If you live in South Carolina and need health insurance, the Affordable Care Act (ACA) marketplace may be your best option for affordable coverage in 2026. But eligibility rules have changed this year, and understanding who qualifies for subsidies, what income limits apply, and how to sign up can feel overwhelming. This guide breaks down everything you need to know about South Carolina ACA eligibility for 2026, including the return of the "subsidy cliff" and what it means for your wallet.
How the ACA Marketplace Works in South Carolina
South Carolina uses the federally run health insurance marketplace at HealthCare.gov. Unlike some states that operate their own exchanges, South Carolina residents shop for plans, compare prices, and apply for financial assistance through the federal platform.
For the 2026 plan year, six private insurers offer ACA marketplace plans in South Carolina. During the most recent open enrollment period, approximately 587,567 South Carolinians selected a marketplace plan, though that number was down about 7% from the previous year.
South Carolina has not expanded Medicaid under the ACA. This is a critical detail that affects eligibility. Because the state has not expanded Medicaid, there is a "coverage gap" where certain low-income adults cannot qualify for either Medicaid or marketplace subsidies. More on this below.
For a full overview of benefits available in the state, visit our South Carolina Benefits Overview.
Who Is Eligible for ACA Marketplace Coverage?
To purchase a health plan through HealthCare.gov in South Carolina, you must meet these basic requirements:
- Live in South Carolina
- Be a U.S. citizen or be lawfully present in the United States
- Not be currently incarcerated
- Not be enrolled in Medicare
Meeting these requirements means you can buy a marketplace plan. However, qualifying for financial assistance (subsidies to lower your monthly premium) has additional income-based requirements.
2026 Income Limits for ACA Subsidies in South Carolina
For the 2026 plan year, premium tax credits (subsidies) are available to individuals and families with household incomes between 100% and 400% of the Federal Poverty Level (FPL). This is a significant change from 2024 and 2025, when enhanced subsidies were available to people at all income levels above 100% FPL with no upper cap.
The enhanced premium tax credits created by the American Rescue Plan expired at the end of 2025. This brought back the "subsidy cliff," meaning households earning above 400% FPL no longer qualify for any premium assistance.
Important note: Because South Carolina has not expanded Medicaid, the minimum income for marketplace subsidies is 100% FPL (not 138% FPL as in expansion states). If your income falls below 100% FPL, you may fall into the coverage gap and not qualify for subsidies or Medicaid. See the coverage gap section below.
ACA Subsidy Income Limits by Household Size (2026)
The following table shows the approximate income range for ACA premium tax credit eligibility in South Carolina. These figures are based on the 2025 Federal Poverty Level guidelines, which are used to determine eligibility for the 2026 plan year.
| Household Size | 100% FPL (Minimum) | 400% FPL (Maximum) |
|---|---|---|
| 1 | $15,650 | $62,600 |
| 2 | $21,150 | $84,600 |
| 3 | $26,650 | $106,600 |
| 4 | $32,150 | $128,600 |
| 5 | $37,650 | $150,600 |
| 6 | $43,150 | $172,600 |
| 7 | $48,650 | $194,600 |
| 8 | $54,150 | $216,600 |
For households larger than 8, add approximately $5,500 per additional person. Verify your exact eligibility at HealthCare.gov or use our free screening tool.
What Do Subsidies Actually Cover?
Premium tax credits reduce your monthly health insurance premium. The amount you save depends on your income level:
- Lower-income households (closer to 100% FPL) receive the largest subsidies and may pay very little each month for coverage.
- Higher-income households (closer to 400% FPL) receive smaller subsidies.
- Above 400% FPL, you pay the full premium with no financial assistance.
In addition to premium subsidies, cost-sharing reductions (CSRs) are available to individuals and families with incomes up to 250% FPL. CSRs lower your deductibles, copayments, and out-of-pocket maximums, but only when you enroll in a Silver-level plan.
What Changed for 2026: The End of Enhanced Subsidies
The expiration of enhanced premium tax credits is the biggest change for South Carolina marketplace enrollees in 2026. Here is what this means in practice:
- Higher monthly premiums for most enrollees. According to SC Appleseed, average premiums in South Carolina rose by approximately 98%, with increases ranging from $600 to $1,188 per year for many families.
- No more $0 premium plans for low-income enrollees. Families earning between 100% and 150% FPL previously had access to zero-cost or very low-cost plans. Those plans are now significantly more expensive.
- The subsidy cliff is back. If your household income exceeds 400% FPL, you receive no premium assistance at all, even if premiums take up a large share of your income.
- No more repayment caps. Starting with the 2026 tax year, there is no limit on how much you may need to repay if you received more premium tax credits than you were entitled to based on your actual income. Accurately estimating your income is more important than ever.
South Carolina's Medicaid Coverage Gap
Because South Carolina has not expanded Medicaid, a significant gap in coverage exists. Here is how it works:
- Adults without dependent children or a disability generally do not qualify for Medicaid in South Carolina, regardless of how low their income is.
- The ACA marketplace subsidies start at 100% FPL. If your income is below 100% FPL, you cannot receive premium tax credits because the ACA originally intended for Medicaid expansion to cover this group.
- An estimated 65,000 South Carolinians fall into this coverage gap, earning too little for marketplace subsidies but not qualifying for Medicaid.
Who Does Qualify for Medicaid in South Carolina?
South Carolina Medicaid covers specific populations with limited income:
- Pregnant women (income up to approximately 199% FPL)
- Children under 19 (income up to approximately 213% FPL through Medicaid and CHIP)
- Parents and caretaker relatives (very low income thresholds)
- Seniors and individuals with disabilities (subject to income and asset limits)
- Individuals needing long-term care (monthly income limit approximately $2,982 in 2026)
If you are not sure whether you qualify for Medicaid or marketplace coverage, use our free eligibility screener to check all programs you may be eligible for.
How to Apply for ACA Marketplace Coverage in South Carolina
Step 1: Gather Your Information
Before you start, have the following ready:
- Social Security numbers for everyone in your household
- Income information (pay stubs, W-2 forms, tax returns, or self-employment records)
- Current health insurance policy numbers (if applicable)
- Immigration documents (if applicable)
Step 2: Visit HealthCare.gov
Go to HealthCare.gov and create an account or log in to your existing account. South Carolina uses the federal marketplace, so this is the only official online portal.
Step 3: Complete Your Application
Fill out the marketplace application with your household information, income details, and coverage preferences. The system will determine if you qualify for premium tax credits, cost-sharing reductions, Medicaid, or CHIP.
Step 4: Compare Plans and Enroll
Review available plans by metal tier (Bronze, Silver, Gold, Platinum). Consider the following:
- Bronze plans have lower premiums but higher out-of-pocket costs
- Silver plans are the only tier that offers cost-sharing reductions for lower-income enrollees
- Gold and Platinum plans have higher premiums but lower out-of-pocket costs
Select the plan that best fits your needs and budget, and complete enrollment.
Step 5: Pay Your First Premium
Your coverage does not begin until you pay your first monthly premium. Set up payment promptly after enrolling to avoid a gap in coverage.
Other Ways to Apply
You are not limited to the website. You can also:
- Call the HealthCare.gov help center at 1-800-318-2596 (TTY: 1-855-889-4325), available 24/7
- Work with a licensed insurance broker or agent in South Carolina
- Contact a Navigator or certified application counselor for free in-person help. Organizations like InsureSC and SC Thrive offer enrollment assistance.
- Enroll through an approved enhanced direct enrollment partner
Enrollment Deadlines and Special Enrollment Periods
The open enrollment period for 2026 coverage ran from November 1, 2025 through January 15, 2026. If you missed open enrollment, you may still be able to get coverage through a Special Enrollment Period (SEP) if you experienced a qualifying life event, such as:
- Losing other health coverage (job loss, aging off a parent's plan, losing Medicaid)
- Getting married or divorced
- Having or adopting a child
- Moving to a new area with different plan options
- Changes in household income that affect eligibility
Looking ahead: Starting with the 2027 plan year, the open enrollment window will be shorter, ending on December 15 instead of January 15. Plan ahead if you need to enroll or change plans for future years.
Tips for Managing Your 2026 ACA Coverage
-
Report income changes promptly. With the return of unlimited repayment requirements, keeping your income estimate accurate throughout the year is critical. If your income changes significantly, update your marketplace application right away.
-
Consider Silver plans if your income is under 250% FPL. Only Silver plans offer cost-sharing reductions that lower your deductibles and copays.
-
Check all your options. Use our free benefits screener to see if you qualify for other programs beyond ACA coverage, including SNAP, LIHEAP, or other assistance.
-
Keep records of your premium payments. You will need documentation of your health insurance and any premium tax credits when you file your taxes.
-
Get help if you need it. Free enrollment assistance is available through Navigators and certified counselors across South Carolina.
Frequently Asked Questions
Can I still get ACA health insurance if I missed open enrollment?
Yes, but only if you qualify for a Special Enrollment Period (SEP). Qualifying events include losing other coverage, getting married, having a baby, or moving to a new area. You typically have 60 days from the qualifying event to enroll.
What if my income is too low for marketplace subsidies?
If your income falls below 100% FPL in South Carolina, you may be in the coverage gap. You would not qualify for marketplace premium tax credits, and because South Carolina has not expanded Medicaid, you likely would not qualify for Medicaid either (unless you are pregnant, a child, disabled, or a parent meeting very low income thresholds). Check with SC Thrive or a Navigator for possible alternatives including community health centers.
Are ACA subsidies still available in 2026?
Yes, premium tax credits are still available for households with incomes between 100% and 400% FPL. However, the enhanced subsidies that were in effect from 2021 through 2025 have expired, so the amount of assistance is reduced compared to previous years, and households above 400% FPL no longer receive any subsidies.
How much will I pay for an ACA plan in South Carolina?
Your premium depends on your age, location within South Carolina, the plan you choose, and your income. With subsidies, some lower-income enrollees may still find affordable options. Without subsidies, full-price premiums can be several hundred dollars per month. Use the HealthCare.gov plan comparison tool or our benefits screener to get a personalized estimate.
What is the difference between Medicaid and ACA marketplace coverage?
Medicaid is a government-funded program for specific low-income populations with very low or no monthly costs. ACA marketplace plans are private insurance plans with monthly premiums that may be reduced through subsidies. In South Carolina, Medicaid eligibility is limited because the state has not expanded the program. Many adults who do not qualify for Medicaid can instead purchase subsidized coverage through the marketplace.
Can I get both Medicaid and an ACA marketplace plan?
No. If you qualify for Medicaid, you are not eligible for marketplace premium tax credits. The marketplace application process will determine which program you qualify for based on your income and household details.
Will South Carolina expand Medicaid?
As of early 2026, South Carolina has not expanded Medicaid. Multiple bills have been introduced in the state legislature, but none have passed. If expansion occurs in the future, it would close the coverage gap and change eligibility thresholds for both Medicaid and marketplace subsidies.
Check Your Eligibility Today
Not sure which programs you qualify for? Use our free benefits screening tool to check your eligibility for ACA marketplace subsidies, Medicaid, SNAP, and other assistance programs in just a few minutes. You can also visit our South Carolina Benefits Overview for a complete look at available programs in the state.
