South Carolina Health Insurance Consumer Guide

To qualify for health coverage through the South Carolina Health Insurance Marketplace, you must:³

• 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.⁴
• If married, file a joint tax return.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

The open enrollment period for individual/family health coverage runs from November 1 to January 15 in South Carolina.⁶ 

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 1.³

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.⁷

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 as of early 2024, 95% of enrollees were receiving premium subsidies, amounting to an average savings of $552/month. After the subsidies (premium tax credits) were applied, the average enrollee’s monthly cost was about $63/month (including those who paid full price).⁸

(Note that the numbers above are based on effectuated enrollment as of early 2024. The chart below shows different metrics and reflects data across all enrollments submitted during the open enrollment period for 2024 coverage.)

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).⁹

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 76,000 low-income adults are in the coverage gap in South Carolina, ineligible for any financial assistance with their health coverage.¹¹ 

Six insurers are offering Marketplace coverage in South Carolina for 2025. Five of them also offered overage for 2024, but Cigna is exiting the South Carolina individual market at the end of 2024 and InStil Health is joining for 2025 (with a limited coverage area, available in only two counties).¹ 

People enrolled in Cigna plans in 2024 will need to select a new plan from a different insurer during the open enrollment period that begins November 1, 2024.¹²

The five returning insurers decreased their average premiums for 2025 (before subsidies are applied).²

Marketplace insurers’ coverage areas vary, but in all but one of South Carolina’s counties, at least three insurers are offering health plans through the Marketplace for 2025.¹

The following average premium changes have been approved for 2025 for the insurance companies that offer plans through the South Carolina Health Insurance Marketplace, amounting to an overall average rate decrease of 1.35%.² (premium changes are calculated before subsidies are applied):

Source: South Carolina Department of Insurance²

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%¹³
• 2016: Average increase of 12.3%¹⁴
• 2017: Average increase of 25.6%¹⁵
• 2018: Average increase of 30.7%¹⁶
• 2019: Average increase of 5.26%¹⁷
• 2020: Average decrease of 3.9%¹⁸
• 2021: Average decrease of 1.5%¹⁹
• 2022: Average increase of 3.1%²⁰
• 2023: Average increase of 7.1%²¹
• 2024: Average increase of 2.7%²²

In the South Carolina marketplace, a record high 571,175 people enrolled in private plans during the open enrollment period for 2024 coverage.²³

The surge in enrollment in recent 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.²⁴ These premium subsidy enhancement provisions have been extended through 2025 by the Inflation Reduction Act.

The enrollment spike in 2024 was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule, when Medicaid disenrollments resumed after a three-year pause during the pandemic. CMS reported that by April 2024, more than 169,000 South Carolina residents had transitioned from Medicaid to a Marketplace plan during the unwinding process.²⁵

Source: 2014,²⁶ 2015,²⁷ 2016,²⁸ 2017,²⁹ 2018,³⁰ 2019,³¹ 2020,³² 2021,³³ 2022,³⁴ 2023,²⁴ 2024³⁵

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]