How to Get Health Insurance in SC: Marketplace and Medicaid

To get health insurance in South Carolina, you have four main routes: the federal marketplace at HealthCare.gov (with subsidies if your income qualifies), Medicaid or CHIP through the state’s Healthy Connections program, coverage through an employer or a former employer via COBRA, and short-term private plans for gaps between other coverage. Which one fits depends on your income, household size, employment status, and whether you have a qualifying life event. About 9% of South Carolinians are uninsured, a rate higher than the national average of 8.2%, in part because the state has not expanded Medicaid to all low-income adults.1America’s Health Rankings. Health Insurance in South Carolina

Marketplace Plans at HealthCare.gov

South Carolina uses the federal marketplace rather than running its own exchange. You can compare individual and family plans, see prices, and check whether you qualify for subsidies that reduce monthly premiums or out-of-pocket costs.2SC Department of Insurance. Affordable Care Act

When You Can Enroll

Open enrollment for 2026 coverage ran November 1, 2025 through January 15, 2026. Signing up by December 15 started coverage January 1; enrolling between December 16 and January 15 pushed the start date to February 1.3HealthCare.gov. Dates and Deadlines

Outside that window, you can still enroll if you’ve had a qualifying life event in the last 60 days. Common triggers are losing other coverage (from a job change or aging off a parent’s plan), getting married or divorced, having or adopting a child, moving to a new county or state, and gaining U.S. citizenship.4BlueCross BlueShield of South Carolina. Special Enrollment Periods Losing Medicaid or CHIP eligibility gives you up to 90 days to pick a marketplace plan.5Centers for Medicare and Medicaid Services. Special Enrollment Periods Available to Consumers Documentation of the life event is required before coverage takes effect. Losing a short-term plan does not qualify.

Who Sells Plans in Your County

Six insurers offer marketplace plans in South Carolina for 2026. Absolute Total Care (Ambetter) and BlueCross BlueShield of South Carolina sell in all 46 counties. Molina Healthcare covers 37 counties, Select Health of South Carolina covers 20, UnitedHealthcare of South Carolina covers 17, and InStil Health is available in five.2SC Department of Insurance. Affordable Care Act Plans come in Bronze, Silver, and Gold tiers.6healthinsurance.org. South Carolina Health Insurance Marketplace

What It Costs, and What Help You Can Get

Sticker premiums vary by age, county, tobacco use, and plan tier. For a 40-year-old non-smoker, the average lowest-cost Bronze plan runs about $410 a month, and the benchmark Silver plan (second-lowest-cost Silver) averages roughly $564 a month before subsidies.7KFF. Average Marketplace Premiums by Metal Tier What you actually pay depends heavily on Advanced Premium Tax Credits (APTCs), which lower your monthly bill. In South Carolina the average APTC is $523 per month.8KFF. Average Monthly Advance Premium Tax Credit

If your household income is up to 250% of the federal poverty level and you choose a Silver plan, you can also get cost-sharing reductions that lower deductibles, copays, and coinsurance.8KFF. Average Monthly Advance Premium Tax Credit

One large affordability variable is the status of the enhanced premium tax credits created by the American Rescue Plan Act and extended through 2025 by the Inflation Reduction Act. Those enhanced subsidies expired at the end of 2025, and as of late 2025 Congress had not passed legislation extending them into 2026.9Commonwealth Fund. Expiring Premium Tax Credits Advocacy groups projected that roughly 183,000 South Carolinians could become uninsured as a result, and many marketplace enrollees faced steep premium increases.10Cover SC. Who Is in the Health Insurance Gap Run your own quote before assuming last year’s price still applies.

How to Apply

The fastest way is online at HealthCare.gov: create an account, complete the application with income and household details, and review the eligibility results and plan options. You can also apply by phone, get free in-person help through HealthCare.gov’s assistance directory, work with a certified enrollment partner or licensed broker, or mail in a paper application (results take about two weeks).11HealthCare.gov. How to Apply After enrolling, you have to pay your first premium directly to the insurer before coverage starts.12HealthCare.gov. Getting Marketplace Health Insurance

Medicaid and CHIP Through Healthy Connections

South Carolina’s Medicaid program is called Healthy Connections and is run by the Department of Health and Human Services (SCDHHS). South Carolina has not expanded Medicaid under the ACA, so non-disabled adults without children generally cannot qualify no matter how low their income is.13SC Daily Gazette. Thousands More Could Get Medicaid Coverage Under SC Request for Limited Expansion Nearly one million residents are enrolled in Medicaid or CHIP.14healthinsurance.org. South Carolina Medicaid

Who Qualifies

Eligibility is grouped by category, each with its own income limit (effective March 1, 2026):15SC Department of Health and Human Services. Program Eligibility and Income Limits

  • Children under 19 (Partners for Healthy Children, the state’s CHIP program): household income up to 208% of the federal poverty level, about $5,720 a month for a family of four.
  • Pregnant women and infants: income up to 194% FPL ($2,580 a month for an individual). Coverage continues 12 months after birth.
  • Parents and caretaker relatives: income up to 62% FPL ($825 a month for an individual).
  • Aged, blind, or disabled individuals: income up to 100% FPL ($1,330 a month for an individual).
  • Working disabled: income up to 250% FPL ($3,325 a month for an individual), with disability criteria and employment required.
  • Uninsured breast or cervical cancer patients under 65 needing treatment: income up to 200% FPL.
  • Former foster care youth up to age 26 who had Medicaid when they aged out: no income limit.

Because the parent income cutoff is so low, South Carolina has a “coverage gap.” Parents earning more than about 67% of the poverty level (roughly $21,540 a year for a family of four) are over the Medicaid limit, while federal marketplace subsidies historically have not begun until income reaches 100% FPL. About 105,000 South Carolinians fall into this gap.14healthinsurance.org. South Carolina Medicaid A pending state waiver called Palmetto Pathways to Independence would extend Medicaid to some parents in the gap, but it remains under federal review and is not available to enroll in.16Medicaid.gov. Palmetto Pathways to Independence

How to Apply

Medicaid and CHIP applications can be filed year-round. You can apply:17SC Department of Health and Human Services. Getting Started

  • Online at apply.scdhhs.gov (an ID.me account unlocks features like saving your application and viewing notices).
  • In person at a local SCDHHS county office, a federally qualified health center, or most hospitals.
  • By mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101.
  • By email (fax bridge) to 8888201204@fax.scdhhs.gov.
  • Through HealthCare.gov, which automatically forwards your file to SCDHHS if the marketplace application shows you may qualify for Medicaid.

Have Social Security numbers and birth dates for everyone in the household, income documentation, benefit histories, bank account information, and details on any current coverage. Pregnant women can receive care while their application is processed by calling (888) 549-0820. Coverage must be renewed each year.17SC Department of Health and Human Services. Getting Started For children specifically, well-child visits are free under CHIP, and total annual family cost-sharing is capped at 5% of income.18HealthCare.gov. Children’s Health Insurance Program

Coverage Through a Job (or a Former Job)

Under the ACA’s employer mandate, businesses with 50 or more full-time equivalent employees have to offer affordable coverage meeting minimum standards to at least 95% of their full-time workers, or face potential tax penalties.19SC Department of Insurance. Information for Small Businesses Smaller employers don’t have to offer coverage, though many do. If your employer offers a plan you can afford, that’s usually the simplest way to get insured, and open enrollment dates are set by the employer.

Keeping Coverage After You Leave a Job

If you lose employer coverage, you can often continue it temporarily. Federal COBRA applies to employers with 20 or more employees. South Carolina’s mini-COBRA law, SC Code Section 38-71-770, covers fully insured group plans at smaller employers with fewer than 20 employees. It gives you the remainder of the policy month at termination plus six additional months, you pay the full premium, and there is no grace period for late payments.20SC Department of Insurance. State Continuation of Health Insurance Coverage To qualify for mini-COBRA, you must have been continuously insured under the employer’s group plan for at least six consecutive months. Losing mini-COBRA coverage does count as a life event for marketplace enrollment.

Short-Term Health Plans

Short-term plans can fill a gap between other coverage, but they are limited-benefit policies. In South Carolina, a short-term plan cannot exceed 11 months and may be renewable.21SC Department of Insurance. Types of Health Insurance Under federal rules effective September 2024, coverage from the same carrier is capped at 120 days in a one-year period, with policies sold in 30, 60, or 90-day terms.22BlueCross BlueShield of South Carolina. Short-Term Health Changes Coming in September These plans can exclude pre-existing conditions, may not cover the essential health benefits required of ACA plans, and losing one does not open a special enrollment period.

If You Can’t Afford a Plan or Don’t Qualify

South Carolina has 25 federally qualified health centers (FQHCs) and look-alike organizations that offer primary care, behavioral health, and other services on a sliding fee scale based on income. They see patients regardless of insurance status.23SC Primary Health Care Association. About SCPHCA The federal locator at findahealthcenter.hrsa.gov will show the closest one.24SC Department of Health and Human Services. Federally Qualified Health Centers

For prescription help while uninsured, SC Thrive partners with Welvista on a Medication Assistance Pharmacy program. Call 800-726-8774 to apply.25SC Thrive. Healthcare Coverage

Tribal Members Have Different Rules

Members of federally recognized tribes, including the Catawba Indian Nation, can enroll in a marketplace plan at any time of year and change plans up to once a month.26HealthCare.gov. American Indians and Alaska Natives Tribal members with household income between 100% and 300% of the federal poverty level who qualify for premium tax credits can enroll in zero cost-sharing plans, which eliminate deductibles, copays, and coinsurance. For a family of four, the income ceiling for zero cost-sharing is about $70,650.27SC Health Connector. Catawba Native American Obamacare Information Regardless of income, tribal members pay nothing out of pocket for care received through Indian Health Service facilities, tribal health programs, or urban Indian health programs. If some household members are tribal and others aren’t, enroll them in separate plans so the tribal member’s cost-sharing protection isn’t diluted.

Where to Get Free Help

You don’t have to navigate this alone, and legitimate help is free.

  • HealthCare.gov’s local help directory at localhelp.healthcare.gov lists navigators, certified application counselors, and licensed brokers by ZIP code.28HealthCare.gov. Find Local Help
  • SC Thrive, a statewide nonprofit, screens residents for Medicaid, CHIP, and marketplace subsidies and helps with applications. Call 800-726-8774 (English and Spanish) or use the online Thrive Hub portal.29SC Thrive. Need Help
  • The SC Department of Insurance runs an Insurance Locator that connects consumers with participating local health insurance agents. Requests can be submitted online, by email at consumers@doi.sc.gov, or by phone at 803-737-6180.30SC Department of Insurance. Insurance Locator
  • For Medicaid-specific questions, the SCDHHS Member Contact Center is at (888) 549-0820, Monday through Friday, 8 a.m. to 6 p.m.17SC Department of Health and Human Services. Getting Started