To find affordable health insurance, South Carolina residents start with a HealthCare.gov plan plus a premium tax credit, available from 100% to 400% of the poverty level ($15,960–$63,840 for one person). Open Enrollment runs Nov 1, 2026 – Jan 15, 2027. South Carolina hasn’t expanded Medicaid, so adults under 100% often get no subsidy.
Updated for the 2027 plan year (October 2026)
Where affordable health insurance in South Carolina starts
For most people who buy their own coverage, affordability comes down to one federal program: the premium tax credit. It limits what you pay for the second-lowest-cost Silver plan in your area to a fixed share of household income, and you can apply it to any metal level.
South Carolina adds no state money on top. There is no state premium subsidy and no reinsurance waiver; the state does not appear on the CMS list of Section 1332 waivers. That makes your income estimate and plan choice especially important.
Shoppers who search for affordable health insurance, South Carolina style, often look only at the monthly premium. A truly affordable plan also has a deductible you could pay and a network that includes your doctors. For the full statewide picture, see our health insurance South Carolina guide; for the national basics, see affordable health insurance.
2027 income limits for affordable health insurance South Carolina families can get
Premium tax credits for 2027 coverage use the 2026 HHS poverty guidelines. In South Carolina, help generally starts at 100% of poverty and stops at 400%.
| Household size | 100% FPL (where credits begin) | 400% FPL (where credits end) |
|---|---|---|
| 1 | $15,960 | $63,840 |
| 2 | $21,640 | $86,560 |
| 3 | $27,320 | $109,280 |
| 4 | $33,000 | $132,000 |
For larger households, add $5,680 per person at the 100% level. Because South Carolina didn’t expand Medicaid (KFF), the 138% Medicaid line used in expansion states does not apply here.
Watch the cliff: the enhanced credits that reached above 400% of poverty ended with 2025. For 2027, crossing 400% by even a small amount means losing the entire credit. Retirement contributions and HSA deposits can lower the income the Marketplace counts.
Your share of the benchmark plan in 2027
IRS Revenue Procedure 2026-26 sets the share of income each household is expected to pay for the benchmark Silver plan in 2027. The credit covers the rest of the benchmark price.
| Household income (% of FPL) | Expected contribution (share of income) |
|---|---|
| Under 133% | 2.15% |
| 133% – 150% | 3.23% – 4.30% |
| 150% – 200% | 4.30% – 6.78% |
| 200% – 250% | 6.78% – 8.66% |
| 250% – 300% | 8.66% – 10.22% |
| 300% – 400% | 10.22% |
| Over 400% | No credit |
Pick a plan cheaper than the benchmark and you pay less than your expected share; pick a pricier one and you pay the difference. The credit is reconciled on the 2027 tax return you file in 2028, as the IRS explains. Our 2027 subsidies guide has worked examples.
If you have a job offer of coverage
An offer of job-based coverage can block the credit. For 2027, if the employee-only premium for your employer’s plan is no more than 10.22% of household income and the plan meets minimum value, you generally can’t get a premium tax credit for yourself.
Family members are tested separately using the cost of family coverage. If adding your spouse or children would cost more than 10.22% of income, they may still qualify for Marketplace savings even though you don’t. Many South Carolina families in manufacturing, retail and hospitality jobs land in exactly this split.
Self-employed, seasonal and gig workers
Coastal tourism, construction, trucking and rideshare work all mean uneven paychecks. The Marketplace bases your credit on expected 2027 household income, and for self-employed people that means net profit after business expenses, not gross receipts.
Make your best estimate, then update your HealthCare.gov application whenever income shifts by a meaningful amount. If you guess too low, you may have to pay back some or all of the extra credit at tax time; if you guess too high, you get the difference back as a refund. Keeping records month by month makes the reconciliation on your 2027 return much easier.
One more caution: plans marketed by phone or social media as cheap “health coverage” are not always ACA plans. If a plan asks health questions, caps benefits or can’t use your premium tax credit, it isn’t a Marketplace plan. Ask for the plan’s name and check it before you pay.
Honesty.AI estimates your 2027 credit, checks the affordability test and compares every plan in your county.
Cost-sharing reductions: the hidden savings on Silver
Households at or below 250% of poverty qualify for cost-sharing reductions, but only on Silver plans. These shrink the deductible, copays and out-of-pocket cap, sometimes dramatically at the lowest incomes.
That’s why a Silver plan can beat a cheaper Bronze plan for someone who expects regular care. Without reductions, the 2027 out-of-pocket maximum is $12,000 for one person and $24,000 for a family. For help comparing tiers, read how to choose a health plan.
Options under 100% of poverty in South Carolina
Below 100% of poverty, most adults fall into the coverage gap. Healthy Connections Medicaid covers non-disabled parents only up to 67% of poverty, and adults without children have no income-based pathway, according to KFF.
- Children can qualify for Healthy Connections Medicaid or CHIP up to 213% of poverty.
- Family planning: the Healthy Connections Family Planning benefit covers men and women up to 194% of poverty.
- Pregnancy, disability or age 65+: separate Medicaid rules apply. Apply at apply.scdhhs.gov.
- Community health centers and free clinics offer sliding-fee or free care to uninsured residents.
- Hospital financial assistance can reduce or erase hospital bills for low-income patients.
A pending state waiver, Palmetto Pathways to Independence, would cover some parents from 67% to 100% of poverty with a work requirement, but SCDHHS lists no approval date. If your 2027 income will reach 100% of poverty, a subsidized Marketplace plan may be your best route.
2027 rate increases and how to protect your budget
Premiums are rising again. KFF found insurers nationwide proposed a median 15% increase for 2027, after roughly 20% in 2026. Preliminary South Carolina filings also show double-digit average increases, and the South Carolina Department of Insurance posts the final county list and rates.
The credit rises with the benchmark price, so subsidized shoppers are partly shielded. Households above 400% are not. Either way, these steps help:
- Report your expected 2027 income, not last year’s.
- Compare every insurer in your county; prices don’t move evenly.
- Check networks before you switch to a cheaper plan.
- Count the deductible and copays, not just the premium.
- Enroll by December 15 for January 1 coverage.
Free in-person help is available from the statewide Navigator, Choose Healthy Life, through localhelp.healthcare.gov.
South Carolina cities: local ways to save
Local hospitals and clinics add options beyond the Marketplace. Our city guides go deeper on the two metros with the most searches.
- Charleston: MUSC Health offers sliding-scale financial assistance for households up to 300% of poverty, and the Barrier Islands Free Medical Clinic on Johns Island serves qualifying uninsured adults who live or work in the tri-county area.
- Greenville: Bon Secours offers free care at or below 200% of poverty and discounts up to 400%, and the Greenville Free Medical Clinic serves eligible uninsured Greenville County residents.
In the Midlands, the Pee Dee and the rural counties along the I-95 corridor, fewer insurers may sell plans, and county health departments run by the South Carolina Department of Public Health offer services such as immunizations and family planning. Hospital financial-assistance policies are worth asking about anywhere in the state, because nonprofit hospitals must have one in writing.
Wherever you live, comparing every plan in your ZIP code is the surest way to find affordable health insurance South Carolina insurers sell for 2027.
Find affordable 2027 coverage the honest way
Honesty.AI is the world’s first patented, licensed AI insurance agent. It compares ACA, alternative and ancillary plans based on your family’s needs and is on your side, by chat, voice or text, 24/7. Honesty Is Your Best Policy®.
Frequently asked questions
What income qualifies for a premium tax credit in South Carolina in 2027?
Generally 100% to 400% of the federal poverty level, if you can’t get Medicaid, Medicare or affordable job-based coverage. For a household of four, that is $33,000 to $132,000.
Does South Carolina have a state health insurance subsidy?
No. South Carolina has no state premium subsidy and no reinsurance waiver. Savings come from the federal premium tax credit and cost-sharing reductions on HealthCare.gov.
Can my family get Marketplace savings if I have job coverage?
Possibly. If family coverage through your job costs more than 10.22% of household income in 2027, your spouse and children may qualify for a premium tax credit even if you don’t.
What are my options if I earn under 100% of poverty in South Carolina?
Most adults below 100% of poverty don’t qualify for Medicaid or a premium tax credit. Children may qualify for Healthy Connections, the Family Planning benefit covers some adults, and community health centers, free clinics and hospital financial assistance can help.
Are Silver plans worth it in South Carolina?
If your income is at or below 250% of poverty, often yes. Only Silver plans carry cost-sharing reductions, which lower deductibles, copays and the out-of-pocket maximum.
Keep learning: read the South Carolina health insurance guide, city guides for Charleston and Greenville, the 2027 subsidies guide, and how to choose a health plan.
