2026 South Carolina ACA Marketplace Rate Changes: The Full Tracker
Every approved 2026 rate change for every SC ACA marketplace carrier. BlueCross BlueShield SC, Ambetter, Molina, UHC, Select Health, First Choice Next. Average +21% gross rate increase before subsidy cliff.
2026 SC ACA Marketplace Rate Changes: The Full Tracker
Every year, carriers on the South Carolina ACA marketplace file proposed rate changes with the SC Department of Insurance. Those rates get reviewed, sometimes adjusted, and ultimately approved for the following plan year. For plan year 2026, the picture is the sharpest jump SC has seen since 2018. This page tracks every approved 2026 rate change, explains why they are so high this year, and walks through what it means for different household incomes in Summerville, Charleston, Mount Pleasant, Nexton, and the rest of the Lowcountry.
The Bottom-Line Numbers
SC 2026 Average Gross Rate Change: +21.0% across the entire marketplace.
That is the weighted average of all approved plans across all carriers. Individual plans vary from about +15% to over +30% depending on the carrier, the plan tier, and the county. “Gross” rate change means the sticker price before premium tax credits are applied — which matters because the 2026 subsidy cliff means many more SC households will see the sticker price as their actual monthly bill.
2026 Approved Rate Changes by Carrier
| Carrier | 2026 Avg Gross Rate Change | Affected Members (approx.) | Primary Reason Cited |
|---|---|---|---|
| BlueCross BlueShield of South Carolina | +19.8% | ~314,000 | Actuarial adjustments, expiration of enhanced subsidies, expected enrollment changes |
| Ambetter from Absolute Total Care | +27.3% | ~180,000 | Utilization trend, pharmacy costs, risk pool adjustment |
| Molina Healthcare of South Carolina | +24.5% | ~95,000 | Medical cost trend, risk adjustment, subsidy sunset |
| UnitedHealthcare | +21.0% (SC average) | ~25,000 | Hospital and pharmacy cost inflation |
| Select Health of South Carolina | +18.5% (est.) | ~15,000 | Standard medical trend |
| First Choice Next | +20.0% (est.) | ~12,000 | Standard medical trend, subsidy sunset |
| InStil Health | +17% (est.) | <5,000 | Limited footprint, early market share |
Sources: ACA Signups SC rate tracker (acasignups.net/rate_changes/2026/sc), SC Department of Insurance final rate approvals, carrier press releases, HealthInsurance.org SC marketplace guide.
Why Are 2026 Rates So High?
Two things happened at once. Neither alone would have been this dramatic. Together, they created the sharpest rate shock SC families have seen in nearly a decade.
1. The Subsidy Cliff Returned on January 1, 2026
Enhanced Premium Tax Credits — the larger, expanded subsidies introduced by the American Rescue Plan Act in 2021 and extended by the Inflation Reduction Act in 2022 — expired on December 31, 2025. They were not renewed. That means for 2026:
- Households above 400% of the Federal Poverty Level ($60,240 for a single person, $120,480 for a family of four in 2026) no longer receive any premium tax credit at all. Their subsidy dropped from whatever it was in 2025 to zero overnight.
- Households below 400% FPL still receive premium tax credits, but under the original pre-ARPA formula, which means the credit is smaller than it was in 2025.
Carriers knew this was coming. They filed 2026 rates assuming the subsidy cliff would return. Part of the +21% SC average rate increase is a reflection of carriers anticipating a worse risk pool (healthier people dropping coverage when their subsidies disappear, leaving a sicker average population).
2. Medical and Pharmacy Trend Is Running Hot
The underlying medical cost trend (hospital, physician, pharmacy, specialty drug) has been running at roughly 7-9% per year in the US, and has been compounding for several years. SC carriers have been absorbing some of this through plan design changes (higher deductibles, narrower networks), but 2026 was the year the absorption stopped and the real cost landed on premiums.
Specialty drug costs (GLP-1s, cancer treatments, gene therapies) are a particularly large driver. Some carriers cited GLP-1 utilization as individually responsible for 2-4% of their rate increase.
What This Means for Different Households
Household #1: Self-Employed Family of Four in Summerville, Income $145,000
- 2025: Paying $680/month after subsidy (benchmark Silver plan)
- 2026: Subsidy dropped to zero. Now paying full sticker price of about $1,420/month.
- Monthly increase: ~$740
- Annual impact: ~$8,880 more than 2025
This is the most painful category. Households in this range are above the subsidy cliff and saw their costs roughly double overnight.
Household #2: Individual 28-Year-Old in Charleston, Income $45,000
- 2025: Paying $50/month after subsidy
- 2026: Still subsidy-eligible (at ~295% FPL), but under the old pre-ARPA formula. Now paying about $140/month.
- Monthly increase: ~$90
- Annual impact: ~$1,080 more than 2025
Less dramatic but still significant for someone earning $45K.
Household #3: Retired Couple in Mount Pleasant, Age 62, Income $95,000
- 2025: Paying $420/month after subsidy (benchmark Silver for a couple)
- 2026: Above 400% FPL for a household of two ($81,760). Now paying full sticker price of about $1,850/month.
- Monthly increase: ~$1,430
- Annual impact: ~$17,160 more than 2025
This is the demographic hit hardest. Early retirees bridging to Medicare with private coverage routinely saw monthly increases over $1,000.
Household #4: Small Business Owner with ICHRA in Nexton
ICHRA (Individual Coverage Health Reimbursement Arrangement) allows employers to reimburse employees for individual marketplace premiums pre-tax. ICHRA became much more attractive in 2026 because it lets small business owners provide tax-advantaged health benefits without dealing with group plan underwriting or the subsidy cliff hit. If you run a 5-50 employee business, 2026 is the year to audit whether ICHRA makes sense for your team. Read the ICHRA guide
Strategies to Reduce Your 2026 Premium
1. MAGI Reduction. If you are close to the 400% FPL cliff, contributing to a SEP-IRA, solo 401(k), HSA, or traditional IRA can reduce your Modified Adjusted Gross Income and potentially bring you back under the threshold. The math is worth running for anyone within $20,000 of the cliff.
2. Plan Tier Change. If you were on a Gold or Platinum plan in 2025 and your subsidy disappeared, switching to a Silver or Bronze plan for 2026 will lower your premium significantly. You trade some out-of-pocket exposure for a much lower monthly bill.
3. HSA-Eligible High-Deductible Plans. A high-deductible Bronze plan paired with an HSA gives you the cheapest monthly premium plus a tax-advantaged savings vehicle. Works well for healthy households.
4. Spousal Employer Coverage. If one spouse has access to an employer plan, check whether adding the family to that plan is cheaper than keeping marketplace coverage. Sometimes it is, sometimes it is not. The answer depends on employer contribution levels.
5. ICHRA (for business owners). If you own a business, you can set up an ICHRA and reimburse yourself for marketplace premiums pre-tax. This is not a subsidy workaround, but it is a meaningful tax-advantaged way to pay for coverage.
6. Catastrophic Plans. If you are under 30 OR have a qualifying hardship exemption, catastrophic plans offer the cheapest premium of all. Limited use case but worth knowing about.
7. Short-Term Plans (With Caution). Short-term medical plans are cheaper than ACA coverage but they do not cover pre-existing conditions, do not have essential health benefits, and do not protect you from medical underwriting. Only consider them if you are between jobs and need cheap bridge coverage for 1-3 months, and only with eyes wide open.
What to Watch for the Rest of 2026
- Congressional action on subsidies. There are ongoing discussions about whether Congress will extend the enhanced subsidies mid-year. If they do, retroactive application is possible but not guaranteed. We will update this page if legislation passes.
- Carrier rate re-filings. Some carriers may file mid-year adjustments if enrollment comes in significantly different than projections. We will track those here.
- 2027 rate filings (due mid-2026). Early signals on 2027 rates will start appearing in June-July 2026. I will update this page as those numbers come in.
Want to know how 2026 rate changes affect your specific household? Book a free consultation or call Michelle at (843) 594-1759. I will pull quotes across all six SC marketplace carriers for your exact situation and walk through the options with you.
Last updated: April 2026. Next scheduled update: July 2026 (mid-year carrier filings), November 2026 (2027 preliminary rates).