South Carolina Health Insurance Guide

Health Insurance Overview in South Carolina

South Carolina has not expanded Medicaid under the ACA. The state uses the federal HealthCare.gov marketplace. South Carolina has a significant uninsured population, particularly among low-income working adults who fall into the coverage gap. The state has had some marketplace competition challenges in rural areas.

Average Health Insurance Costs in South Carolina

Marketplace Enrollment in South Carolina

South Carolina residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in South Carolina

Medicaid in South Carolina

South Carolina has not expanded Medicaid. Traditional Medicaid covers very limited categories. Adults without children generally do not qualify regardless of income.

Children's Health Insurance (CHIP) in South Carolina

South Carolina's Partners for Healthy Children covers children under 19 in families with incomes up to 208% of the federal poverty level.

What Makes South Carolina Unique

South Carolina's decision not to expand Medicaid has left an estimated 185,000 adults in the coverage gap — too poor for marketplace subsidies, not sick enough for traditional Medicaid, and without children who might qualify for CHIP. South Carolina's growing manufacturing economy (BMW, Volvo, Boeing) provides employer coverage for many, but agricultural and service workers remain particularly vulnerable.

ACA Subsidies: What South Carolina Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

South Carolina’s Marketplace for 2027: Insurers, Rates, and Dates

South Carolina residents enroll through HealthCare.gov. Full-price premiums rose about 21% on average for 2026, before subsidies. 6 insurers sold plans for 2026. Proposed 2027 changes average about 16.6% before subsidies.

About 588,000 people enrolled for 2026. About 89% received premium tax credits, and the average net premium after credits was about $139 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in South Carolina

South Carolina has not expanded Medicaid, leaving an estimated 63,000 low-income adults in the coverage gap. Its six insurers all return for 2027, with proposed increases averaging about 16.6%. From 2027, non-citizens must be lawful permanent residents, Cuban/Haitian entrants, or COFA migrants to receive tax credits.

Tips for Choosing Health Insurance in South Carolina

South Carolina residents earning 100%+ of the federal poverty level should check HealthCare.gov for subsidy eligibility. Partners for Healthy Children provides children's coverage. Adults below the poverty level have very limited options. Community health centers serve uninsured patients on a sliding fee scale.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.
• South Carolina has not expanded Medicaid, so if your income falls below the federal poverty level you may fall into the coverage gap — a community health center or sliding-scale clinic can serve as a bridge until your income qualifies for marketplace subsidies.

Frequently Asked Questions

How many insurers sell marketplace plans in South Carolina?

Six insurers sold South Carolina marketplace plans for 2026, with proposed 2027 changes averaging about 16.6% before subsidies.

When is open enrollment in South Carolina for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do South Carolina marketplace enrollees pay after subsidies?

In 2026 about 89% of South Carolina enrollees received premium tax credits, and the average net premium was about $139 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.