By Mauldin Insurance Group  |  Lexington, South Carolina  |  April 2026

 

You went out on your own. You're a freelancer, a contractor, a small business owner with no employees, or maybe someone who just left a corporate job to start something new. Congratulations — that takes guts.

But now comes the question nobody warned you about: where do you get health insurance?

When you were on a company plan, it was simple. HR handled it, your employer paid most of the premium, and you barely thought about it. Now that you're self-employed here in the SC Midlands, health insurance is entirely on you — and the options are more confusing than they need to be.

This guide cuts through the noise. Here's exactly what your options are, what they cost, and how to figure out which one makes sense for your situation.

 

 

Option 1: The ACA Marketplace (Healthcare.gov)

The Affordable Care Act Marketplace — sometimes called the Exchange or Healthcare.gov — is the most common path for self-employed individuals and families in South Carolina. It's where you go to shop for individual and family health insurance plans when you don't have employer coverage.

The biggest advantage: subsidies. If your income falls between 100% and 400% of the federal poverty level — and for many self-employed people in the SC Midlands, it does — you may qualify for a premium tax credit that dramatically lowers your monthly cost. Some people qualify for plans under $50/month.

South Carolina uses the federal marketplace at Healthcare.gov. Open Enrollment typically runs November 1 through January 15 for coverage starting January 1. But if you recently left a job with employer coverage, you qualify for a Special Enrollment Period — giving you 60 days to enroll outside of Open Enrollment.

ACA Plan Tiers — What They Mean in Plain English:

• Bronze: Lowest monthly premium, highest deductible. Best if you're healthy and rarely use care — you're protecting against catastrophe.
• Silver: Middle ground. This is also the tier that triggers Cost-Sharing Reductions if you qualify income-wise — making it the sweet spot for many SC Midlands families.
• Gold/Platinum: Higher premium, lower deductible. Best if you have regular medical needs, take prescriptions, or have a family that uses healthcare frequently.

 

💡  SC Midlands Note In Lexington and Richland Counties, BCBS of South Carolina and Ambetter are typically the primary ACA carriers. Plan availability, network size, and provider access vary — this is exactly where an independent agent adds value by comparing options across carriers for you.

 

 

Option 2: Medicaid (SC Healthy Connections)

If your self-employment income is below a certain threshold, you may qualify for Medicaid through South Carolina's Healthy Connections program — even as an adult without children.

South Carolina has not expanded Medicaid under the ACA, which means eligibility is more limited than in other states. Adults without dependent children generally do not qualify unless they are pregnant, disabled, or meet specific criteria. However, if you have children in the household, they may qualify for CHIP coverage even if you do not qualify for Medicaid yourself.

We can help you quickly determine if Medicaid is an option for your household based on your income and family composition.

 

 

Option 3: A Spouse or Domestic Partner's Employer Plan

If your spouse or domestic partner has employer-sponsored coverage that offers dependent enrollment, this is often the most cost-effective option available. Employer group plans benefit from pooled risk and employer cost-sharing — two things you lose when you go to the individual market.

The catch: you typically can only enroll during your spouse's open enrollment period, or within 30 days of losing your own prior employer coverage (which qualifies as a life event). If you're newly self-employed and just left a job, act quickly — this window closes.

 

 

Option 4: COBRA — Temporary Bridge Coverage

If you recently left an employer, COBRA lets you continue your previous employer's group health plan for up to 18 months. The coverage is identical to what you had — same network, same plan — but you now pay the full premium that your employer was previously subsidizing, plus a 2% administrative fee.

COBRA is expensive. Employer group premiums average $7,000–$8,000/year for an individual and $22,000+ for a family — and you were probably only paying a fraction of that before. COBRA makes sense as a short-term bridge if you have a significant health situation or if your income will be variable in the first year of self-employment.

⚠️  Important Timing Note COBRA enrollment must be elected within 60 days of losing employer coverage. After that window closes, you cannot go back. If you're in the first 60 days since leaving your job, call us before that deadline — we can help you compare COBRA against ACA Marketplace options side by side.

 

 

Option 5: Health Care Sharing Ministries

Health care sharing ministries (HCSMs) are organizations where members share each other's medical costs. They are not technically insurance and are not regulated the same way. Plans are typically much cheaper than ACA plans and can be appealing on cost alone.

However, they come with significant limitations: pre-existing conditions may be excluded, there are no guaranteed benefits, mental health and substance abuse coverage is often absent, and members can be denied sharing for expenses that don't align with the ministry's religious guidelines.

Bottom line: HCSMs can work for very healthy individuals who understand the tradeoffs and want to minimize monthly cost. They are not a good fit for families with ongoing health needs, anyone who relies on regular prescriptions, or anyone who wants guaranteed coverage.

 

 

How Much Does Health Insurance Cost for Self-Employed SC Residents?

Here are illustrative 2026 monthly premium ranges for ACA Silver plans in Lexington County — before subsidies:

Household	Full Premium (no subsidy)	With Subsidy (estimate)
Individual, age 30	$280–$380/mo	$0–$120/mo*
Individual, age 45	$420–$560/mo	$50–$220/mo*
Individual, age 55	$580–$750/mo	$100–$380/mo*
Couple, both age 40	$840–$1,100/mo	$200–$550/mo*
Family (2 adults + 2 kids)	$1,400–$1,900/mo	$300–$900/mo*

 

* Subsidy estimates for SC Midlands households with income between 150%–300% of federal poverty level. Actual amounts depend on household size, income, and plan selected. Contact us for a personalized estimate.

 

 

The Self-Employed Tax Deduction You Might Be Missing

Here's a benefit most self-employed people in SC don't fully use: 100% of health insurance premiums you pay for yourself and your family are tax-deductible as an adjustment to income on your federal return — not just as an itemized deduction. This means the deduction applies even if you don't itemize.

If you're paying $600/month in premiums and you're in the 22% tax bracket, that's a $1,584 annual tax savings you'd be leaving on the table without this deduction. Your accountant or tax preparer should be handling this — but it's worth confirming.

 

 

Why an Independent Agent Is Your Best First Call

Healthcare.gov will show you plans. But it won't explain the difference between network types, help you check if your doctor is in-network, or tell you which Silver plan has the best prescription formulary for your specific medications.

As an independent agency here in Lexington, we work with multiple carriers. We can sit down with you, look at your income, your health situation, and your priorities — and help you find the right plan at the right price. No commission pressure to push you toward any particular carrier. Just honest advice.

That's what we're here for. Give us a call.

 

 

The Bottom Line

Being self-employed in the SC Midlands doesn't mean you have to settle for bad coverage or pay full freight for a health plan. With the right guidance, most self-employed individuals and families can find solid, affordable coverage — especially if subsidies apply.

Call us. We'll figure it out with you.

 

Get Your Free Quote Today No pressure. No jargon. Just honest guidance from your local Lexington, SC team. 📞 Call or Text Ben: 803-920-8827 🌐 mauldininsurancegroup.com/health-insurance 📍 Proudly serving Lexington, Columbia, Irmo, Chapin, Lake Murray & the SC Midlands