Health Insurance in South Carolina: A 2026 Guide to Coverage Options
Compare ACA marketplace plans, off-marketplace private coverage, and South Carolina Healthy Connections Medicaid eligibility — for self-employed South Carolinians, between-jobs workers, small business owners, and families across Charleston, Columbia, Greenville, Myrtle Beach, and the rest of the Palmetto State.
South Carolina’s individual health insurance market is anchored by the federal ACA marketplace at HealthCare.gov. With about 5.3 million residents, a strong tourism and small business economy, and a coastal geography that shapes both costs and carrier availability, SC offers solid coverage options for residents shopping for individual plans. South Carolina has not expanded Medicaid, so its Healthy Connections Medicaid program covers a narrower range of adults than expansion states like neighboring North Carolina. This guide covers what’s available in 2026, what it costs, who qualifies for help paying for it, and how to choose the right plan whether you live in Charleston, Columbia, Greenville, Myrtle Beach, or anywhere in between.
How Health Insurance Works in South Carolina
South Carolina uses the federal health insurance marketplace at HealthCare.gov rather than running its own state-based exchange. SC residents shop the same plans, with the same enrollment windows, as residents of most other Southern states.
A few South Carolina-specific facts worth knowing:
- South Carolina has not expanded Medicaid under the Affordable Care Act, which means Healthy Connections (SC’s Medicaid program) covers a narrower range of adults than expansion states.
- SC’s uninsured rate has historically run between 11% and 13%, slightly above the national average.
- The largest health insurance carrier in the state is BlueCross BlueShield of South Carolina (which sells individual marketplace plans through BlueChoice HealthPlan), with significant additional market share from Ambetter (Absolute Total Care / Centene), Molina Healthcare, Cigna, and Aetna CVS Health.
- South Carolina’s economy — heavy in tourism (Myrtle Beach, Charleston), manufacturing, agriculture, and small business — produces a meaningful self-employed and 1099 workforce that relies on the marketplace.
- The Charleston region in particular has experienced rapid population growth over the last decade, expanding the individual marketplace.
Average Health Insurance Costs in South Carolina in 2026
South Carolina premiums tend to run roughly in line with the southeastern average, with coastal counties slightly higher than inland metros. Below are realistic 2026 monthly premium ranges for a 40-year-old non-smoker, before any subsidy is applied:
| Plan Tier | Typical Monthly Premium |
|---|---|
| Bronze | $390 – $475 |
| Silver | $500 – $600 |
| Gold | $590 – $700 |
| Platinum | $680 – $830 |
| Catastrophic (under 30) | $270 – $350 |
These are pre-subsidy numbers. Most South Carolina marketplace shoppers pay between $0 and $230 per month after premium tax credits are applied. About four in five SC enrollees qualify for some level of subsidy, and lower-income enrollees frequently pay nothing at all.
A 25-year-old typically pays 30–40% less than these figures. A 60-year-old typically pays 2.5 to 3 times more.
Premiums vary across South Carolina. Coastal regions (Charleston, Hilton Head, Myrtle Beach) tend to run slightly higher than inland metros (Columbia, Greenville) due to a smaller risk pool and higher medical costs along the coast.
ACA Marketplace Plans in South Carolina
The ACA marketplace at HealthCare.gov is the most common path to coverage for South Carolinians without employer benefits. Here’s what to know.
Carriers offering marketplace plans in South Carolina in 2026:
- BlueChoice HealthPlan of South Carolina (BlueCross BlueShield of SC) — broadest county coverage in the state
- Ambetter from Absolute Total Care (Centene) — most counties
- Molina Healthcare — selected counties
- Cigna Healthcare — selected metros
- Aetna CVS Health — selected counties
- Oscar Health — limited counties
Open Enrollment for 2026 plans: November 1, 2025 through January 15, 2026. To have coverage effective January 1, you need to enroll by December 15, 2025.
Special Enrollment Period (year-round): If you’ve had a qualifying life event in the last 60 days — losing job-based coverage, moving, getting married, having a baby, or aging off a parent’s plan — you can enroll outside the standard window.
All marketplace plans in South Carolina cover the ten essential health benefits required by the ACA: doctor visits, prescriptions, emergency services, hospitalization, maternity, mental health, preventive care, lab work, pediatric care, and rehabilitative services.
For a deeper look at how ACA plans work, see our guide to ACA marketplace plans. For options outside the marketplace, see our guide to private health insurance plans.
Who Qualifies for Coverage Help in South Carolina?
There are two main forms of financial help with health insurance in South Carolina: ACA premium subsidies (for marketplace plans) and Healthy Connections (SC Medicaid). Each has different rules.
ACA Premium Subsidies
Subsidies on HealthCare.gov are based on your household income and family size. Most South Carolina shoppers qualify if their household income falls within these rough ranges:
- Single person: $15,000 – $60,000 per year
- Couple: $20,000 – $80,000 per year
- Family of 4: $30,000 – $120,000 per year
Higher earners may also qualify if a benchmark Silver plan would cost more than 8.5% of their household income. The only way to know exactly what you qualify for is to enter your real numbers — a licensed agent can run this for you at no cost.
Households earning under 250% of the federal poverty level can also qualify for cost-sharing reductions on Silver plans, which lower deductibles, copays, and out-of-pocket maximums. For most subsidy-eligible South Carolinians, a Silver plan is the default smart choice.
Healthy Connections (SC Medicaid)
Healthy Connections is more restrictive than Medicaid in expansion states. In general, Healthy Connections covers:
- Children below certain income thresholds
- Pregnant women up to roughly 199% of the federal poverty level
- Parents and caretaker relatives at low income levels
- Adults aged 65+, blind, or disabled who meet income and resource limits
- Some adults receiving long-term care services
Most non-disabled adults without children do not qualify for Healthy Connections regardless of income. This creates a “coverage gap” for adults below the federal poverty level who do not qualify for either Medicaid or full ACA subsidies.
If you’re not sure whether you qualify for Healthy Connections, an agent can help you check before applying for a marketplace plan.
Health Insurance by Major South Carolina City
Plan availability, network options, and provider quality vary across South Carolina’s major metros. Here’s what’s available in the four largest.
Health Insurance in Charleston
Charleston (Charleston County) is one of the fastest-growing metros in the Southeast and a major individual marketplace. Major in-network health systems include the Medical University of South Carolina (MUSC Health) — the state’s flagship academic medical center — Roper St. Francis Healthcare, and Trident Health. BlueChoice and Ambetter both have strong Charleston networks, with Cigna and Aetna offering selected plans. Coastal premiums in Charleston tend to run slightly higher than inland SC.
Health Insurance in Columbia
Columbia (Richland County) is the state capital and a major government and university center. Major in-network health systems include Prisma Health (the state’s largest health system), Lexington Medical Center, and Palmetto Health Children’s Hospital. Columbia premiums are moderate and BlueChoice anchors the market with Ambetter and Molina also active.
Health Insurance in Greenville
Greenville (Greenville County) has solid plan availability and access to one of the strongest health systems in the Upstate. Major in-network systems include Prisma Health Upstate (formerly Greenville Health System) and Bon Secours St. Francis Health System. Greenville premiums tend to be moderate, with BlueChoice, Ambetter, and Cigna active in the market.
Health Insurance in Myrtle Beach
Myrtle Beach (Horry County) is South Carolina’s coastal tourism hub. Major in-network systems include Conway Medical Center, Tidelands Health, and Grand Strand Medical Center. Plan availability is solid but premiums tend to run slightly higher than inland SC due to the smaller year-round risk pool. BlueChoice and Ambetter are the primary carriers, with limited additional options.
Compare South Carolina Health Insurance Plans
Tell us a little about yourself and a licensed South Carolina agent will compare your marketplace and private options side by side. 100% free, no obligation.
How to Choose the Right South Carolina Health Insurance Plan
Use this checklist when comparing plans:
- Estimate your 2026 household income. This determines your subsidy. Be as accurate as you can — overestimating gives you a bigger subsidy now but may mean repayment at tax time.
- Check your CSR eligibility. If your income is under 250% of the federal poverty level, focus on Silver plans for the cost-sharing reductions.
- Verify your doctors are in-network. Networks vary significantly between carriers. MUSC, Prisma Health, Roper St. Francis, and Bon Secours are not all in every plan’s network.
- Compare deductibles AND out-of-pocket maximums. The deductible is what you pay before coverage kicks in. The OOP max is your worst-case yearly exposure.
- Check the prescription formulary. Make sure your medications are covered and at what tier.
- Compare at least three plans in your tier of choice before deciding.
Frequently Asked Questions About South Carolina Health Insurance
Did South Carolina expand Medicaid under the ACA?
No. South Carolina has not expanded Medicaid, which means Healthy Connections eligibility for adults remains stricter than in expansion states like neighboring North Carolina. This is the main reason so many working-age South Carolinians rely on the ACA marketplace.
What is Healthy Connections and do I qualify?
Healthy Connections is South Carolina’s Medicaid program. It covers children, pregnant women, low-income parents and caretakers, seniors aged 65+, and people with disabilities. Most non-disabled adults without children do not qualify regardless of income. If you’re unsure, a licensed agent can help you verify eligibility before applying for a marketplace plan.
Can I get health insurance in South Carolina if I’m self-employed?
Yes — and most self-employed South Carolinians shop the ACA marketplace through HealthCare.gov, which often qualifies them for substantial subsidies. Self-employed individuals operating as an LLC or S-Corp can also explore small business or group plans, and may be able to deduct premiums as a business expense.
What insurance companies offer plans in South Carolina?
BlueChoice HealthPlan (BlueCross BlueShield of South Carolina) is the largest carrier and offers plans in nearly every county. Ambetter (Absolute Total Care), Molina Healthcare, Cigna, Aetna CVS Health, and Oscar Health also offer plans across various counties — most heavily in Charleston, Columbia, Greenville, and Myrtle Beach.
When is Open Enrollment in South Carolina?
For 2026 plans, Open Enrollment runs from November 1, 2025 through January 15, 2026. To have coverage effective January 1, enroll by December 15, 2025.
What if I lose my job in South Carolina?
Losing job-based coverage opens a 60-day Special Enrollment Period during which you can buy an ACA marketplace plan. A subsidized marketplace plan is often significantly cheaper than COBRA continuation coverage from your former employer. Short-term medical plans are also available year-round if you only need a brief bridge.
Is health insurance more expensive in Charleston or Columbia?
Charleston premiums typically run slightly higher than Columbia for the same coverage tier, driven by higher medical costs along the coast and a smaller individual risk pool. The gap is usually modest and is largely offset by subsidies for eligible households.
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