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Learn About Medicaid Costs and Coverage in South Carolina

Medicaid coverage in South Carolina makes affordable health care available to eligible individuals or families who qualify based on income and other factors. The types of Medicaid insurance and coverage available to applicants includes a range of medical services. The funding for Medicaid coverage comes from both the federal and state governments. Medicaid covers various medical services, but it also excludes certain services that are deemed unnecessary. Medicaid cost estimates are generally low, but in some cases, there are minimal costs to the beneficiary. Primarily, Medicaid costs include some out-of-pocket expenses that the program may not cover. Get answers to the question “How much is Medicaid in SC?” and more by reading the sections below.


What services are covered by Medicaid in South Carolina?

The federal government establishes basic Medicaid coverage guidelines, including what mandatory services the program will provide. States may expand and adapt Medicaid insurance benefits depending on regional needs and resources. Often, what Medicaid covers in a state depends on local resources, leading to the exclusion of certain types of coverage. Some Medicaid benefits are optional, and they may or may not be adopted by the state. For instance, the Affordable Care Act (ACA) introduced an optional expansion of Medicaid to cover more individuals, particularly adults without dependents. South Carolina chose not to extend Medicaid as outlined in the ACA. However, South Carolina Medicaid coverage benefits involve several mandatory services. Some of the services covered by Medicaid in SC include:

  • Transportation services.
  • Doctor visits.
  • Emergency room.
  • X-Rays.
  • Testing and treatment for specific diseases.
  • Inpatient and outpatient care.
  • Services from a primary care physician.

Medicaid coverage in South Carolina extends to a broad range of residents throughout the state. Both families and individuals benefit from the assistance. Furthermore, certain groups receive additional benefits. For instance, SC Medicaid coverage provides children with extra aid, such as vision and hearing screens. To learn more about services offered through Medicaid, you can download our free guide.

What does Medicaid not cover in South Carolina?

Becoming familiar with the services not covered by Medicaid in South Carolina allows prospective applicants to understand if Medicaid can help them. Resources are limited, so state and federal officials prioritize essential services and ignore elective services. Therefore, Medicaid insurance does not extend to services such as cosmetic procedures, vision (for adult beneficiaries) and occupational, speech or respiratory therapy. However, South Carolina does allow Medicaid participants to join a health plan, which may offer extra services that Medicaid typically does not cover.

How much does Medicaid cost in South Carolina?

The cost of Medicaid in South Carolina is kept as low as possible, since the purpose of the program is to help residents living in low income households. Additionally, it is important to note that, in some cases, eligible applicants may face additional costs. Before applying for Medicaid coverage, petitioners should be aware of such potential costs. For example, households requiring certain services or requesting preventative care may have to pay out-of-pocket expenses. Additionally, some beneficiaries may be exempt from additional costs.

South Carolina Medicaid costs may involve copayments. However, in cases where copayments are due, Medicaid insurance limits the maximum amount for which a recipient may be charged. Eligible applicants for Medicaid coverage will receive a notification from state agents in the mail regarding possible expenses, payment maximums and other vital details. Additionally, providers involved with the Medicaid program may choose to charge less than the set limit, but it is up to the discretion of the provider. Providers cannot charge any more for SC Medicaid coverage than the limits established by the program. Important information to note is that expenses related to the program may change based on a broad range of factors.

Co-payments under South Carolina Medicaid insurance are generally kept low. For example, adult Medicaid beneficiaries must pay $3.40 for one medical equipment item. Adults must provide a co-pay of $3.30 per doctor visit. In some cases, the answer to “How much does Medicaid cost in SC?” is zero. Some exemptions keep recipients from any out-of-pocket expenses. For instance, copayment costs for Medicaid are waived for recipients who are younger than 19 years of age. Additionally, eligible applicants should be aware that Medicaid coverage extends across many procedures which are provided at a low cost. While many require copayments, other services do not. For instance, chemotherapy and a range of aid provided to the elderly or the disabled do not incur copayments. To learn more about Medicaid costs and coverage, download our free guide today.