South Carolina residents have access to a range of health insurance options through the Affordable Care Act (ACA) marketplace. Whether you are shopping for coverage for the first time or looking to switch plans, understanding what South Carolina ACA benefits and coverage includes can help you make informed decisions and potentially save thousands of dollars each year. With a record 631,948 South Carolinians enrolled in marketplace plans for the 2025 coverage year, more people in the Palmetto State are taking advantage of ACA benefits than ever before.
What the ACA Covers in South Carolina
Every ACA marketplace plan sold in South Carolina is required to cover 10 categories of essential health benefits (EHBs). This means that regardless of which insurer or plan tier you choose, your coverage must include:
- Ambulatory patient services (outpatient care you receive without being admitted to a hospital)
- Emergency services (emergency room visits)
- Hospitalization (inpatient care when you are admitted to a hospital)
- Maternity and newborn care (prenatal checkups, labor and delivery, and postnatal care)
- Mental health and substance use disorder services (counseling, therapy, and inpatient treatment)
- Prescription drugs
- Rehabilitative and habilitative services and devices (physical therapy, occupational therapy, and related equipment)
- Laboratory services (blood tests, imaging, and diagnostics)
- Preventive and wellness services and chronic disease management (annual checkups, screenings, vaccinations, and disease management programs)
- Pediatric services (dental and vision care for children under 19)
All ACA plans also cover preventive services at no additional cost when you see an in-network provider. This includes annual wellness visits, blood pressure screenings, cholesterol tests, immunizations, cancer screenings (such as mammograms and colonoscopies), and many more services.
Insurance Companies Offering ACA Plans in South Carolina
For the 2026 plan year, six insurance companies offer marketplace coverage in South Carolina:
- Blue Cross Blue Shield of South Carolina
- Ambetter from Absolute Total Care
- Molina Healthcare of South Carolina
- Select Health
- UnitedHealthcare
- InStil Health
The availability of specific insurers may vary by county. When you shop on the marketplace, you will see which companies offer plans in your area along with pricing and coverage details for each option.
ACA Plan Tiers Explained
South Carolina marketplace plans are organized into four metal tiers, plus a catastrophic option for eligible individuals:
| Plan Tier | Actuarial Value | Monthly Premium | Out-of-Pocket Costs |
|---|---|---|---|
| Bronze | 60% | Lowest | Highest |
| Silver | 70% | Moderate | Moderate |
| Gold | 80% | Higher | Lower |
| Platinum | 90% | Highest | Lowest |
| Catastrophic | Below 60% | Very Low | Very High (for emergencies) |
Silver plans are often the best value for people who qualify for cost-sharing reductions (CSR), which lower your deductibles and copays. CSR subsidies are only available with Silver-tier plans.
Income Limits for ACA Subsidies in South Carolina
Financial help with your monthly premiums is available through premium tax credits (also called subsidies). In South Carolina, you may qualify for subsidies if your household income falls between 100% and 400% of the federal poverty level (FPL). South Carolina has not expanded Medicaid under the ACA, which makes marketplace subsidies especially important for low-income residents.
2025 Federal Poverty Level Guidelines (Used for 2026 Coverage)
| Household Size | 100% FPL | 150% FPL | 200% FPL | 250% FPL | 400% FPL |
|---|---|---|---|---|---|
| 1 | $17,990 | $26,985 | $35,980 | $44,975 | $71,960 |
| 2 | $24,360 | $36,540 | $48,720 | $60,900 | $97,440 |
| 3 | $30,730 | $46,095 | $61,460 | $76,825 | $122,920 |
| 4 | $37,100 | $55,650 | $74,200 | $92,750 | $148,400 |
| 5 | $43,470 | $65,205 | $86,940 | $108,675 | $173,880 |
| 6 | $49,840 | $74,760 | $99,680 | $124,600 | $199,360 |
Important note for South Carolina residents: Because South Carolina has not expanded Medicaid, adults earning below 100% FPL who do not qualify for traditional Medicaid may fall into a "coverage gap." Approximately 105,000 South Carolinians find themselves in this situation, earning too much for Medicaid but too little for marketplace subsidies. If you are in this situation, check your eligibility for all available programs to explore every option.
Cost-Sharing Reductions (CSR)
If your income falls between 100% and 250% of FPL, you may also qualify for cost-sharing reductions when you enroll in a Silver plan:
| Income Level | CSR Benefit |
|---|---|
| 100% to 150% FPL | Highest savings: plan covers about 94% of costs |
| 150% to 200% FPL | Strong savings: plan covers about 87% of costs |
| 200% to 250% FPL | Moderate savings: plan covers about 73% of costs |
How to Apply for ACA Coverage in South Carolina
South Carolina uses the federal marketplace through HealthCare.gov. Here is a step-by-step guide to enrolling:
Step 1: Check Your Eligibility
Before you start, use our free benefits screener to see what programs you may qualify for, including ACA subsidies, Medicaid, CHIP, and other assistance programs.
Step 2: Gather Your Information
You will need the following documents:
- Social Security numbers for everyone in your household
- Employer and income information (pay stubs, W-2 forms, or tax returns)
- Current health insurance policy numbers (if applicable)
- Immigration documents (if applicable)
Step 3: Create an Account on HealthCare.gov
Visit HealthCare.gov and create an account. You can also call the marketplace call center at 1-800-318-2596 for help (available 24/7).
Step 4: Complete Your Application
Fill out the application with your household and income information. The system will determine your eligibility for premium tax credits and cost-sharing reductions.
Step 5: Compare Plans and Enroll
Review the available plans in your area, compare premiums, deductibles, copays, and provider networks. Select the plan that best fits your needs and budget, then complete your enrollment.
Step 6: Pay Your First Premium
Your coverage will not begin until you pay your first monthly premium. Set up autopay to avoid any gaps in coverage.
Open Enrollment and Special Enrollment Periods
The annual open enrollment period for 2026 ACA coverage typically runs from November 1 through January 15. Outside of open enrollment, you can only sign up for or change your plan if you experience a qualifying life event, such as:
- Losing existing health coverage
- Getting married or divorced
- Having or adopting a child
- Moving to a new area
- Losing Medicaid or CHIP eligibility
- Turning 26 and aging off a parent's plan
If you experience a qualifying life event, you generally have 60 days to enroll in a new plan through a Special Enrollment Period (SEP).
The Medicaid Coverage Gap in South Carolina
South Carolina is one of the states that has not expanded Medicaid under the ACA. Traditional Medicaid in South Carolina covers:
- Children under 19
- Pregnant women (income up to 199% FPL)
- Parents and caretakers (income up to about 67% FPL)
- Elderly and disabled individuals who meet specific criteria
- Low-income adults receiving SSI benefits
Adults without children generally do not qualify for Medicaid in South Carolina, regardless of how low their income is. This creates the coverage gap, where individuals earning below 100% FPL cannot access marketplace subsidies and do not qualify for Medicaid.
South Carolina submitted a request in 2025 for a limited Medicaid expansion that could cover an estimated 11,400 parents with incomes between 67% and 100% FPL. However, full expansion has not been adopted. If you are unsure about your eligibility, use our screener to check all programs at once.
Getting Help With Enrollment in South Carolina
Several resources are available to help South Carolina residents navigate ACA enrollment:
- Navigators and Certified Application Counselors: Free, in-person help is available through community organizations like CareSouth Carolina and other local groups
- Licensed insurance brokers: Can help you compare plans at no cost to you
- HealthCare.gov call center: 1-800-318-2596 (24/7, with multilingual support)
- South Carolina Department of Insurance: Visit doi.sc.gov for state-level consumer assistance
Frequently Asked Questions
How much does ACA health insurance cost in South Carolina?
Costs vary based on your age, location, household size, income, and plan tier. Many South Carolinians qualify for premium tax credits that significantly reduce monthly premiums. Some residents pay as little as $0 per month after subsidies. Check your eligibility to get a personalized estimate.
Can I get ACA coverage if I have a pre-existing condition?
Yes. Under the ACA, insurance companies in South Carolina cannot deny you coverage or charge you more because of a pre-existing health condition. This applies to all marketplace plans.
What happens if my income changes during the year?
If your income increases or decreases, you should update your information on HealthCare.gov. Your subsidy amount may change based on your updated income. Failing to report changes could result in owing money at tax time or missing out on additional savings.
Is dental coverage included in ACA plans?
Pediatric dental coverage is included as an essential health benefit for children under 19. Adult dental coverage is not required but may be available as a standalone dental plan through the marketplace or as an add-on to certain health plans.
What if I cannot afford any marketplace plan?
If you fall into the coverage gap in South Carolina (income below 100% FPL and not eligible for Medicaid), you may qualify for an exemption from the federal tax penalty. You should also explore community health centers, which offer care on a sliding fee scale based on your ability to pay. Check all your options to see if you qualify for other assistance programs.
When is open enrollment for 2026 coverage?
Open enrollment for 2026 ACA plans runs from November 1, 2025, through January 15, 2026. If you miss this window, you will need a qualifying life event to enroll during a Special Enrollment Period.
Take the Next Step
Finding the right health coverage in South Carolina does not have to be overwhelming. Start by checking your eligibility for all available benefits to see what programs and savings you may qualify for. You can also visit our South Carolina Benefits Overview page for a complete look at all assistance programs available in the Palmetto State.
