See your South Carolina health insurance coverage options.

To qualify for health coverage through the South Carolina Health Insurance Marketplace, you must:⁶

• Live in South Carolina
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your household income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If your employer offers health benefits but you feel the coverage is too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁷

The open enrollment period for individual/family health coverage runs from November 1 to January 15 in South Carolina.⁸ 

If you need your coverage to start on January 1, you must submit your application by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁶

Outside of open enrollment, a special enrollment period (generally triggered by a specific qualifying life event) is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in South Carolina, you can: 

• Visit Healthcare.gov to access South Carolina’s health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
• Contact the HealthCare.gov call center at 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, 7 days a week (closed on holidays).
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator, or a certified application counselor.
• Enroll via an approved enhanced direct enrollment entity.⁹

South Carolina uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov. 

In the South Carolina Marketplace, about nine out of ten eligible enrollees save money on premium payments amounting to an average savings of $566/month in 2023. After subsidies (premium tax credis) were applied, the average enrollee’s monthly cost was about $60/month.¹⁰

The Affordable Care Act also ensures that people with household incomes up to 250% of the poverty level can enroll in Silver-level plans that have reduced out-of-pocket costs (i.e. lower out-of-pocket costs than Silver plans available to people with higher incomes).¹¹

Between the premium subsidies and cost-sharing reductions, you may find that a plan obtained through the South Carolina Health Insurance Marketplace will provide you with the best overall value.

Source: CMS.gov¹⁰

South Carolina has not yet implemented the ACA’s expansion of Medicaid, so there is still a coverage gap in the state: Childless, non-disabled adults with income below the poverty level are not eligible for Medicaid (due to the lack of Medicaid expansion) and are also not eligible for Marketplace subsidies (because the ACA called for them to have Medicaid, which South Carolina has not implemented).

An estimated 94,000 low-income adults are in the coverage gap in South Carolina, ineligible for any financial assistance with their health coverage.¹² 

There are six insurers offering health plans through the South Carolina exchange for 2024 coverage.¹ This includes one newcomer, as UnitedHealthcare has joined the South Carolina Health Insurance Marketplace for 2024:¹³

Marketplace insurers’ coverage areas vary, but in nearly all of South Carolina’s counties, at least three insurers are offering health plans through the Marketplace for 2024.²

The following average 2024 rate changes were approved for insurance companies that offer plans through the South Carolina Health Insurance Marketplace, amounting to a weighted average rate increase (before subsidies are applied) of 2.7%.¹

Source: South Carolina Department of Insurance.¹

For perspective, here’s an overview of how weighted average full-price (pre-subsidy) individual/family premiums have changed in South Carolina over time:

• 2015: Average increase of less than 1%.¹⁴
• 2016: Average increase of 12.3%.¹⁵
• 2017: Average increase of 25.6%.¹⁶
• 2018: Average increase of 30.7%.¹⁷
• 2019: Average increase of 5.26%¹⁸
• 2020: Average decrease of 3.9%.¹⁹
• 2021: Average decrease of 1.5%.²⁰
• 2022: Average increase of 3.1%.²¹
• 2023: Average increase of 7.1%.²²

In the South Carolina marketplace, 382,968 people enrolled in private plans for the 2023 coverage period.²³ This was by far a record high for the state, and was an increase of 27% over 2022’s enrollment. But 2022 enrollment in South Carolina Marketplace plans had also been a record-high.²⁴

The surge in enrollment during these years was due in large part to the American Rescue Plan (ARP) which made the ACA’s premium subsidies more substantial and more widely available.²⁵ These premium subsidy enhancement provisions have been extended through 2025 by the Inflation Reduction Act.

Source: 2014,²⁶ 2015,²⁷ 2016,²⁸ 2017,²⁹ 2018,³⁰ 2019,³¹ 2020,³² 2021,³³ 2022,³⁴ 2023²⁵

HealthCare.gov
800-318-2596

State Exchange Profile: South Carolina
The Henry J. Kaiser Family Foundation overview of South Carolina’s progress toward creating a state health insurance exchange.

South Carolina Primary Health Care Association (Navigator organization)

South Carolina Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 768-3467 / [email protected]