COBRA Alternatives in South Carolina (2026)

Your options after leaving a job in South Carolina

If you leave a job in South Carolina, your options depend on your employer's size. Employers with 20 or more workers generally must offer federal COBRA, which can last up to 18 months, but you pay the full premium plus up to a 2% fee.

Smaller employers with fully insured group plans fall under South Carolina's continuation law. If you were covered for at least six months, you can keep the plan for the rest of the month it ends plus six more months, paying the whole group premium. You cannot use it if you are eligible for Medicare or for similar group coverage elsewhere.

Losing job-based coverage also gives you a 60-day special enrollment period for a Marketplace plan. If your income dropped, tax credits based on your new expected yearly income may make a Marketplace plan cheaper than COBRA.

If your income fell very low, check Healthy Connections Medicaid. Because the state has not expanded Medicaid, adults without children usually qualify only through disability, pregnancy or another specific group, and parents qualify only at very low income.

How federal COBRA works

Federal COBRA lets you keep your former employer’s group plan if the employer had 20 or more employees. Coverage usually lasts up to 18 months, and you can be charged the full premium plus a 2% administrative fee, because your employer stops paying its share.

You generally have 60 days from your election notice to choose COBRA. Coverage is retroactive, so some people wait and only elect it if they need care during that window. Talk to an agent before relying on that, because missing the deadline ends the option.

South Carolina mandatory continuation privilege (S.C. Code Section 38-71-770)

If your group coverage ends for any reason other than not paying your share, you can keep it for the rest of that month plus six more months, paying the full group premium yourself. This is much shorter than federal COBRA's 18 months, and it does not apply if you are eligible for Medicare, eligible for similar group coverage elsewhere, or entitled to longer continuation under federal law.

• Who it covers: Employees covered under a fully insured group hospital, surgical or major medical policy issued or renewed in South Carolina who were insured continuously for at least six months. It matters most for workers at employers too small for federal COBRA.
• How long: The rest of the month coverage ends, plus 6 more months

Marketplace plans and your special enrollment period

Losing job-based coverage opens a 60-day special enrollment period, so you don’t have to wait for open enrollment. In South Carolina, HealthCare.gov is the federal government’s official marketplace for South Carolina. We’re an independent, licensed insurance agency, not part of HealthCare.gov or any government agency, and we can help you compare Marketplace plans and enroll. South Carolina uses the federal Marketplace. For 2027 coverage, enroll by December 15, 2026 if you want your plan to start January 1.

Marketplace premiums are based on your expected income for the year, not last year’s. If you’re between jobs, a lower income estimate can mean a much larger premium tax credit. The enhanced federal premium tax credits ended on December 31, 2025. The House passed a three-year extension in January 2026, but the original rules apply for 2026, so households earning more than 400% of the federal poverty level no longer get any premium tax credit and others pay a larger share of income. Even so, more than 89% of South Carolina Marketplace enrollees qualified for help in 2026, and the average subsidized enrollee paid about $76 a month.

If your income dropped

South Carolina has not expanded Medicaid, so there is no general Medicaid category for working-age adults without children. Parents and caretakers with a child at home qualify only with income at or below 62% of the poverty level (about $825 a month for a single person). Adults without children may qualify only through specific groups, such as disability, pregnancy, breast or cervical cancer treatment, or former foster care up to age 26.

About 63,000 uninsured South Carolina adults fall into the coverage gap (KFF estimate for 2024): their income is below the poverty line, too low for Marketplace tax credits, but they do not fit a Medicaid category. A limited Family Planning benefit is available to adults with income at or below 194% of the poverty level, but it is not full health coverage.

What coverage costs