Coverage gap: South Carolina has not expanded Medicaid. Adults earning below $15,960/year (100% FPL) who don't fit traditional categories may have no affordable coverage option. Those above 100% FPL qualify for marketplace subsidies.
South Carolina Medicaid Income Limits 2026
The following table shows the key income thresholds for South Carolina in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | N/A | $63,840 |
| 2 | $21,640 | N/A | $86,560 |
| 3 | $27,320 | N/A | $109,280 |
| 4 | $33,000 | N/A | $132,000 |
| 5 | $38,680 | N/A | $154,720 |
| 6 | $44,360 | N/A | $177,440 |
Because South Carolina has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
About Healthy Connections
Who Qualifies in South Carolina
In South Carolina, your ability to qualify for Medicaid, known as Healthy Connections, is limited because the state has not expanded its program under the Affordable Care Act. This means most adults, particularly childless adults, will not be eligible regardless of how low their income is, creating a "coverage gap." Healthy Connections primarily serves children with household incomes up to 213% of the federal poverty level (FPL), pregnant women with household incomes up to 199% FPL, parents and caretaker relatives with dependent children if their household income does not exceed 100% FPL, and individuals who are aged, blind, or disabled. For example, a single parent with one child would need to have a monthly income below approximately $1,763 to qualify as a parent. For individuals 65 or older, blind, or disabled, the monthly income limit is $1,330 for a single person and $1,804 for a household of two, with asset limits of $9,950 for an individual and $14,910 for a couple. In 2024, approximately 1.42 million South Carolinians were covered by Medicaid, representing about 26.1% of the state's population.
If You're Near the Income Line
If your income is near the Medicaid cutoff, you might transition to marketplace coverage on HealthCare.gov. If your income is above 100% FPL (for an individual, that's $15,060 annually in 2024), you could be eligible for significant subsidies to help pay for a plan. For instance, with a benchmark Silver plan costing around $529 per month in South Carolina, subsidies can drastically reduce what you actually pay. It's important to report any income changes to the marketplace, as this could shift your eligibility between Medicaid and subsidies. During the recent unwinding of continuous Medicaid coverage, many South Carolinians lost their benefits, but if your circumstances change, you can reapply at any time.
What Healthy Connections Covers
Healthy Connections covers a wide range of medically necessary services, including doctor visits, hospital care, prescriptions, and medical equipment. The program generally has no cost-sharing for most services for those with full benefits. South Carolina also has specific programs like Healthy Connections Prime, a voluntary managed care program for seniors who are eligible for both Medicaid and Medicare, offering comprehensive benefits including home and community-based services. Additionally, the state resumed annual eligibility reviews for Medicaid members starting April 1, 2023, so if you receive a renewal form, completing it promptly is crucial to maintain your coverage.
Options in the Coverage Gap
For South Carolinians in the coverage gap—those with incomes too high for Medicaid but too low for marketplace subsidies—practical alternatives exist. Community health centers often offer services on a sliding scale based on your income. Many hospitals provide charity care programs to help uninsured patients with medical bills. Some counties may also have indigent care programs. Free clinics, such as the MUSC CARES Clinic in Mount Pleasant, offer free primary care and preventive services to uninsured adults. If your income increases and you rise above 100% FPL, remember to recheck HealthCare.gov, as you would then become eligible for marketplace subsidies to make health insurance more affordable. South Carolina's uninsured rate was approximately 9%, or 469,000 residents, in 2023, higher than the national average of 8.2%.
Marketplace Insurance in South Carolina
South Carolina residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in South Carolina costs approximately $529/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in South Carolina might pay for a Silver plan after subsidies, based on the $529/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $449/mo |
| 200% FPL | $31,920 | ~$173/mo | $356/mo |
| 250% FPL | $39,900 | ~$277/mo | $252/mo |
| 300% FPL | $47,880 | ~$392/mo | $137/mo |
| 400% FPL | $63,840 | ~$523/mo | $6/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in South Carolina. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. South Carolina uses the federal marketplace at HealthCare.gov.
How to Get Coverage in South Carolina
Your path depends on your income:
- Income above $15,960/year (100% FPL): You qualify for marketplace subsidies. Apply through HealthCare.gov during open enrollment (Nov 1 – Jan 15) or after a qualifying life event.
- Income below $15,960/year: Check if you qualify for traditional Medicaid (children, pregnant women, disabled). Apply through Healthy Connections.
- Children: South Carolina's CHIP program covers kids in families up to 200-300% FPL regardless of expansion status.
Calculate Your Subsidy in South Carolina
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in South Carolina.
Frequently Asked Questions
What is the income limit for Medicaid in South Carolina?
South Carolina has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Has South Carolina expanded Medicaid under the ACA?
No, South Carolina has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
How do I get help paying for health insurance in South Carolina?
South Carolina residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the South Carolina Medicaid program called?
South Carolina's Medicaid program is known as Healthy Connections. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
How do I keep my health insurance if I lose Medicaid in South Carolina?
If your Healthy Connections coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
I don't qualify for Medicaid or subsidies in South Carolina — what can I do?
If you're in the coverage gap (earning below $15,960/year but not qualifying for traditional Medicaid), look into community health centers in South Carolina that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
Will South Carolina ever expand Medicaid?
Medicaid expansion has been a politically contentious issue in South Carolina. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with South Carolina's legislative updates for the latest status.