The Medicaid situation
South Carolina is one of 10 states that has not expanded Medicaid under the ACA. Traditional Medicaid in the state covers children, pregnant women, and parents with very low incomes, but the income thresholds are extremely tight. Childless adults are not eligible for Medicaid regardless of how little they earn.
This creates the coverage gap. An estimated 65,000 South Carolinians earn too much for traditional Medicaid but less than 100% of the federal poverty level ($15,960/year for a single person for 2027 coverage), making them ineligible for marketplace subsidies. If the state were to expand Medicaid, over 340,000 residents would become eligible for coverage.
A bill was introduced in the state legislature for the 2025-2026 session that would expand Medicaid eligibility to adults under 65 with incomes up to 133% FPL, but it has not advanced. For now, the coverage gap remains.
What plans cost in 2027
Premiums are rising again for 2027. KFF puts South Carolina's average benchmark Silver premium for a 40-year-old at $702 a month for 2027, up from $564 in 2026, an increase of about 24%. That comes after an average increase of about 21% before subsidies for 2026.
The enhanced premium tax credits expired after 2025 and were not extended. For 2027, there is no premium tax credit above 400% FPL (about $63,840 for a single person or $86,560 for a household of two), so people above that line pay full price. For people between 100% and 400% FPL, the tax credit absorbs much of the benchmark increase, but the share of income you are expected to pay is higher than it was during 2021-2025.
Open Enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1.
Major carriers in South Carolina (2027)
Six insurers offer plans on the South Carolina marketplace for 2027. Oscar is new for 2027. Molina Healthcare is not on the 2027 list.
- BlueCross BlueShield of South Carolina is the dominant carrier with the broadest statewide network. Available in most counties and generally the default choice for people who want broad provider access.
- Ambetter from Absolute Total Care (a Centene subsidiary) has covered the largest number of marketplace enrollees in recent years. Often has some of the lowest premiums but uses narrower networks.
- First Choice Next, from Select Health of South Carolina, sells marketplace plans in the Charleston, Columbia, and Upstate areas, among others.
- Oscar Health is new to the South Carolina marketplace for 2027, with plans in counties including Charleston and Florence.
- UnitedHealthcare of South Carolina offers plans in select counties.
- InStil Health joined the South Carolina marketplace for 2026 and offers plans in a small number of counties, including Florence.
Key regions
Charleston / Lowcountry
The Charleston metro (Charleston, Berkeley, Dorchester counties) has multiple carrier options including BlueCross, Ambetter from Absolute Total Care, First Choice Next, and Oscar. Competition keeps premiums somewhat lower than rural areas. The region has a large hospital system presence (MUSC, Roper St. Francis) that anchors most carrier networks.
Columbia / Midlands
Richland and Lexington counties have access to most of the state's carriers. Prisma Health and Lexington Medical Center are the major hospital systems. BlueCross and Absolute Total Care are the most popular choices.
Greenville-Spartanburg / Upstate
BlueCross, Ambetter from Absolute Total Care, and First Choice Next offer plans in Greenville and Spartanburg counties. Prisma Health dominates the provider landscape in this region.
Rural South Carolina
Many rural counties, particularly in the Pee Dee and rural Lowcountry, have fewer carrier options. Some counties may only have two or three insurers. Premiums tend to be higher, and provider networks are thinner. BlueCross and Absolute Total Care are typically available statewide.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Resources for South Carolinians
- HealthCare.gov for plan shopping and enrollment (South Carolina uses the federal marketplace)
- SC Department of Insurance for state-specific marketplace information and consumer assistance
- CoverSC for information about the Medicaid coverage gap and advocacy efforts
- Community health centers across the state provide care on a sliding fee scale for uninsured and underinsured residents