South Carolina residents shop for ACA health plans through HealthCare.gov, the federal marketplace, since the state runs no exchange of its own.
South Carolina has not adopted Medicaid expansion under the ACA. This leaves a coverage gap for adults who earn too little to qualify for marketplace subsidies but don't meet the state's traditional, narrower Medicaid eligibility categories.
Because of this gap, South Carolina residents should check subsidy eligibility closely during enrollment, since even a small change in estimated household income can shift eligibility for premium tax credits. Community health centers and free or reduced-cost clinics can also be a useful supplement for residents who remain without an affordable coverage option after checking marketplace plans.