Moving to South Carolina creates an immediate health coverage decision, and the stakes are higher than in most states because South Carolina is one of 10 states that has not expanded Medicaid under the Affordable Care Act. The 40 expansion states plus DC extend free Medicaid to adults with incomes up to 138% of the Federal Poverty Level ($22,025 single, $45,540 family of 4 in 2026 per HHS ASPE guidelines). South Carolina does not. South Carolina's Medicaid program, called Healthy Connections and administered by the South Carolina Department of Health and Human Services (SCDHHS), generally covers only narrow categories: pregnant women (to approximately 194% FPL), children (Healthy Connections Kids to approximately 208% FPL), seniors and people with disabilities, and parents of dependent minor children at only approximately 62% FPL. Non-disabled adults without dependent children fall entirely outside Healthy Connections eligibility regardless of income. The 60-day Special Enrollment Period is your primary safety net for finding coverage after a South Carolina move. South Carolina uses the federally-facilitated Marketplace at healthcare.gov rather than a state-run exchange, so enrollment is centralized. Applying within the first two weeks of your move typically produces coverage starting the first of the following month, minimizing any gap between old coverage and new.
South Carolina's non-expansion status creates a coverage gap for an estimated 105,000 South Carolina adults who earn between 0% and 100% FPL and do not qualify for Healthy Connections or ACA Marketplace subsidies. Federal law set 100% FPL ($15,960 single in 2026) as the floor for ACA premium tax credits. Without Medicaid expansion, adults below that floor have no subsidized coverage pathway in South Carolina. Children fare far better: Healthy Connections Kids provides CHIP coverage for South Carolina residents under age 19 at household incomes up to approximately 208% FPL ($33,197 for a single adult with a child, approximately $68,640 for a family of 4 in 2026), and enrollment is year-round with no premiums and no cost-sharing. Check ACA income limits to see if your projected South Carolina income qualifies for premium tax credits, or review Medicaid income limits for the 2026 thresholds by household size. Most adults moving to South Carolina with incomes between 100% and 400% FPL ($15,960 to $63,840 single in 2026) will find that healthcare.gov Marketplace plans with premium tax credits are their best option, with Silver plans often available for $10 to $150 per month after the 2026 credit.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes people make when moving to South Carolina and switching health coverage:
- Assuming South Carolina has expanded Medicaid. South Carolina is one of 10 non-expansion states as of 2026. Adults moving from expansion states like California, New York, or Illinois lose Medicaid eligibility immediately and cannot re-apply in South Carolina at the same income level unless they qualify for specific Healthy Connections categories (pregnant, disabled, or parent with income under ~62% FPL).
- Waiting until the last week of the 60-day window. Marketplace enrollment processed after the 15th of a month produces coverage starting the first of the month after next, not the first of next month. A Day 55 enrollment means potentially 6 or more weeks of uncovered time.
- Using COBRA without comparing South Carolina Marketplace plans first. COBRA costs 102% of the full premium, typically $400 to $900 per month for an individual or $1,200 to $2,800 per month for a family. South Carolina Marketplace Silver plans with 2026 premium tax credits often run $10 to $200 per month after the credit, making COBRA rarely the better choice.
- Forgetting to cancel old state coverage. Maintaining simultaneous Marketplace plans in two states creates subsidy reconciliation issues on your 1095-A tax form. The IRS will reconcile any excess advance premium tax credit on your 2026 federal return, which can produce an unexpected tax bill.
- Not checking if your children qualify for Healthy Connections Kids. Even if you do not qualify for any Healthy Connections Medicaid program, your children under 19 may qualify for Healthy Connections Kids CHIP at household incomes up to approximately 208% FPL. Healthy Connections Kids has no premiums and no cost-sharing; enrollment is year-round.
- Reporting your old state's income for the ACA subsidy calculation instead of your projected South Carolina income. The Marketplace calculates subsidies based on your Modified Adjusted Gross Income (MAGI) from your move date through December 31, 2026, which may differ substantially from what you earned in your prior state.
South Carolina's Non-Expansion Status: What It Means for Adults Moving In
South Carolina's decision not to expand Medicaid under the ACA creates a coverage gap affecting roughly 105,000 South Carolina adults. Federal law set 100% of the Federal Poverty Level ($15,960 for a single adult in 2026) as the floor for ACA premium tax credits on the Marketplace. Without Medicaid expansion, South Carolina adults with incomes below 100% FPL have no subsidized coverage pathway: they earn too little for Marketplace subsidies and too much for traditional Healthy Connections Medicaid (which is generally unavailable to non-disabled adults without dependent children regardless of income). Healthy Connections, South Carolina's Medicaid program administered by SCDHHS at scdhhs.gov, extends standard coverage to pregnant women at approximately 194% FPL and to parents of dependent minor children at only approximately 62% FPL ($9,895 per year for a family of 2 in 2026). Non-disabled adults without dependent children receive no Healthy Connections benefit regardless of how low their income falls. Adults moving to South Carolina from an expansion state like California (Medi-Cal), New York, Massachusetts (MassHealth), or Illinois face an immediate coverage cliff if their income is below the poverty line and they are not pregnant or parents of minor children.
Adults moving to South Carolina who fall in the coverage gap (income below 100% FPL, not pregnant, not a parent of a minor child) face limited options. The ACA Marketplace cannot help below 100% FPL. Healthy Connections Medicaid cannot help without qualifying category status. Community health centers (federally qualified health centers, or FQHCs) operate across South Carolina and offer primary and preventive care on a sliding-fee scale for uninsured adults, with fees as low as $20 to $40 per visit. Find an FQHC near your South Carolina address at findahealthcenter.hrsa.gov. Free clinics and hospital charity care programs also exist in most South Carolina counties. For prescription costs, the $35 insulin cap under the IRA 2022 applies to Medicare but not to uninsured adults; GoodRx and manufacturer patient assistance programs remain the primary cost-reduction tools for the uninsured in South Carolina.
Healthy Connections Kids: South Carolina CHIP Coverage for Children After Your Move
Healthy Connections Kids is South Carolina's Children's Health Insurance Program (CHIP), providing free coverage with no premiums and no cost-sharing for uninsured children under age 19 whose households meet income requirements. South Carolina operates Healthy Connections Kids as a Medicaid-expansion CHIP model, meaning coverage is provided through the Healthy Connections (Medicaid) infrastructure rather than a separately branded CHIP program. In 2026, Healthy Connections Kids covers children in households with incomes up to approximately 208% of the Federal Poverty Level: roughly $33,197 for a household of 1, $45,011 for a household of 2, and $68,640 for a household of 4 per SCDHHS 2026 guidelines. Enrollment is year-round with no SEP deadline required. Benefits include well-child visits, immunizations, dental care, vision, mental health, and prescription drugs. Apply through the Healthy Connections Citizen Portal at apply.scdhhs.gov or by calling SCDHHS at 1-888-549-0820. Your children may qualify for Healthy Connections Kids even if you as an adult do not qualify for any Healthy Connections Medicaid program.
Documents Needed for Your South Carolina Health Coverage SEP Application
Healthcare.gov requires two categories of documentation for a move-triggered Special Enrollment Period in South Carolina: proof of South Carolina residency and proof of prior minimum essential coverage. South Carolina residency proof must show your physical address (not a PO box) and should be dated within 60 days of your move date; a signed lease or mortgage statement, a utility connection bill, or a bank statement with the South Carolina address all qualify. Prior coverage proof is the document most applicants fail to gather in advance. Your prior insurer is legally required under HIPAA Section 9831 to provide a Certificate of Creditable Coverage within a reasonable time after your coverage ends; request it by phone or email immediately after your South Carolina move. If you had Medicaid in your prior state, the termination notice from that state's Medicaid agency serves as the prior coverage document. For employer coverage, the COBRA election notice or the employer-provided coverage termination letter works. Without prior coverage documentation, healthcare.gov may pend your SEP application for manual review, which can delay your coverage start date by weeks. Request the HIPAA Certificate before you move if you can, as prior insurers sometimes take 7 to 14 days to issue it.
COBRA vs South Carolina Marketplace: Which Should You Choose After Moving?
After moving to South Carolina and leaving employer coverage in another state, two continuation pathways are typically available: COBRA continuation from your prior plan and a new ACA Marketplace plan through healthcare.gov. COBRA preserves your old plan at 102% of the full premium. For individual coverage that averaged $600 to $700 per month in total employer cost, COBRA often runs $612 to $714 per month; for family coverage that averaged $1,800 per month, COBRA runs $1,836 per month or more. COBRA is federally required for employers with 20 or more employees and lasts 18 months for most job-separations and up to 36 months for events like divorce or death. South Carolina Marketplace Silver plans, by contrast, drop most enrollees with household incomes between 100% and 400% FPL to $10 to $200 per month after 2026 premium tax credits. The trade-off is that you will likely need to select new in-network providers in South Carolina rather than retaining your prior-state doctors. The practical decision matrix: choose COBRA only if you are in the middle of an active course of treatment (surgery recovery, chemotherapy, an ongoing specialty referral) with a specific provider who is not in any South Carolina Marketplace network, or if you have already met a large annual deductible you want to preserve. Otherwise, compare healthcare.gov Silver plans first using the move SEP, and use COBRA only as a temporary bridge if needed.
Frequently Asked Questions
How long do I have to get health insurance after moving to South Carolina?
You have 60 days from the date you establish South Carolina residency to enroll in an ACA Marketplace plan through healthcare.gov using the move-triggered Special Enrollment Period (SEP). For example, if you moved to South Carolina on June 13, 2026, your SEP window runs through August 12, 2026. Healthy Connections Medicaid programs (including Healthy Connections Kids CHIP) have no enrollment deadline and accept applications year-round. Miss the 60-day Marketplace window and you must wait until ACA Open Enrollment, which runs November 1 through December 15, 2026 for 2027 coverage, unless another qualifying life event occurs. The 2026 to 2027 OEP is shorter than prior years under new federal rules.
Does South Carolina have Medicaid expansion? What does that mean if I move there?
South Carolina has not expanded Medicaid under the ACA. Standard Healthy Connections (SC Medicaid) for non-disabled adults without dependent children provides no coverage at any income level. If you move from an expansion state like California, New York, or Massachusetts, your prior Medicaid ends immediately and South Carolina's Healthy Connections will not provide equivalent coverage for most adults. Pregnant women may qualify up to approximately 194% FPL. Parents of dependent minor children qualify at approximately 62% FPL, an extremely low threshold. Adults with incomes between 100% and 400% FPL should apply for ACA Marketplace subsidies at healthcare.gov. Adults below 100% FPL who are not in a qualifying category fall into South Carolina's coverage gap, which affects roughly 105,000 residents.
What is Healthy Connections Kids and can my children enroll after we move to South Carolina?
Healthy Connections Kids is South Carolina's CHIP program, providing free coverage with no premiums or cost-sharing to uninsured children under age 19. In 2026, South Carolina covers children in households with incomes up to approximately 208% of the Federal Poverty Level. For a family of 4, that is approximately $68,640. Enrollment is year-round with no deadline; you can apply at any time after establishing South Carolina residency through the Healthy Connections Citizen Portal at apply.scdhhs.gov or by calling SCDHHS at 1-888-549-0820. Your children may qualify for Healthy Connections Kids even if you as an adult do not qualify for any Healthy Connections Medicaid program.
What documents do I need to apply for the move SEP at healthcare.gov?
Healthcare.gov requires proof of South Carolina residency and proof of prior minimum essential coverage for at least one day in the 60 days before your move. For South Carolina residency: a signed lease, mortgage statement, utility bill, or bank statement at your South Carolina address dated within 60 days of the move. For prior coverage: a HIPAA Certificate of Creditable Coverage from your prior insurer, your prior Marketplace plan termination notice, your prior-state Medicaid termination letter, or your employer's COBRA election notice. Gather the prior coverage document before you move if possible. Without it, your SEP application may be pended for manual review, delaying coverage start by weeks. Your prior insurer must provide the HIPAA Certificate under Section 9831; request it immediately after your move.
Should I keep COBRA or switch to a South Carolina Marketplace plan?
For most people moving to South Carolina with incomes between 100% and 400% FPL ($15,960 to $63,840 single in 2026), a South Carolina Marketplace Silver plan with premium tax credits will cost significantly less than COBRA. COBRA charges 102% of your full prior premium, often $400 to $900 per month for an individual or $1,200 to $2,800 per month for a family. South Carolina Marketplace Silver plans with credits typically run $10 to $200 per month. The 60-day window for both the move SEP and COBRA election run concurrently. Choose COBRA only if you have ongoing treatment with a specific provider who is not in any South Carolina Marketplace network, or if you have already met a large annual deductible you want to preserve for the rest of 2026.
What if I was uninsured before moving to South Carolina? Can I still enroll?
Unfortunately, healthcare.gov's move-triggered SEP requires proof that you had minimum essential coverage for at least one day in the 60 days before your move. If you were uninsured before moving to South Carolina, you do not qualify for the move SEP. Your options are: (1) apply for Healthy Connections Kids for your children year-round at apply.scdhhs.gov, (2) apply for standard Healthy Connections if you are pregnant or meet another qualifying category, or (3) wait for the ACA Open Enrollment Period running November 1 through December 15, 2026 for 2027 coverage. Community health centers (FQHCs) in South Carolina offer sliding-scale primary care for the uninsured; find one at findahealthcenter.hrsa.gov.
Does South Carolina have its own health insurance marketplace or do I use healthcare.gov?
South Carolina uses the federally-facilitated Marketplace, meaning all ACA plan enrollment goes through healthcare.gov. South Carolina does not operate a separate state-based exchange. Log in to healthcare.gov, enter your South Carolina ZIP code, and select your qualifying life event (moving to a new coverage area). The site will show all available 2026 plans from private insurers in your South Carolina county, with real-time estimates of your premium tax credits based on the income you enter. Six private insurers offered plans on the 2026 SC Marketplace. If you prefer assistance, navigator organizations funded under the ACA can help you enroll for free; find one at localhelp.healthcare.gov.
What happens to my ACA subsidies from my prior state when I move to South Carolina?
Your prior state's Marketplace plan and associated premium tax credits end when you establish South Carolina residency. You must terminate the old plan in your old state's exchange or through healthcare.gov and enroll in a new plan through healthcare.gov for South Carolina. Your 2026 federal taxes will require reconciling the advance premium tax credits for both your prior-state plan and your new South Carolina plan using Form 8962 and your 1095-A tax form. Keeping two simultaneous Marketplace plans in different states creates subsidy reconciliation problems and a potential tax liability, so cancel the prior plan as soon as your South Carolina enrollment is confirmed.
