South Carolina Health Insurance Marketplace: Your 2026 Guide to ACA Plans, Subsidies & Enrollment

South Carolina's Health Insurance Marketplace

South Carolina uses the federal health insurance marketplace at HealthCare.gov. The state does not operate its own exchange. When South Carolina residents shop for ACA marketplace plans, they enter their zip code and household information at HealthCare.gov to see certified plans available in their county, calculate premium tax credits, and enroll.

South Carolina has 46 counties. The Charleston, Columbia, Greenville, and Myrtle Beach areas tend to have more carrier options and more competitive pricing. Rural counties in the Pee Dee region, the Lowcountry, and the Upstate may have fewer carriers, with BlueCross BlueShield of South Carolina maintaining the broadest statewide presence.

SC Medicaid (Healthy Connections): Who Qualifies?

South Carolina Medicaid, known as Healthy Connections, has strict eligibility requirements. Without Medicaid expansion, most working-age adults without dependent children do not qualify for SC Medicaid regardless of income. The program primarily covers:

• Children under 19 (through Medicaid and CHIP — SC Healthy Connections Kids)
• Pregnant women (up to 194% FPL)
• Adults 65 or older with limited income and assets
• Adults with qualifying disabilities
• Parents/caretaker relatives with very low incomes (threshold varies)

If you don't fall into one of these categories and earn under 100% FPL, you may be in the coverage gap. Contact the SC Department of Health and Human Services (scdhhs.gov) to check your eligibility or speak with a licensed broker who knows South Carolina's specific rules.

ACA Subsidies for South Carolina Residents

For South Carolinians who earn above 100% of the federal poverty level and don't have access to affordable employer coverage, ACA premium tax credits provide substantial relief. In 2026:

• 100%–150% FPL ($15,060–$22,590 for a single adult): Near-zero premium Silver plans with enhanced Silver 94 cost-sharing reductions; deductibles can be as low as $300
• 150%–200% FPL ($22,590–$30,120): Strong subsidies; Silver 87 CSRs significantly reduce out-of-pocket costs
• 200%–250% FPL ($30,120–$37,650): Moderate-to-significant subsidies; Silver 73 CSRs
• 250%–400% FPL ($37,650–$60,240): Subsidies that reduce monthly premiums by $100–$350
• Above 400% FPL: No premium tax credit in 2026 — the 400% FPL income cap returned when the enhanced subsidies expired

Average Cost of South Carolina Health Insurance

South Carolina premiums vary by county. Coastal and metro areas with more competition tend to have lower premiums. Estimated unsubsidized monthly premiums for a 40-year-old in 2026:

• Bronze plans: $360–$470/month; high deductibles ($6,500–$9,000)
• Silver plans: $510–$630/month; moderate deductibles; CSRs transform these for lower-income enrollees
• Gold plans: $610–$750/month; deductibles around $1,500–$3,000

After subsidies, the average SC marketplace enrollee pays approximately $88/month. Many residents earning between 100% and 200% FPL pay $0–$30/month for a Silver plan with enhanced cost-sharing reductions.

Top Health Insurance Carriers in South Carolina

• BlueCross BlueShield of South Carolina — the dominant carrier with statewide availability across all 46 counties; broad network that includes most major hospitals and physician groups in the state
• Molina Healthcare South Carolina — value-oriented HMO plans available in select SC markets, particularly in the Columbia and Upstate areas
• Ambetter from Absolute Total Care — part of the Centene family; available in select South Carolina markets with competitive Silver plan pricing
• Oscar Health — available in the Charleston and Columbia metro areas; tech-forward with strong telehealth integration

Enrolling in South Carolina Health Insurance: Step by Step

1. Check SC Healthy Connections eligibility first, especially if you have children, are pregnant, or have a qualifying disability
2. Visit HealthCare.gov and log in or create an account
3. Enter your South Carolina zip code, household members, and projected 2026 income
4. Review your estimated premium tax credit and browse available plans
5. Compare plans by total annual cost — don't just compare monthly premiums
6. Verify your physicians and any preferred hospitals are in-network
7. Enroll before January 15 for February coverage; pay first premium to activate

South Carolina Special Enrollment Periods

Outside of open enrollment (November 1 – January 15), qualifying life events trigger a 60-day Special Enrollment Period. Common qualifying events for South Carolinians include losing employer coverage, getting married, having a child, moving to a new county, or aging off a parent's plan at 26. Act promptly — 60 days passes faster than expected, and missing the SEP means waiting until the next open enrollment.