families, pregnant women, residents over 65, people with disabilities, and the blind.
Depending on income and health status, Medicaid SC has varying costs for different members. For instance, you could be responsible for copays as little as $1 to $4 or have no out-of-pocket costs.
The Healthy Connections card is your proof of enrollment. You need this card to enroll in other Medicaid plans, pay for services, and more. If multiple people in your home receive Medicaid coverage, they’ll each have a card in their name.
This card also has your Medicaid SC number, which is essentially your program identification. Insurance companies will ask for this number if you decide to enroll in additional Medicaid plans, and you’ll use this card when you go to doctors’ appointments, the hospital, the pharmacy, or another healthcare provider.
South Carolina Medicaid allows some people to also enroll in a Managed Care Organization plan, in which case you will receive an additional card from the provider you choose. When you enroll in an MCO plan, the MCO pays for your healthcare, although you are still a Medicaid member.
If Healthy Connections doesn’t tell you to enroll in an MCO plan, you’ll enroll in traditional or fee-for-service Medicaid.
You can apply for South Carolina’s Medicaid program in several ways:
You must meet strict eligibility requirements to qualify for the Healthy Connections program. Although many think Medicaid eligibility solely relies on income, you must also have specific health needs. Be sure to review the requirements in great detail before assuming you're entitled to benefits.
For instance, those with low income must also be pregnant, disabled, blind, or over the age of 65 to qualify. You may also be eligible if you have a child or someone in your house with a disability.
If you have the medical need for Medicaid, you must determine whether your income qualifies. So, what does South Carolina consider low income? The answer depends on how many people are in your household. Here’s a quick breakdown of what annual income qualifies for Medicaid based on household size:
If you have more people in your household, simply add $5,140 for each additional person. For example, the maximum qualifying income for a six-person house is $35,140 + $5,140 = $40,280, the maximum qualifying income for a seven-person house is $40,280 + $5,140 = $45,420, and so on.
You should receive a response from Medicaid SC via mail between 45 and 90 days after applying. If the program approves your application, it will send you the Healthy Connections card. You must keep track of this card as it gives you access to various Medicaid benefits and allows you to enroll in low-cost plans.
As of April 2023, you must submit your annual review form every 12 months to maintain Healthy Connections coverage. This annual renewal process paused as a result of the COVID-19 pandemic, which means that for the last three years, you didn’t need to worry about renewing your Medicaid membership.
Now that the renewal process is restarting, you should watch the mailbox for your renewal forms from the South Carolina Department of Health and Human Services. You must complete these forms and send them back by the specified date to maintain coverage. Otherwise, the program will deem you no longer eligible.
If you lose your Healthy Connections card, you can call the member contact center at 1-888-549-0820. After calling, you can expect your replacement card in the next seven to ten days. If you need to schedule an appointment with your doctor before then, they can typically verify your Medicaid status.
South Carolina’s Medicaid program offers well-rounded healthcare coverage by providing numerous benefits, from routine doctor visits to family planning services. As a member, you can get extra coverage by enrolling in additional Medicaid or Managed Care Organization plans, but the following services are standard for your Healthy Connections membership.
Adults and children can receive various dental services through South Carolina Medicaid. For instance, adults can receive coverage for exams, X-rays, fillings, extractions, cleanings, and anesthesia. Meanwhile, children can get a cleaning every six months as well as fillings.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in South Carolina is advisable.
South Carolina’s Medicaid program covers numerous prescription drugs and some over-the-counter medications. If you want Medicaid to cover a specific drug, check the Preferred Drug List to see whether Healthy Connections will cover it before finding out the hard way that it doesn't. If you don’t see the drug on this list, you may still be able to receive coverage with prior authorization, which you will need your doctor’s help with.
If you’re looking for additional help covering your prescription medications, you can also apply for the South Carolina Drug Card. This program is available to any underinsured or uninsured South Carolina resident who needs help paying for their prescription drugs. With no enrollment requirements or program costs, the South Carolina Drug Card can help you get more affordable prescriptions from multiple pharmacies throughout the state, including CVS, Walgreens, Kmart, BI-LO, and more.
While South Carolina’s Medicaid program covers numerous essential healthcare services, it also offers extended healthcare. For instance, you can also receive coverage for home health, behavioral health, audiology, vision, and family planning services. Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Another benefit South Carolina Medicaid offers is the Women, Infants, and Children program. WIC is a nutrition program that aims to help mothers and their children stay healthy by helping moms get healthy foods during pregnancy. After you give birth, WIC will also help you get healthy foods for your baby until they are five years old. You can call 1-855-472-3433 to learn more about this program.
When enrolling in South Carolina Medicaid, you will receive a Member’s Guide listing all the services available to you. You can also learn more about what extended healthcare services you qualify for by contacting the South Carolina Department of Health and Human Services.
If eligible, you can receive transportation to and from your doctors’ appointments at no cost to you by calling Modivcare and scheduling a ride. However, South Carolina Medicaid typically does not cover any out-of-state services, so you must see doctors within the given region to receive coverage.
What if you’re traveling? If you’re out of state and have an emergency medical situation, you can go to the closest hospital and give them your Healthy Connections card. You should also ensure the doctor or hospital you visit accepts Medicaid. If you are traveling outside of Florida for leisure, invest in proper travelers insurance.
If you receive an approved service from an out-of-state hospital or clinic, Medicaid will typically reimburse you for the cost.
South Carolina’s Medicaid doesn’t have any programs specifically for students, but anyone who meets the eligibility requirements is welcome to apply.
As previously mentioned, one of these eligibility requirements is being 65 years old or older, so seniors who also meet the financial eligibility requirements can enroll in Healthy Connections and take advantage of its various benefits, which include long-term care.
However, in addition to the standard Medicaid eligibility requirements, you must meet certain functional or medical requirements to qualify for long-term care coverage. Essentially, you must prove you physically need the level of care that long-term care services, such as nursing homes, provide.
Seniors can apply for and enroll in different long-term care programs through Medicaid SC, including the following:
South Carolina Medicaid is available to any state resident who meets the eligibility requirements. In addition to seniors and those with disabilities, military members or veterans and American Indians can take advantage of the state’s Medicaid program.
In 2018, around one-third of American Indian and Alaska Native adults enrolled in Medicaid in the U.S.
American Indians who meet the standard eligibility requirements for Medicaid can enroll in Healthy Connections and take advantage of the various benefits it offers. If you are an American Indian and enroll in South Carolina Medicaid, you won’t be responsible for paying premiums, copays, or any other out-of-pocket costs.
Additionally, South Carolina Medicaid, along with other state Medicaid programs, regularly partakes in Tribal Consultations, which gives Tribes a chance to share their input on policies and issues that affect them directly.
The Medicaid program is open to all qualifying South Carolina residents, including military members and veterans. However, South Carolina has several other programs to help military members and their families.
For example, SC Thrive supports military members, families, and veterans through multiple different programs, such as:
Although you can receive several types of additional coverage through South Carolina Medicaid, there are several services it doesn’t cover, including the following:
It is also important to note that the Medicaid program in South Carolina does not cover the cost of Medicaid. Considering the rising cost of funerals, burials and related services, it’s important to invest in quality funeral insurance.
Healthy Connections clearly covers a lot, which can leave you wondering exactly what services you can get. Here’s a quick breakdown of common services and treatments you can receive coverage for through South Carolina Medicaid:
| Dental | |
|---|---|
| One of the prime benefits of South Carolina Medicaid is that it covers several additional services to give you more well-rounded coverage, including dental. Here are the dental services you can get coverage for: | |
| X-Rays and Exams | Adults and children can receive routine dental exams and X-rays along with preventative cleanings. |
| Wisdom Teeth | Adults have an annual benefit cap of $1,000, which covers fillings, cleanings, and extractions, including wisdom teeth removal. |
| Vision | Medicaid SC provides the following vision services for enrollees: |
|---|---|
| Eye Exams | Healthy Connections covers the costs of eye exams for children but only medically necessary exams for adults. |
| Glasses | Children can receive coverage for eyeglasses through South Carolina Medicaid. |
| Laser Eye Surgery | Medicaid typically won’t cover laser eye surgery unless your doctor says it’s medically necessary since it is an elective procedure. |
| Surgery | Typically, Medicaid only pays for medically necessary surgeries: |
|---|---|
| Rhinoplasty | Unless you need rhinoplasty to fix an injury, birth deformity, or some other medical issue, you’ll likely have to pay for this out of pocket. |
| Breast Reduction | Medicaid may pay for your breast reduction surgery if your doctor deems it necessary for your health. |
| Hospital | South Carolina Medicaid will cover several hospital-related services and treatments: |
|---|---|
| Hospital stays | Medicaid will pay for your overnight hospital stays as well as services you receive in the hospital, like lab work, X-rays, and screening, diagnostic, and treatment services. |
| Ambulance transportation | You can receive coverage for ambulance rides during a medical emergency that requires such transportation. |
| Giving birth | Medicaid will cover the costs of hospital births. Plus, you can receive additional healthcare coverage for up to 60 days after you deliver your baby. |
| Sexual Health | South Carolina Medicaid offers some coverage for services that promote sexual health: |
|---|---|
| Gynecology | Medicaid offers coverage for gynecological visits if you are pregnant or your doctor refers you to a gynecologist for medically necessary reasons. |
| Erectile Dysfunction | You will not typically receive coverage for medications or treatments that address erectile dysfunction. You can talk with your doctor about your other options. |
| Birth Control (Including IUDs) | Medicaid considers family planning a limited benefit, but if you’re eligible, you can receive coverage for birth control, sterilization, lab tests, and even family planning counseling. |
| Fertility Treatment | Healthy Connections typically won’t cover fertility treatments or prescriptions, but you can consult your physician about your options for conceiving. |
| Specialist Services | South Carolina Medicaid offers some coverage for services that promote sexual health: |
|---|---|
| Dermatology | Medicaid may cover your dermatology visits if your physician refers you to a dermatologist for medically necessary reasons. |
| Physiotherapy | While you need a referral for physiotherapy, South Carolina Medicaid does offer coverage for physical and occupational therapy. |
| Massage Therapy | You generally won’t receive coverage for massage therapy unless your doctor says it’s medically necessary. |
| Podiatry and Foot Care | In 2020, the SCDHHS made an amendment to the South Carolina Title XIX State Plan, which allowed the state’s Medicaid program to offer coverage for certain podiatry services. |
| Allergist and Allergy Testing | If your allergies are severe enough and your doctor refers you to an allergist, Medicaid may help cover the costs. |
| Sleep Physician Services and CPAP Machines | Medicaid offers coverage for durable medical equipment, which can include CPAP machines if your doctor says it’s medically necessary. Like most other specialists, you’ll need a referral to see a sleep physician, and Medicaid will only cover the costs if your primary care doctor says it’s essential for your health. |
When you receive your approval letter from Healthy Connections, it may tell you to choose a health plan from a listed Managed Care Organization. Enrolling in an MCO plan can help you get more coverage and greater benefits with your Medicaid, which is especially helpful since Medicaid does not cover everything you may need.
However, not everyone who qualifies for South Carolina Medicaid is eligible for MCO plans. Still, you can extend your coverage by enrolling in a third-party health insurance plan. This gives you access to more benefits and a wider provider network, potential out-of-state coverage, lower copays, and more extensive coverage. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Which plans should you consider as a South Carolina Health Connections enrollee? Our team at Insurdinary can help.
Contact Insurdinary today to get free quotes from South Carolina’s top healthcare providers!
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
