For individual and family health insurance, South Carolina uses the federal Marketplace at HealthCare.gov. Open Enrollment for 2027 runs Nov 1, 2026 – Jan 15, 2027; enroll by Dec 15 for Jan 1 coverage. South Carolina has not expanded Medicaid, so most adults need income of at least 100% of the poverty level for Marketplace savings.
Updated for the 2027 plan year (October 2026)
- How health insurance works in South Carolina
- South Carolina 2027 at a glance
- 2027 Open Enrollment dates
- Healthy Connections Medicaid and the coverage gap
- Coverage for children and family planning
- Insurers and 2027 rates
- 2027 subsidies
- Free help and consumer protection
- South Carolina city guides
- Frequently asked questions
How health insurance South Carolina residents buy works in 2027
If you don’t get coverage through a job, Medicare, Medicaid or the military, you buy your own plan on the ACA Marketplace. South Carolina does not run a state exchange. Residents shop on HealthCare.gov or through a licensed agent or assistant connected to it, and the price of a given plan is the same either way.
Every Marketplace plan covers essential health benefits, including doctor visits, hospital stays, prescriptions, maternity care and mental health care. No insurer can deny you or charge you more because of a pre-existing condition. That protection is the main difference between an ACA plan and many alternative plans.
Cost is usually the first question. Our affordable health insurance South Carolina guide walks through 2027 income limits, subsidy shares and cost-sharing reductions in detail. This page is the statewide overview.
The Marketplace is a big part of coverage here. According to the CMS 2026 Open Enrollment snapshot, 587,567 South Carolinians selected a Marketplace plan for 2026.
Health insurance South Carolina 2027 at a glance
These are the agencies and programs that shape your options for 2027. Each one links to an official source so you can check the details yourself.
| Topic | South Carolina for 2027 |
|---|---|
| Exchange | HealthCare.gov (federal Marketplace) |
| Open Enrollment | Nov 1, 2026 – Jan 15, 2027; enroll by Dec 15 for Jan 1 coverage |
| Medicaid expansion | Not adopted (KFF, October 2026) |
| Medicaid program | Healthy Connections Medicaid, run by SCDHHS; apply at apply.scdhhs.gov |
| Children (Medicaid and CHIP) | Healthy Connections; children covered up to 213% FPL |
| Family planning | Healthy Connections Family Planning limited benefit, up to 194% FPL |
| State subsidy or reinsurance | None; federal premium tax credits only |
| Insurance regulator | South Carolina Department of Insurance (SCDOI) |
| In-person Navigator | Choose Healthy Life, statewide (CMS 2026–2027 grant) |
| Uninsured rate (2024) | 9.0% (U.S. Census Bureau) |
The uninsured rate comes from the Census Bureau’s 2024 American Community Survey brief. It reports 9.0% of all South Carolinians uninsured, and 13.1% of working-age adults ages 19 to 64.
2027 Open Enrollment dates in South Carolina
South Carolina follows the federal calendar because it uses HealthCare.gov. Open Enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027, and the day you enroll decides when your plan begins.
| If you enroll… | Coverage starts |
|---|---|
| Nov 1 – Dec 15, 2026 | January 1, 2027 |
| Dec 16, 2026 – Jan 15, 2027 | February 1, 2027 |
| After Jan 15, 2027 | Only with a qualifying life event |
Treat December 15 as your real deadline. Losing job coverage, moving, marriage or a new baby can open a Special Enrollment Period, generally for 60 days. See our Open Enrollment 2027 guide for the full rules.
Healthy Connections Medicaid and the coverage gap
South Carolina has not expanded Medicaid, according to the KFF Medicaid expansion tracker. The state’s program, Healthy Connections Medicaid, is run by the South Carolina Department of Health and Human Services (SCDHHS).
For adults, the limits are tight. KFF reports that South Carolina covers non-disabled parents and caretakers up to 67% of the poverty level, and adults without dependent children have no income-based pathway (KFF eligibility limits). Pregnant women, children, older adults and people with disabilities have separate rules.
The coverage gap
Adults below 100% of poverty who don’t meet those limits fall into the coverage gap: no Medicaid and no premium tax credit. KFF has estimated about 65,000 South Carolinians are in this gap (KFF South Carolina Medicaid fact sheet, 2025).
Palmetto Pathways to Independence (pending)
SCDHHS submitted a waiver called Palmetto Pathways to Independence to CMS on June 23, 2025. It would cover parents and caretakers ages 19 to 64 with income from 67% to 100% of poverty who complete 80 hours a month of work or other community engagement. SCDHHS lists no approval or start date, so treat it as pending.
Apply for Medicaid at apply.scdhhs.gov or call SCDHHS at (888) 549-0820. If you apply on HealthCare.gov and look Medicaid-eligible, your application is sent to the state.
Coverage for children and family planning
Children in South Carolina often qualify even when parents don’t. The state covers children through Healthy Connections Medicaid and CHIP up to 213% of the poverty level, with the cutoffs varying by age, according to KFF’s children’s eligibility table.
Healthy Connections also has a Family Planning limited benefit for men and women up to 194% of poverty who don’t qualify for full Medicaid. SCDHHS notes it is not full coverage under the ACA, so adults on it should still look at a Marketplace plan if they qualify.
Honesty.AI sorts out who qualifies for what and compares every 2027 plan in your South Carolina county.
Insurers and 2027 rates in South Carolina
The South Carolina Department of Insurance ACA page lists which Marketplace insurers sell in each county. For 2026, the on-exchange insurers were Absolute Total Care (Ambetter) and BlueCross BlueShield of South Carolina in all 46 counties, plus Molina, Select Health of South Carolina, UnitedHealthcare and InStil Health in some counties.
As of mid-October 2026, the department had not yet published its final 2027 rate approvals or county list. Preliminary 2027 filings point to another round of double-digit average increases, in line with KFF’s national finding that insurers proposed a median 15% increase for 2027.
Two national exits don’t touch South Carolina: Cigna, which is leaving the individual market in all its states after 2026, was not on the state’s 2026 Marketplace list, and Aetna already left. See KFF’s 2027 insurer tracker.
Tip: Carriers and networks vary by county. When HealthCare.gov window shopping opens before November 1, compare every 2027 option for your ZIP code instead of auto-renewing.
2027 subsidies for South Carolina coverage
The premium tax credit caps what you pay for the benchmark Silver plan at a share of your income. In South Carolina, eligibility generally runs from 100% to 400% of the federal poverty level, which is $15,960 to $63,840 for one person. The enhanced credits of 2021–2025 expired, so the 400% cliff applies again in 2027.
For 2027 coverage, IRS Revenue Procedure 2026-26 sets the expected contribution from 2.15% of income for the lowest earners to 10.22% for households between 300% and 400% of poverty. The IRS premium tax credit page explains how the credit is reconciled at tax time.
The 2027 out-of-pocket maximum is $12,000 for one person and $24,000 for a family. Households up to 250% of poverty can get cost-sharing reductions on Silver plans. Full tables are in our 2027 health insurance subsidies guide.
Immigrant families: starting January 1, 2027, federal law limits premium tax credits to certain groups, including green card holders. Other lawfully present immigrants can still buy a plan without the credit. See HealthCare.gov’s immigrant coverage page.
Free help and consumer protection in South Carolina
You don’t have to sort through health insurance South Carolina options alone. The state has a federally funded Navigator, licensed agents and a regulator that handles complaints.
- Navigator: Choose Healthy Life holds the CMS Navigator grant for August 2026 through August 2027. It covers the whole state, with in-person help in 15 counties including Charleston and Greenville, per the CMS awardee summaries. Book by ZIP code at localhelp.healthcare.gov.
- South Carolina Department of Insurance: call 803-737-6160 about claims, denials or agent conduct, or use the SCDOI ACA page.
- Licensed agents: an agent can compare every Marketplace plan at no extra cost to your premium. Honesty® Insurance Services, LLC (NPN 21094885) is licensed in South Carolina.
Whoever helps you, HealthCare.gov calculates your subsidy. You can read how the health insurance Marketplace works before you start.
South Carolina city guides: Charleston and Greenville
Networks, hospitals and safety-net programs differ across the state. We wrote local guides for the two metros with the most searches for health insurance.
- Health insurance in Charleston — MUSC Health and Roper St. Francis networks, MUSC financial assistance, Fetter Health Care Network and hurricane-season tips.
- Health insurance in Greenville — Prisma Health and Bon Secours networks, the Greenville Free Medical Clinic and manufacturing-job coverage changes.
Columbia, Myrtle Beach, Rock Hill and Spartanburg residents follow the same Marketplace rules, but insurer choices and networks change by county, so always compare for your own ZIP code.
Choosing a plan: tips for health insurance South Carolina shoppers
The lowest premium isn’t always the lowest yearly cost. Look at the deductible, the out-of-pocket maximum and whether your doctors are in network.
- Estimate your 2027 household income and size.
- List your doctors, hospital and prescriptions.
- Look at Silver plans first if your income is under 250% of poverty.
- Check each plan’s 2027 network and drug list.
- Enroll by December 15 for January 1 coverage.
Our guide on how to choose a health plan explains metal tiers and network types in plain language.
ACA plans versus alternative and ancillary coverage
Not every policy sold in South Carolina is an ACA plan. Short-term medical plans, fixed-indemnity plans and similar products may have lower premiums, but they may exclude pre-existing conditions, cap benefits, and never qualify for the premium tax credit. Ancillary coverage such as dental, vision or accident insurance can sit alongside a Marketplace plan rather than replace it.
A good rule: if you qualify for a premium tax credit, compare a subsidized ACA plan first, then decide whether any extras are worth adding. If you earn over 400% of poverty and face the full premium, read the fine print of any alternative carefully before giving up ACA protections.
Find your 2027 South Carolina plan the honest way
Honesty.AI is the world’s first patented, licensed AI insurance agent. It compares ACA, alternative and ancillary plans, applies your subsidy and works for you, by chat, voice or text, 24/7. Honesty Is Your Best Policy®.
Frequently asked questions
Where do I buy health insurance in South Carolina?
South Carolina uses the federal Marketplace at HealthCare.gov. You can enroll there directly or through a licensed agent or assistant connected to it. The state does not run its own exchange.
When is open enrollment for 2027 in South Carolina?
Open Enrollment runs November 1, 2026 through January 15, 2027. Enroll by December 15, 2026 for coverage starting January 1, 2027. Enrollments from December 16 through January 15 start February 1.
Did South Carolina expand Medicaid?
No. South Carolina has not expanded Medicaid. Healthy Connections Medicaid covers non-disabled parents only up to 67% of the poverty level, and most adults without children have no income-based pathway.
What is Palmetto Pathways to Independence?
It is a waiver South Carolina submitted to CMS in June 2025 that would cover parents and caretakers from 67% to 100% of poverty who meet a work or community engagement requirement. SCDHHS lists no approval or start date.
Which insurers sell Marketplace plans in South Carolina?
For 2026, Absolute Total Care (Ambetter) and BlueCross BlueShield of South Carolina sold in all 46 counties, with Molina, Select Health, UnitedHealthcare and InStil Health in some counties. Check the 2027 list for your ZIP code on HealthCare.gov.
Keep learning: see affordable health insurance in South Carolina, local guides for Charleston and Greenville, the 2027 Open Enrollment guide, and the 2027 subsidies guide.
