How It Works and Who It’s For

The Marketplace is for South Carolina residents who:

• Live in South Carolina

• Are lawfully present in the U.S.

• Are not incarcerated

• Are not enrolled in Medicare

It serves people who do not qualify for affordable employer coverage, Medicaid, or CHIP. The Marketplace also screens applicants for Medicaid and CHIP eligibility and refers them to Healthy Connections (South Carolina Medicaid) if they qualify.

Open Enrollment Period in South Carolina

• Open Enrollment for 2025: November 1, 2024 – January 15, 2025

• Enroll by December 15 for coverage starting January 1, 2025

• Enroll between December 16 and January 15 for coverage starting February 1, 2025

Outside of this period, you need a qualifying life event to enroll or change plans.

Special Enrollment Period (SEP) Rules

A SEP is available if you experience a qualifying life event, such as:

• Loss of other health coverage

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

• Change in household income

You typically have 60 days from the event to enroll in a new plan.

Types of Health Insurance Plans Available

Marketplace plans are divided into four “metal” tiers, plus catastrophic coverage for those under 30 or with a hardship exemption:

• Catastrophic Plans: For those under 30 or with a hardship exemption; low premiums, high deductibles, and coverage for all essential benefits after the deductible is met.

Plan Types:

• HMO: Lower premiums, limited network, referrals required for specialists. Most plans in South Carolina are HMOs.

• EPO: Must use network providers, no out-of-network coverage except emergencies, no referrals needed. Blue Cross Blue Shield offers EPO plans.

• PPO: Only Blue Cross Blue Shield offers PPO plans on the Marketplace, allowing out-of-network care at a higher cost.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes between 100% and 400% of the federal poverty level, with expanded eligibility through 2025. Subsidies are only available for Marketplace plans.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing deductibles, copays, and coinsurance.

• Medicaid/CHIP: South Carolina has not expanded Medicaid. Medicaid (Healthy Connections) is available to low-income children, pregnant women, parents with very low income, and people with disabilities. CHIP covers children in families with higher incomes.

How to Compare and Choose a Plan in South Carolina

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the South Carolina Exchange

For 2025, six insurers offer Marketplace coverage in South Carolina:

• Absolute Total Care (Ambetter)

• BlueCross BlueShield of South Carolina

• InStil Health (new for 2025)

• Molina Healthcare of South Carolina

• Select Health of South Carolina (First Choice)

• UnitedHealthcare of South Carolina

Coverage areas and plan options vary by county. BlueChoice Health Plan and Celtic Insurance Company are available only off-exchange or in limited areas.

Navigating South Carolina’s Online Enrollment Portal

How to Apply:

1. Go to the federal enrollment website and create an account.

2. Enter household and income information to check eligibility for subsidies or programs.

3. Compare available plans by premiums, coverage, and network.

4. Select a plan and complete enrollment.

5. Pay your first premium to activate coverage.

Where to Get Help:

• Certified Navigators, Enrollment Assisters, and agents are available statewide for free, in-person, phone, or virtual assistance.

Alternatives to the Marketplace

• Short-term health plans: Available for up to four months; not ACA-compliant, may exclude pre-existing conditions, and offer fewer consumer protections.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some. South Carolina law recognizes these ministries as separate from insurance regulation.

Common Mistakes to Avoid During Enrollment

• Waiting until the last minute to enroll

• Not comparing multiple plans or checking network/drug coverage

• Overlooking financial assistance eligibility

• Not updating income or household information if it changes during the year

• Choosing the wrong metal tier for your needs

• Not making the first premium payment to activate coverage

State-Specific Health Programs or Initiatives

• Healthy Connections: South Carolina’s Medicaid and CHIP program.

• Navigator Assistance: Free enrollment help is available statewide from local organizations and Navigator programs, with a focus on underserved communities.

• South Carolina Health Insurance Pool: A safety net for those unable to obtain insurance due to medical conditions or high premiums.

• Public Health Initiatives: Partnerships and task forces to increase health equity and access for people with disabilities.

• Medicaid Expansion: South Carolina has not expanded Medicaid, leaving some adults in a coverage gap, but studies continue to highlight potential benefits if expansion occurs in the future.

South Carolina’s Marketplace offers a variety of plans, robust consumer protections, and strong assistance resources for residents seeking affordable health coverage.