Health insurance in South Carolina
South Carolina did not expand Medicaid, so adults below $15,960 can fall through the gap entirely. 11.2% of under-65 residents are uninsured.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
South Carolina uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
South Carolina has a coverage gap
South Carolina has not adopted the Medicaid expansion. That creates a specific and badly-known problem: the premium tax credit was written on the assumption that everyone below 100% of the poverty guideline would be covered by an expanded Medicaid, so the credit does not start until 100%. In a state that did not expand, an adult below that line qualifies for neither.
In practice that means an adult in South Carolina earning under $15,960 a year — roughly $1,330 a month — may be offered no help at all, while someone earning slightly more gets a substantial subsidy. It is the one part of this system where earning less can leave you worse off.
South Carolina's uninsured rate is 11.2% of under-65 residents, or 475,998 people. Some of them are in this gap.
If your income is near the line, it is worth getting the number right before you assume you do not qualify. Projected annual income is what counts, not last month's pay.
How much choice South Carolina counties get
Counties in South Carolina carry between 2 and 5 insurers, so competition is fairly even across the state without being uniform.
No county in South Carolina is down to a single insurer. Since the previous plan year, 46 counties in South Carolina gained an insurer and none lost one.
Heavy marketplace use
587,567 South Carolina residents selected a marketplace plan for 2026. Against the state's under-65 population that is 138 per thousand, well above the 26-state median of 79, and 3rd highest of the 26 states on this site.
Of those, 84,654 — 14% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (11th of 26).
The spread inside South Carolina
Greenville County is the largest county we publish here, with 463,426 under-65 residents; Pickens County is the smallest, with 104,996. Greenville County has 3 insurers offering 48 plans, and Pickens County has 3 offering 48.
The widest choice in South Carolina is in Charleston County — 4 insurers, 60 plans. The narrowest is Anderson County, with 3 insurers and 39 plans. Same state, same rules, 21 more plans to choose from.
Uninsured rates range from 9.0% in York County to 14.1% in Horry County — 1.6 times as high, within one state.
The 14 largest counties in South Carolina
By under-65 population, covering 77% of the state's under-65 residents. South Carolina has 46 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Greenville County | 463,426 | 11.5% | 3 | 48 | 132 |
| Charleston County | 344,054 | 9.5% | 4 | 60 | 149 |
| Richland County | 335,221 | 10.3% | 4 | 60 | 138 |
| Spartanburg County | 300,077 | 12.4% | 4 | 44 | 115 |
| Horry County | 291,194 | 14.1% | 3 | 48 | 175 |
| Lexington County | 256,624 | 10.8% | 3 | 52 | 120 |
| York County | 251,592 | 9.0% | 4 | 48 | 84 |
| Berkeley County | 219,189 | 10.1% | 4 | 60 | 123 |
| Anderson County | 173,004 | 11.4% | 3 | 39 | 130 |
| Dorchester County | 145,347 | 10.0% | 4 | 60 | 123 |
| Aiken County | 138,502 | 10.4% | 3 | 43 | 128 |
| Beaufort County | 135,242 | 11.3% | 3 | 52 | 175 |
| Florence County | 107,661 | 10.1% | 4 | 57 | 188 |
| Pickens County | 104,996 | 12.0% | 3 | 48 | 109 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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