Health Insurance in South Carolina

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 ($15,650/year for a single person), 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 2026

South Carolina marketplace premiums increased by an average of 21% before subsidies for 2026. A major factor is the expiration of enhanced premium tax credits at the end of 2025. For enrollees who no longer qualify for subsidies (those above 400% FPL), the impact is severe. Some individuals saw their annual premiums nearly double, with average increases of $600 to over $1,100 per year.

For people who still qualify for subsidies (between 100% and 400% FPL), the increases are partially absorbed. Low-income enrollees below 200% FPL can still find $0-premium Bronze plans and low-cost Silver plans with cost-sharing reductions in most counties. But the subsidies are smaller than they were during the 2021-2025 enhanced period, so many middle-income enrollees will pay more.

The benchmark Silver plan for a 40-year-old in South Carolina runs around $600-$700/month before subsidies, depending on the county. After subsidies, costs vary widely based on income.

Major carriers in South Carolina (2026)

Six insurers offer plans on the South Carolina marketplace for 2026:

• BlueCross BlueShield of South Carolina is the dominant carrier with the broadest statewide network. It approved an average rate increase of about 20% for 2026. Available in most counties and generally the default choice for people who want broad provider access.
• Absolute Total Care (a Centene subsidiary, similar to Ambetter in other states) covers the largest number of marketplace enrollees, with roughly 205,000 members. It approved a 27% rate increase for 2026. Often has some of the lowest premiums but uses narrower networks.
• Molina Healthcare of South Carolina serves about 42,600 enrollees with a rate increase of roughly 25% for 2026. Molina tends to offer competitive pricing, especially for Bronze and Silver plans.
• Select Health of South Carolina operates in 20 counties, concentrated in the Upstate (Greenville, Spartanburg, Anderson) and Lowcountry (Charleston, Berkeley, Dorchester) regions.
• UnitedHealthcare of South Carolina entered the state marketplace in recent years and offers plans in select counties.
• InStil Health is new to the South Carolina marketplace for 2026, writing plans in five counties: Chesterfield, Darlington, Florence, Spartanburg, and York. A new entrant can sometimes mean more competitive pricing in those areas.

Key regions

Charleston / Lowcountry

The Charleston metro (Charleston, Berkeley, Dorchester counties) has multiple carrier options including BlueCross, Absolute Total Care, Molina, and Select Health. 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

The Upstate has solid carrier competition. Select Health, BlueCross, Absolute Total Care, and the new InStil Health (in Spartanburg and York counties) all offer plans. 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

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