Before you start

South Carolina residence
Income information for subsidy or Medicaid eligibility
An SSN or ITIN for marketplace applications
Evidence of your move, if enrolling outside the annual window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date. Compare the deductible and out-of-pocket maximum rather than the premium alone. In this metro the strongest plans generally come from MUSC, Boeing, the port and the base — the hospitality sector's are much thinner.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use HealthCare.gov
South Carolina has no state exchange, so the federal marketplace is where you apply and where the advance premium tax credit is calculated. Open Enrollment runs on the federal calendar, from 1 November, and the dates are published on the site each year.
OnlineWho: You
3
Use the move as a Special Enrollment Period rather than waiting
A permanent move to a new area is a qualifying life event. Someone arriving in April can enrol in April; the window is generally 60 days. People sit uninsured for months because they assume the annual window is the only door.
OnlineWho: YouWithin 60 days of moving
4
Check whether you fall in the coverage gap before you assume a subsidy
Because South Carolina did not expand Medicaid, marketplace subsidies for adults start at the federal poverty level rather than below it. If your first-year income will be low — a spouse not yet working, a freelance ramp-up, part-time hospitality — model the actual number on HealthCare.gov before you rely on a subsidy that may not be there.
OnlineWho: You
5
Register with a primary care practice early
New-patient waits are long across the Lowcountry, and the metro has grown faster than its primary care capacity. Federally qualified health centres charge on a sliding fee scale regardless of insurance status and are the fallback worth knowing about before you need it.
In personWho: You
6
Make a hurricane plan that includes prescriptions and medical equipment
An evacuation order gives you days, not weeks. Keep a fortnight of medication, know whether your pharmacy chain has stores inland, and if anyone in the household needs powered medical equipment, register with the county's special-needs evacuation programme before the season starts rather than during a storm.
OnlineWho: YouBefore 1 June

Documents you’ll need

Proof of South Carolina residence
Income documentation for subsidies or Medicaid
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of your move or of losing prior coverage, for a Special Enrollment Period

Things most newcomers don’t know

South Carolina did not expand Medicaid, and that creates a real gap.

In expansion states, adults below 138% of the federal poverty level go on Medicaid. Here they do not, and marketplace subsidies for adults generally start at 100% of the poverty level — so someone earning below that can be too poor to qualify for help and still ineligible for Medicaid. It is the opposite of the intuition that lower income means more support, and it catches people whose first year here is lean.

Source: HealthCare.gov — Medicaid expansion and you

Moving here is itself a qualifying life event.

You do not have to wait until November. A permanent move to a new area opens a Special Enrollment Period, generally 60 days long. It is the single most useful thing to know about the US system in your first month, and it is the one most newcomers miss.

Source: HealthCare.gov — dates and deadlines

The teaching hospital is on the peninsula, and that is not incidental.

MUSC is an academic medical centre with the state's children's hospital, a level I trauma centre and the specialist services that would otherwise mean driving to Columbia or Atlanta. For a metro of this size, having tertiary care physically downtown is unusual and it is a genuine argument for the region if anyone in the household has a complex condition.

Source: HRSA — find a federally qualified health centre

Hurricane season is a health-planning problem, not just a property one.

Evacuation happens by zone with short notice, pharmacies close, and dialysis, oxygen and refrigerated medication all become logistics questions. County special-needs registries exist for exactly this and they want you signed up before the season, not during a storm.

Source: Ready.gov — hurricanes and evacuation planning

Common mistakes to avoid

Assuming Medicaid will catch you on a low income. In South Carolina it generally will not.
Waiting for November when moving here already opened a Special Enrollment Period.
Choosing on premium alone and meeting a five-figure deductible in January.
Not registering for a primary care practice until you are ill.
Entering hurricane season without a fortnight of medication and an inland pharmacy plan.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.