ACA Health Insurance in South Carolina: Your Complete Guide to Affordable Care Act Plans, Marketplace Subsidies & Finding the Right Coverage

Did you know that thousands of South Carolina residents are paying MORE than they need to for health insurance — or going without coverage altogether — simply because they don't know what help is available? At Mauldin Insurance Group in Lexington, SC, we help individuals, families, and self-employed South Carolinians navigate the ACA Marketplace, find available subsidies, and get covered — often for far less than they expected.

 

Whether you're self-employed, between jobs, aging off a parent's plan, or simply not offered health insurance through your employer, the Affordable Care Act (ACA) Marketplace may be one of the best options available to you. But understanding how it works — the tiers, the subsidies, the enrollment windows, and the fine print — can feel overwhelming.

That's where we come in. This guide will walk you through everything you need to know about ACA health insurance in South Carolina, and show you exactly how Mauldin Insurance Group makes the process simple, personal, and stress-free.

 

What Is the ACA Marketplace? A Plain-English Overview

The Affordable Care Act, signed into law in 2010 and often called 'Obamacare,' created the Health Insurance Marketplace — a regulated system where individuals and families can shop for, compare, and enroll in private health insurance plans. In South Carolina, residents access the federal marketplace at HealthCare.gov.

ACA plans are required by law to cover a core set of essential health benefits, including:

• Doctor visits and preventive care (including annual physicals, vaccinations, and screenings — often at no cost to you)
• Hospitalization and emergency care
• Prescription drug coverage
• Mental health and substance use disorder services
• Maternity and newborn care
• Pediatric care including dental and vision for children
• Rehabilitation services for recovery from illness or injury
• Chronic disease management and lab services

 

Every plan on the Marketplace must offer these benefits. What differs between plans is how costs are shared between you and your insurer — which is where the metal tiers come in.

 

Understanding ACA Plan Tiers: Bronze, Silver, Gold & Platinum

ACA plans are grouped into four metal tiers based on how costs are split. The tier doesn't reflect the quality of care — it reflects how you and the insurance company share costs.

 

Plan Type	Deductible	Monthly Premium	Best For	MIG Can Help?
Bronze	High ($6,000–$8,000)	Lowest	Healthy, young adults	✓ Yes
Silver	Moderate ($3,000–$5,000)	Mid-range	Most families, subsidy eligible	✓ Yes
Gold	Lower ($1,000–$3,000)	Higher	Frequent medical needs	✓ Yes
Platinum	Very Low (<$1,000)	Highest	Chronic conditions	✓ Yes

 

Important: If you qualify for cost-sharing reductions (CSRs), you must enroll in a Silver plan to receive that extra savings on deductibles and copays. This is one of the most commonly missed opportunities we see at Mauldin Insurance Group — and it can save families thousands of dollars per year.

 

ACA Subsidies: How Much Can You Save in South Carolina?

One of the biggest misconceptions about ACA health insurance is that it's expensive. The truth? Many South Carolinians qualify for significant financial assistance that dramatically reduces their monthly premiums — and many don't even know it.

Premium Tax Credits (PTCs)

Premium Tax Credits are subsidies that lower your monthly health insurance premium. They are available to individuals and families who:

• Have household income between 100% and 400% of the Federal Poverty Level (FPL)
• Do not have access to affordable employer-sponsored insurance
• Are not eligible for Medicaid or Medicare
• Are enrolled through the HealthCare.gov Marketplace

 

Thanks to the American Rescue Plan and the Inflation Reduction Act, enhanced subsidies have been available that cap what you pay at a percentage of your income — meaning many middle-income families pay far less than they'd expect for comprehensive coverage.

 

Real-World Example: A family of four in Lexington, SC earning $70,000/year may qualify for hundreds of dollars per month in premium tax credits. A single person earning $35,000 could reduce their monthly premium to as little as $0–$50/month depending on the plan. Mauldin Insurance Group runs your numbers for free so you know exactly what you'll pay before you commit.

 

Cost-Sharing Reductions (CSRs)

In addition to lower premiums, some lower-income households also qualify for Cost-Sharing Reductions. CSRs reduce your out-of-pocket costs — things like your deductible, copays, and maximum out-of-pocket limit. To get CSRs, you must enroll in a Silver plan through the Marketplace.

CSRs are available to individuals and families with household incomes between 100% and 250% of the Federal Poverty Level.

 

South Carolina & the ACA: What You Need to Know Locally

South Carolina has not expanded Medicaid under the ACA, which means there is a coverage gap for some low-income adults who earn too little to qualify for Marketplace subsidies but do not qualify for SC Medicaid. If you fall into this gap, Mauldin Insurance Group can help you explore alternative options and short-term coverage solutions.

For those who do qualify for Marketplace plans, South Carolina residents have access to a variety of carriers and plans. The landscape of available insurers and plans changes annually, which is one of the key reasons it's so valuable to work with a local independent agent who reviews your options every year.

Lexington County and the surrounding Midlands region — including Columbia, Cayce, West Columbia, Gilbert, Batesburg-Leesville, Chapin, and Irmo — all fall within South Carolina's ACA Marketplace coverage areas. Mauldin Insurance Group serves clients throughout the entire state, from the Upstate to the Lowcountry.

 

When Can You Enroll? Understanding Enrollment Periods

Open Enrollment Period (OEP)

The primary window to shop for and enroll in ACA Marketplace coverage runs from November 1 through January 15 of the following year. Coverage purchased during Open Enrollment typically begins January 1 (if enrolled by December 15) or February 1 (if enrolled between December 16 and January 15).

Special Enrollment Periods (SEPs)

Life changes can open a 60-day Special Enrollment Period outside of Open Enrollment. Qualifying life events include:

• Losing job-based health coverage
• Getting married or divorced
• Having a baby, adopting a child, or placing a child for adoption or foster care
• Moving to a new state or ZIP code
• Aging off a parent's plan at 26
• A change in income that affects your subsidy eligibility
• Gaining citizenship or lawful presence status

 

If you've had a qualifying life event, time matters. Miss the 60-day SEP window and you may have to wait until Open Enrollment. Mauldin Insurance Group helps you act quickly and correctly when life changes happen.

 

Why Work With an Independent Insurance Agent Like Mauldin Insurance Group?

You have a few options when shopping for ACA coverage: you can go directly to HealthCare.gov, work with a navigator, or work with a licensed independent insurance agent like Mauldin Insurance Group. Here's why working with us makes such a meaningful difference:

We Work for YOU — Not the Insurance Company

As an independent agency, Mauldin Insurance Group is not captive to any single insurance carrier. We represent multiple carriers and compare plans side-by-side on your behalf. Our job is to find the best coverage at the best price for your specific situation — full stop.

We Know South Carolina

We're your neighbors. We live and work in Lexington County. We understand the local healthcare landscape, the hospital networks, the pharmacy access, and the nuances that matter to people right here in our community. We're not a call center in another state — we're down the road.

We Do the Math For You

Subsidy calculations, cost-sharing structures, deductibles, out-of-pocket maximums, network restrictions — these details matter, and they can be confusing. We break it all down in plain language so you can make a truly informed decision.

We're With You Year-Round

Our relationship doesn't end when you enroll. We're here when you have billing questions, need help filing a claim, want to add a family member, or when Open Enrollment comes back around and it's time to review your options again.

Our Services Are Free to You

That's right — there is no additional cost to working with Mauldin Insurance Group. We are compensated by the insurance carriers, not by our clients. You get expert, personalized guidance at no cost to you.

 

Ready to Find Your Perfect ACA Plan? Getting started takes just a few minutes. No obligation, no pressure — just honest answers from people who care. 📞 Call or Text: 843-509-2462 🌐 MauldinInsuranceGroup.com 📍 Proudly serving Lexington, Columbia & all of South Carolina

 

Who Should Consider an ACA Marketplace Plan?

ACA Marketplace plans are a great fit if you are:

• Self-employed or a freelancer without access to group coverage
• A small business owner who doesn't have employer-sponsored insurance
• Between jobs and have lost your employer coverage (COBRA is often very expensive — an ACA plan may be far more affordable)
• Turning 26 and aging off your parent's health plan
• A part-time worker not eligible for employer health benefits
• A recent college graduate entering the workforce
• An early retiree (ages 55–64) who isn't yet eligible for Medicare
• Newly married and navigating insurance for the first time together
• A new South Carolina resident who needs to establish local coverage

 

If any of these describe you, there's a strong chance the ACA Marketplace has a plan that fits your life and your budget. Let Mauldin Insurance Group help you find out.

 

Frequently Asked Questions About ACA Insurance in South Carolina

Q: What is the income limit to qualify for ACA subsidies in 2026?

A: For 2026, enhanced subsidies under the Inflation Reduction Act remain available. Individuals and families with household incomes above 100% of the Federal Poverty Level can qualify for Premium Tax Credits. There is no hard upper income limit thanks to the enhanced subsidy rules — even middle and upper-middle income households may qualify if their premium costs exceed a certain percentage of their income. Contact Mauldin Insurance Group for a free subsidy estimate based on your specific household income and size.

 

Q: Can I get ACA coverage if I'm self-employed?

A: Absolutely. Self-employed individuals — including freelancers, gig workers, independent contractors, and small business owners — are among the most common ACA enrollees. Because you don't have access to employer-sponsored coverage, you can shop the full Marketplace and may qualify for significant premium subsidies. Mauldin Insurance Group specializes in helping self-employed South Carolinians find the right plan at the right price.

 

Q: What happens if I miss Open Enrollment?

A: If you miss the Open Enrollment Period (November 1 – January 15), you generally cannot enroll in a Marketplace plan until the next Open Enrollment unless you experience a qualifying life event that triggers a Special Enrollment Period. Qualifying events include losing other health coverage, moving, getting married, having a baby, and others. Don't wait — if you've had a qualifying event, call us immediately, because the SEP window is only 60 days.

 

Q: How does an ACA plan compare to COBRA?

A: COBRA allows you to continue your employer's health plan after leaving a job, but you pay the full premium — including the portion your employer used to pay — plus an administrative fee. This can often cost $600–$1,500+ per month for an individual or $1,500–$3,500+ for a family. An ACA Marketplace plan, especially one with subsidy assistance, is frequently far more affordable. Mauldin Insurance Group can compare COBRA to ACA options for you so you can make the smartest financial decision.

 

Q: Does South Carolina have Medicaid expansion?

A: No. South Carolina has not expanded Medicaid under the ACA. This means that some low-income adults who earn too little to qualify for Marketplace subsidies may fall into a coverage gap. If you are in this situation, Mauldin Insurance Group can discuss other coverage options that may be available to you.

 

Q: Can I keep my current doctor with an ACA plan?

A: It depends on the plan's network. Different ACA plans (HMO, PPO, EPO) have different network structures. Some plans require you to use in-network providers, while others give you more flexibility. Before you enroll, Mauldin Insurance Group checks whether your preferred doctors and hospitals are in-network — something many people overlook when shopping on their own.

 

Q: Are prescription drugs covered by ACA plans?

A: Yes. All ACA Marketplace plans are required to cover prescription drugs as one of the ten essential health benefits. However, the specific drugs covered and the cost-sharing for each tier of drugs vary by plan. If you take specific medications, Mauldin Insurance Group can help you find a plan whose drug formulary includes your prescriptions at the most affordable cost.

 

Q: How do I know if I qualify for a Special Enrollment Period right now?

A: The best way to find out is to speak with a licensed insurance agent. Mauldin Insurance Group can review your situation — recent job loss, move, marriage, birth of a child, or other life event — and determine whether you qualify for an SEP and help you enroll quickly and correctly. Call us at 843-509-2462 or visit MauldinInsuranceGroup.com.

 

Q: Is there a penalty for not having health insurance?

A: At the federal level, the individual mandate penalty was reduced to $0 starting in 2019, so there is no federal tax penalty for being uninsured. However, going without health coverage still carries significant financial risk — one hospitalization or serious illness can result in tens of thousands of dollars in medical bills. Having coverage protects your financial health as much as your physical health.

 

Q: Why should I use Mauldin Insurance Group instead of going directly to HealthCare.gov?

A: Working through HealthCare.gov yourself gets the job done, but you won't have a licensed expert comparing plans for you, checking your subsidy eligibility, verifying your doctor's network, reviewing your prescription drug coverage, or following up when issues arise. Mauldin Insurance Group provides all of this — at no additional cost to you, because we are compensated by the insurance carriers. You get expert help for free. It's one of the smartest decisions you can make when enrolling in health coverage.

 

 

Start Your Journey to Better Coverage Today

Health insurance is one of the most important financial decisions you make each year. The right plan protects your health, your family, and your finances. The wrong plan — or no plan at all — can leave you exposed to costs that follow you for years.

At Mauldin Insurance Group, we've built our reputation in Lexington, SC by doing things the right way: with honesty, expertise, and genuine care for every person we serve. We're not here to sell you the most expensive plan — we're here to find you the right one.

Whether you're enrolling for the first time, reconsidering your current coverage, or helping a family member find a plan, we're ready to help. The consultation is free. The guidance is real. And the difference it makes can be significant.

 

Let's Find the Right Plan for You. No pressure. No jargon. Just honest help from people who care. 📞 Call or Text: 843-509-2462 🌐 MauldinInsuranceGroup.com 📍 Lexington, SC | Serving All of South Carolina