Shifting Tides in the South Carolina
Health Insurance Marketplace
An analysis of enrollment trends, consumer behavior, and geographic shifts between 2025 and 2026.
Executive Summary
Between 2025 and 2026, the South Carolina health insurance marketplace experienced a mild overall contraction in total enrollment. More notably, however, the underlying composition of these enrollments shifted dramatically. Consumers are migrating heavily toward lower-premium Bronze plans, abandoning Silver and Gold tiers. Simultaneously, the system is struggling to attract new enrollees and retain those who previously relied on auto-renewal. Geographically, while some mid-sized counties saw growth, major population hubs and specific counties like Spartanburg suffered steep declines.
Contextualizing the Contraction: The ACA Subsidy Lapse
A primary driver of these structural shifts and the overall decline in enrollment is the lapse of enhanced Advanced Premium Tax Credits (APTCs), originally expanded under the American Rescue Plan Act and Inflation Reduction Act. The expiration of these enhanced subsidies at the end of 2025 resulted in a sudden and significant increase in out-of-pocket premium costs for consumers. This "sticker shock" directly correlates with the mass migration from higher-tier (Silver/Gold) plans to more affordable Bronze plans, as well as the sharp drop in new consumer acquisition and the failure to retain auto-renewing members who may have been priced out upon renewal.
Note on Methodology: Data from York County has been excluded from this analysis due to identified reporting anomalies in the 2025 aggregate metrics.
Key Findings
Overall Enrollment
-3.0%
Slight decline in total active consumers across the state.
Bronze Plan Shift
+16.1%
Massive migration to Bronze tiers as Silver (-31.1%) and Gold (-32.4%) plummeted.
New Consumers
-17.1%
Sharp drop in first-time enrollees entering the marketplace.
Active Renewals
+2.6%
Slight increase in consumers actively shopping, offsetting a 12.4% drop in auto-renewals.
The Flight to Bronze
Affordability appears to be the primary driver of consumer behavior in 2026. The data shows a decisive abandonment of higher-tier metal plans in favor of the lowest-premium Bronze plans.
Consumer Engagement Crisis
The marketplace is struggling with acquisition and passive retention. The pipeline of new consumers has shrunk significantly, and fewer people are allowing their plans to auto-renew.
Geographic Disparities
Bucking the Trend (Growth)
While the state saw an overall decline, several counties experienced notable growth in total enrollments, suggesting localized outreach success or shifting demographics.
- Clarendon County +16.2%
- Florence County +11.0%
- Beaufort County +8.4%
Areas of Concern (Decline)
Major population centers suffered the highest absolute losses. Most concerning is Spartanburg, which saw an alarming structural collapse in enrollment.
- Spartanburg County -21.4% (-9,400+ enrollees)
- Greenville County -9.7% (-6,500+ enrollees)
- Horry County -9.3% (-5,200+ enrollees)
Interactive Data Explorer
Use the dashboard below to explore county-level demographics, income brackets (FPL), and enrollment shifts in detail.
