How the ACA Marketplace Works in South Carolina (2027 Update)

If you do not get health insurance through a job, Medicare or Medicaid, the Marketplace is where you buy it in South Carolina. For 2027, the companies in your county, the prices and the tax credit rules have all changed.

Open enrollment runs November 1, 2026 through January 15, 2027. If you want coverage to start January 1, enroll by December 15, 2026.

This guide covers who sells plans in your county, what every plan must cover, how the tax credit works now and how to apply. For the full picture, see our South Carolina Health Insurance 2027 guide.

• You had Molina in 2026. Molina is not offering plans for 2027. You need a new plan, and it is worth picking one yourself so you are not placed in a plan automatically.
• You already have a Marketplace plan. Look before you let it renew. A change in the plan your tax credit is based on can change your price after your tax credit, even if your plan's price barely moved.
• Your income is above 400% of the federal poverty level. For 2027 you generally pay full price, unless Congress acts.
• Your income is below 100% of the federal poverty level. You generally do not qualify for a Marketplace tax credit. Contact us or SC Healthy Connections (SCDHHS) to check every option.

The Health Insurance Marketplace (sometimes called "the exchange" or Obamacare) is where individuals and families without job-based coverage, Medicare or Medicaid compare and buy plans. South Carolina does not run its own exchange, so everything goes through HealthCare.gov. You can shop there on your own or with a licensed agent.

The plans are private health insurance that meets the Affordable Care Act's rules. They cover ten essential health benefits. They cannot turn you down or charge you more for a pre-existing condition. They are the only kind of individual coverage that can come with a federal premium tax credit.

The Marketplace lists every ACA plan sold in your county and checks whether your household qualifies for financial help. That help is only available on Marketplace plans. If you buy directly from an insurance company, outside the Marketplace, you cannot use a premium tax credit.

About 587,600 South Carolinians picked a Marketplace plan during 2026 open enrollment.

Six insurance companies sell 2027 Marketplace plans in South Carolina. Which ones you see depends on your county. The table shows how many counties each company is in and what changed for 2027.

Most counties have three companies to choose from. Eleven have only Ambetter and BlueCross: Abbeville, Bamberg, Barnwell, Edgefield, Greenwood, Jasper, Lee, Marlboro, McCormick, Oconee and Sumter. Florence and York have the most, with five each. See every county in our company-by-county guide.

If you had Molina in 2026, you need a new plan for 2027. It is worth picking one yourself so you are not placed in a plan automatically.

Every Marketplace plan in South Carolina covers the ten essential health benefits:

• Outpatient care
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Lab services
• Preventive and wellness services, including chronic disease management
• Pediatric services, including children's dental and vision

Many preventive services, such as annual checkups, recommended screenings and vaccines, are covered with no cost-sharing when you use an in-network provider, even before you meet your deductible.

Some plans add extras on top of the essential benefits, like adult dental and vision.

Metal levels describe how you and the plan split costs, not what is covered. On the 2027 South Carolina Marketplace you will see:

• Bronze and expanded bronze: lowest premiums, highest deductibles.
• Silver: middle premiums. The only level that can come with cost-sharing reductions, which lower your deductible and copays, if your income is under 250% of the federal poverty level.
• Gold: higher premiums, lower deductibles. In some South Carolina counties, gold costs only a little more than silver for 2027.
• Catastrophic: for people under 30 or with a hardship exemption.

No platinum plans are sold on the South Carolina Marketplace for 2027. See Bronze vs. Silver vs. Gold for 2027 for help choosing.

Network type matters just as much as metal level. There are no PPOs on the South Carolina Marketplace. BlueCross's BlueEssentials and BlueConnect plans are EPOs (exclusive provider organizations) with a statewide network. Every other plan is an HMO.

With either type, care outside the network generally is not covered except emergencies. So checking your doctors and hospital before you enroll is the most important step. More in HMO vs EPO in South Carolina.

The premium tax credit lowers your monthly premium. It is based on your projected 2027 household income and the price of the plan your tax credit is based on, which is the second-lowest-cost silver plan in your county.

Three things are different for 2027:

• The enhanced credits are gone. The larger tax credits available through 2025 expired. For 2027 the credit is generally limited to households between 100% and 400% of the federal poverty level, unless Congress acts. Above 400%, you generally pay full price. See who qualifies and what the 400% limit means for South Carolina households.
• The plan your tax credit is based on costs more everywhere. For a 40-year-old, its price went up in all 46 counties, from +11.0% in Beaufort to +46.8% in Lee. The average is +24.8%.
• Repayment is no longer capped. Starting with tax year 2026, the IRS requires you to repay the full amount of any excess advance credit if your income ends up higher than you estimated. Our guide to estimating your 2027 income can help. This is general information, not tax advice; a CPA can help with your specific situation.

South Carolina did not expand Medicaid. Adults with income below 100% of the poverty level generally do not qualify for a Marketplace tax credit, and many do not qualify for Medicaid either. If that is you, contact us or SC Healthy Connections (SCDHHS) to check every option.

Age matters a lot. The table shows 2027 monthly premiums for the plan your tax credit is based on, in several larger counties. These are full prices before any tax credit. Your cost after any tax credit will depend on income and household.

A 60-year-old pays a little over twice what a 40-year-old pays for the same plan. That is why losing the tax credit above 400% of the federal poverty level hits early retirees hardest. See every county in our 2027 rate changes by county.

Before you start. Have these ready:

• Social Security numbers (or immigration documents) for everyone applying
• Your best estimate of 2027 household income: pay stubs, W-2s, 1099s or last year's return
• Information about any job-based coverage you are offered
• A list of your doctors, hospital and prescriptions

During the application. HealthCare.gov asks about your household, income and other coverage. Then it estimates your tax credit and any cost-sharing reductions. Your "household" follows tax-filing rules, so anyone you claim as a dependent counts even if they are not applying. You will then see plans filtered by metal level, premium, deductible and network.

After you choose. Pay your first month's premium. Coverage does not start until you do. If the Marketplace asks for documents to verify income or citizenship, send them by the deadline in the notice.

• November 1, 2026: open enrollment begins.
• December 15, 2026: last day to enroll for a January 1 start. Details in our open enrollment guide.
• January 15, 2027: open enrollment ends. Enrollments from December 16 through January 15 start February 1.

A federal rule would have shortened the window to December 15, but a court vacated that part, and HealthCare.gov kept January 15.

Outside open enrollment, you need a qualifying life event, such as losing other coverage, moving, marriage or a new baby. You usually have 60 days to act. See Special Enrollment Periods in SC.

• Auto-renewing without looking. A change in the plan your tax credit is based on can change your price after your tax credit, even if your plan's price barely moved.
• Guessing at income. With no repayment cap, an estimate that is too low can cost you at tax time.
• Picking on premium alone. A cheap plan that leaves out your hospital is not cheap.
• Missing December 15. If you want January 1 coverage, that is the date that matters.

Start with your doctors, your prescriptions and a realistic income estimate. Then compare the plans in your county before December 15.