Health Insurance in South Carolina: Plans, Costs, and Enrollment

Health insurance South Carolina residents can access is available through the federal marketplace at HealthCare.gov, employer-sponsored plans, Medicaid, and Medicare. Because South Carolina is one of the states that has not expanded Medicaid under the ACA, understanding all available health insurance South Carolina options is especially important for uninsured residents looking for affordable coverage. This article is general information, not insurance, legal, or financial advice.

South Carolina saw strong marketplace enrollment growth for several years, driven in large part by the temporary enhanced premium tax credits that made coverage far more affordable. That picture changed for 2026: those enhanced credits expired at the end of 2025 and, as of this update, had not been extended, pushing net premiums up for many enrollees. Meanwhile, the state’s decision not to expand Medicaid continues to leave a significant coverage gap for low-income adults. This policy guide explains the full landscape of health coverage in the Palmetto State — and why you should verify the latest figures before you enroll.

South Carolina Health Insurance Marketplace

South Carolina uses the federal marketplace, HealthCare.gov, for individual and family health insurance enrollment. The state does not operate its own exchange.

Key marketplace facts for South Carolina in 2026:

• Enrollment platform: HealthCare.gov
• Major insurers: Blue Cross Blue Shield of South Carolina (BlueCross), Ambetter (Absolute Total Care), Molina Healthcare, and other carriers in select regions (participation changes year to year — confirm on HealthCare.gov)
• Open enrollment: Roughly November 1 through January 15. See open enrollment and confirm current dates on HealthCare.gov, as they can shift
• Plan tiers: Catastrophic, Bronze, Silver, Gold. Platinum plans are not available in most South Carolina counties
• Financial assistance: Premium tax credits and cost-sharing reductions are available based on income, though the credits are less generous now that the enhanced (ARPA/IRA) subsidies have lapsed

Blue Cross Blue Shield of South Carolina has long been the dominant insurer in the state, offering plans across all 46 counties. Ambetter and Molina provide additional competition in metropolitan areas including Charleston, Columbia, and Greenville. Because carrier lineups shift each plan year, always check which insurers actually offer plans in your county.

The Enhanced Subsidy Change You Need to Know

From 2021 through 2025, the American Rescue Plan and Inflation Reduction Act temporarily boosted ACA premium tax credits — capping benchmark premiums as a share of income and extending help above the old 400% federal-poverty-level cutoff. Those enhanced credits expired at the end of 2025. As of this update, according to KFF, they had not been extended, marketplace enrollment fell nationally for the first time in years, and insurers proposed steep rate increases for the following year.

Practically, this means the “many people pay $50 or less” experience of recent years no longer holds for everyone. Standard ACA premium tax credits still exist for eligible incomes, but they are less generous than the expired enhanced version, so your net premium may be considerably higher than it was in 2024 or 2025. This is exactly the kind of figure that changes with legislation, so verify the current subsidy rules and your own quote on HealthCare.gov before assuming any price.

Average Health Insurance Costs in South Carolina

Health insurance South Carolina premiums vary by age, county, plan tier, and tobacco use. The figures below are rough, pre-subsidy estimates for a 40-year-old individual and should be treated as ballpark ranges only — always price your specific plan on HealthCare.gov:

South Carolina’s premiums tend to run slightly above the national average, partly because of the state’s higher-than-average rates of chronic conditions and its non-expansion status, which keeps a comparatively sicker risk pool in the individual market. With the enhanced subsidies gone, more of the sticker price now falls on enrollees than in the prior few years.

Premium tax credits still reduce costs for eligible residents, and a large share of South Carolina marketplace enrollees receive some subsidy. But how much you pay now depends on income, household size, and the benchmark plan in your county under the current (post-enhancement) rules — so run your own numbers rather than relying on last year’s typical costs.

Medicaid in South Carolina

South Carolina has not expanded Medicaid under the ACA, so adult eligibility remains very limited. This creates a coverage gap for many low-income residents.

• Parents and caretaker relatives: Eligible only at very low incomes (roughly two-thirds of the federal poverty level; confirm the current threshold with SCDHHS)
• Childless adults: Generally not eligible for Medicaid regardless of income, unless they qualify through disability or another categorical criterion
• Children: Covered through Medicaid or the state’s CHIP program, with higher income limits than adults
• Pregnant women: Eligible up to a higher income limit than other adults
• Elderly and disabled: Eligible through traditional Medicaid categories
• Enrollment: Through the South Carolina Department of Health and Human Services (SCDHHS) online portal, local offices, or by phone (find current contact details on the SCDHHS website)

The coverage gap affects an estimated 100,000-plus South Carolinians who earn too much for the state’s limited Medicaid but too little to qualify for marketplace subsidies (which begin at 100% of FPL). These residents have very limited options for affordable coverage. Exact estimates vary by source and year, so treat the figure as approximate.

Choosing a Plan in South Carolina

When selecting health insurance South Carolina coverage, consider these key factors:

• Network type: Most South Carolina marketplace plans are HMO or EPO style, with some broader options from BlueCross. Compare HMO vs. PPO plans to understand the tradeoffs
• Provider network: Verify that your doctors and preferred hospitals are in-network — especially important in rural areas where provider choices are limited
• Regional availability: Not all insurers offer plans in every county. Rural areas may have only one or two carrier options
• Total annual costs: Use the HealthCare.gov cost estimator to compare plans on expected total out-of-pocket cost, not just the monthly premium
• Prescription drug formulary: Check that your medications are covered, and note any step therapy or prior-authorization requirements

Health Insurance by Region in South Carolina

Plan availability and pricing vary across South Carolina’s regions:

• Charleston and coastal Lowcountry: Multiple insurer options with relatively competitive pricing; the MUSC Health network is widely available through BlueCross plans
• Columbia and the Midlands: Reasonable insurer competition with access to Prisma Health and other major systems
• Greenville-Spartanburg (Upstate): A growing market with Prisma Health and Bon Secours networks and multiple carrier choices
• Pee Dee and rural areas: Fewer insurer options, potentially higher premiums, and more limited provider networks; BlueCross is often the only marketplace option in the most rural counties

South Carolina-Specific Considerations

Several factors are distinctive to the health insurance South Carolina landscape:

• No Medicaid expansion: The absence of expansion leaves a coverage gap for low-income adults. Advocacy groups continue to push for expansion, which KFF has estimated would extend coverage to well over 100,000 uninsured South Carolinians
• Tobacco surcharge: South Carolina allows the full 50% tobacco surcharge, which can add hundreds of dollars per month to premiums for smokers
• Hurricane exposure: Coastal residents face hurricane risk; special enrollment periods are sometimes opened after major federally declared disasters
• No state individual mandate: South Carolina does not penalize residents for being uninsured
• Rural health challenges: Several rural hospitals have closed in recent years, limiting access to care in some areas and affecting in-network provider availability for marketplace plans

How to Enroll in Health Insurance in South Carolina

1. Check Medicaid eligibility: Low-income parents, children, pregnant women, and people with disabilities should first check Medicaid eligibility through SCDHHS
2. Visit HealthCare.gov: Create an account and complete an application to determine marketplace eligibility and your current subsidy amount
3. Compare plans: Browse plans in your county, comparing premiums, networks, deductibles, and estimated total costs
4. Enroll during open enrollment: Select your plan before the deadline (typically around January 15) for coverage starting as early as January 1 if you enroll by the mid-December cutoff, or February 1 otherwise — confirm the exact dates on HealthCare.gov
5. Seek free help: Certified navigators and licensed insurance agents provide free enrollment assistance across South Carolina, and the South Carolina Department of Insurance offers consumer help

Where to Get Free Help

You do not have to navigate this alone, and unbiased help is free:

• HealthCare.gov: The official “Find Local Help” tool lists certified navigators and agents near you
• SCDHHS: For Medicaid and CHIP questions and applications
• South Carolina Department of Insurance (SC DOI): For consumer assistance, complaints, and questions about how insurance is regulated in the state

Look up current phone numbers and hours on each agency’s official website rather than relying on numbers from third-party pages, which can be outdated or misleading.

Frequently Asked Questions

What is the cheapest health insurance in South Carolina?

The lowest-premium marketplace options are typically Bronze and Catastrophic plans, and some enrollees still qualify for subsidies that reduce the net cost substantially. With the enhanced subsidies expired, however, $0 premiums are less common than in 2024–2025, so price your own plan on HealthCare.gov. For those stuck in the Medicaid coverage gap, affordable options are unfortunately very limited.

Does South Carolina have Medicaid expansion?

No. South Carolina has not expanded Medicaid under the ACA. Adult eligibility remains very limited, primarily covering parents with very low incomes and people with disabilities. Childless adults generally do not qualify regardless of income, leaving an estimated 100,000-plus residents in a coverage gap.

Did the enhanced premium tax credits get extended?

The temporary enhanced premium tax credits expired at the end of 2025 and, as of this update, had not been extended, which raised net premiums for many enrollees in 2026. Standard ACA premium tax credits still exist but are less generous. This is a fast-moving policy area, so verify the current law on HealthCare.gov or KFF before you enroll.

Can I get health insurance outside of open enrollment in South Carolina?

Yes, if you have a qualifying life event such as losing employer coverage, getting married, having a baby, or moving. You generally have 60 days from the event to enroll. Medicaid and CHIP enrollment is available year-round.

How many South Carolinians are uninsured?

Roughly 10 to 11 percent of South Carolina residents lack health insurance, though estimates vary by source and year and may rise if premiums climb after the enhanced subsidies expire. The non-expansion Medicaid policy is a significant contributing factor, as is the state’s large low-wage workforce without employer coverage.

Final Takeaway

Health insurance South Carolina residents can access includes federal marketplace plans through HealthCare.gov, limited Medicaid for qualifying populations, employer-sponsored options, and Medicare for those who are eligible. The state’s non-expansion Medicaid policy creates real challenges for low-income adults, and the expiration of the enhanced premium tax credits has made 2026 marketplace coverage more expensive for many. Compare plans during open enrollment, understand the difference between HMO and PPO networks, use free navigators, and always verify current subsidy rules and prices on HealthCare.gov. For more on healthcare policy, visit our policy guide.

Sources

• HealthCare.gov (Centers for Medicare & Medicaid Services) — federal marketplace enrollment, open enrollment dates, subsidy eligibility
• KFF (Kaiser Family Foundation) — expiration of enhanced premium tax credits, 2026 enrollment decline, proposed 2027 rate increases, Medicaid coverage gap estimates
• South Carolina Department of Insurance (SC DOI) — state insurance regulation and consumer assistance
• South Carolina Department of Health and Human Services (SCDHHS) — Medicaid eligibility and enrollment