Hospital Indemnity · Under 65 · Greenville & the Upstate
Earn too much for an ACA subsidy, or tired of paying high Marketplace premiums for a plan you barely use? Hospital indemnity insurance pays you set cash amounts for hospital stays, surgery, ER and doctor visits, and you can apply any time of year. Poston Health compares options for individuals, families and self-employed people under 65 in Greenville, Spartanburg, Anderson and across the Upstate.
The extra ACA subsidies ended December 31, 2025, so the “subsidy cliff” is back. If your household income is over the cutoff, you pay the full premium yourself. Here’s what that looks like in Greenville County:
$63,840
Earn more than this as a single person and you get no ACA premium tax credit for 2027. The cutoff is $86,560 for a couple and $132,000 for a family of four.
$847/mo
Full price of the cheapest Bronze plan for a 60-year-old in Greenville County. A 60-year-old couple pays $1,694 a month, or $20,327 a year.
$7,500
Typical Bronze deductible per person before the plan pays its share. The typical out-of-pocket maximum is $10,000 a person, on top of your premiums.
| Age | Cheapest Bronze plan | Benchmark Silver plan |
|---|---|---|
| 30 | $354/month | $526/month |
| 40 | $399/month | $592/month |
| 50 | $557/month | $827/month |
| 60 | $847/month | $1,257/month |
| 64+ | $936/month | $1,390/month |
| Family of 4 (two 40-year-olds, two kids) | $1,275/month | $1,887/month |
And it’s going up again. South Carolina insurers asked for average increases of about 17% for 2027. If you’re healthy and rarely use your plan, that’s a lot to pay for coverage you may not use until you’ve spent $7,500.
Sources: CMS 2026 Rate and Plan Attributes Public Use Files, individual market, Greenville County (Rating Area 23), before tax credits; benchmark Silver = second-lowest-cost Silver plan; deductible and out-of-pocket maximum are medians for Greenville Bronze plans. Income cutoffs = 400% of the HHS 2026 poverty guidelines, which apply to 2027 coverage. 2027 increase is insurers’ requested average.
Hospital indemnity insurance is a fixed-benefit plan that pays a set amount of cash when you’re in the hospital, usually a daily amount for each day you’re admitted. Many plans for people under 65 also pay set amounts for surgery, emergency room and urgent care visits, doctor visits, lab work and imaging. You choose the benefit level when you apply, and the plan pays that amount no matter what the hospital bills.
There’s usually no deductible and no network to stay inside. You can buy a policy any month of the year, without waiting for Open Enrollment.
You’re admitted to the hospital, have surgery, visit the ER or urgent care, see a doctor or get a scan your policy covers.
Send the insurance company the claim form and your itemized bill. We’ll help you with your first one.
The plan pays the set benefit amount, no matter what the provider charges. Use it for the bill, rent, groceries or a lost paycheck.
If you’re paying full price for a Marketplace plan, you have other options. Many healthy people under 65 in the Upstate build their own coverage around a hospital indemnity plan instead. A typical setup looks like this:
Because these plans are priced on your age and health, not on the cost of a full ACA plan, a healthy person can often pay noticeably less each month. We’ll show you both side by side before you decide.
| Benefit | What one plan pays (example range) |
|---|---|
| Hospital stay | $1,000 to $2,000 a day |
| Hospital admission | $2,000 to $4,000 a year |
| ICU | $500 to $1,000 a day, on top of the hospital stay benefit |
| Inpatient or outpatient surgery | Up to $4,000 to $12,000, depending on the surgery |
| Emergency room | $500 to $1,000 a visit |
| Urgent care | $200 to $400 a visit |
| Doctor office visits | $50 to $150 a visit |
| MRI, CT or PET scan | $400 to $800 |
| Labs and X-rays | $50 to $100 |
| Ambulance | $500 to $1,000 ground, $1,500 to $3,000 air |
Example benefit levels from one hospital indemnity plan’s three benefit options, rounded. Not a quote. Benefits, maximums, exclusions and availability vary by insurance company, plan and state, and annual or per-period maximums apply.
Be clear on the trade-off. These plans pay set amounts, not your whole bill, and they have maximums. A long hospital stay, cancer treatment or a major surgery can cost more than the plan pays. That’s the risk you take for a lower premium. We’ll walk you through what’s covered and what isn’t so there are no surprises.
It’s a great fit for some people and the wrong choice for others. Here’s how we think about it:
Not sure? We’ll quote both. We help with individual and family health insurance on and off the Marketplace too, so we’ll tell you honestly which one costs less for you. See our 2027 ACA Open Enrollment guide.
| Hospital indemnity plan | ACA Marketplace plan | |
|---|---|---|
| Monthly premium | Based on your age, health and the benefits you pick | Based on age; full price if you’re over the subsidy cutoff |
| When you can buy | Any time of year | Open Enrollment (Nov 1 – Jan 15) or after a qualifying life event |
| Health questions | Yes. You can be declined | None |
| Pre-existing conditions | May be excluded or limited for a period | Covered |
| How it pays | Set cash amounts per day or service, paid to you | A share of the bill after your deductible |
| Deductible | Usually none | Typically $7,500 on Bronze |
| Doctors and hospitals | Any licensed provider | The plan’s network |
| Most you could owe | No cap. Costs above the benefits are yours | Capped by the out-of-pocket maximum (typically $10,000 on Bronze) |
| Meets ACA coverage rules? | No | Yes |
No. The federal tax penalty for going without ACA coverage dropped to $0 in 2019, and South Carolina doesn’t have a penalty of its own. (HealthCare.gov)
Singles over $63,840 and families of four over $132,000 pay full price on the Marketplace.
Business owners, contractors, realtors and gig workers buying their own coverage.
Retired before you’re eligible for other coverage and facing four-figure monthly premiums.
You rarely see a doctor and want protection from a big hospital bill.
Need coverage now and can’t wait for Open Enrollment.
Add hospital indemnity on top of a Bronze or HSA plan to cover your deductible.
We’re a locally owned, independent agency at 4115 E North St in Greenville. We also help with individual and family health insurance and employee benefits, so we can see your whole picture, not just one policy. Meet us by phone, online or in person.
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Hospital indemnity insurance is a fixed-benefit plan that pays you a set amount of cash when you’re admitted to the hospital, such as $1,000 a day. Many plans for people under 65 also pay set amounts for surgery, ER and urgent care visits, doctor visits, labs and imaging. The money goes to you, no matter what the provider charges.
It can be for healthy people under 65 who earn too much for a premium tax credit and pay full price for a Marketplace plan. Hospital indemnity plans can cost less per month, but they pay set amounts instead of covering your whole bill, and they have health questions and limits on pre-existing conditions. If you have ongoing health needs, an ACA plan is usually the safer choice.
For 2027 coverage, single people earning more than about $63,840, couples over about $86,560 and families of four over about $132,000 don’t get a premium tax credit. In Greenville County, the cheapest full-price Bronze plan is about $847 a month for a 60-year-old. A hospital indemnity plan, alone or with accident and critical illness coverage, is one lower-cost option to compare.
No. The federal penalty for not having ACA coverage was reduced to $0 starting in 2019, and South Carolina has no state penalty.
Yes. Hospital indemnity isn’t tied to ACA Open Enrollment, so you can apply any month of the year.
Usually not right away. Most plans ask health questions and may decline you or exclude pre-existing conditions for a period of time. We’ll explain each plan’s rules before you apply.
Yes. Hospital indemnity pays you set amounts no matter which licensed doctor or hospital you use, so there’s no network to stay in.
It depends on your age, health, the benefit levels you choose and any add-ons like accident or critical illness coverage. Poston Health compares plans from several insurance companies and shows you the price next to your ACA options. Call (864) 526-7702 for a quote.
No. Hospital indemnity is a limited-benefit plan. It isn’t major medical insurance, doesn’t have an out-of-pocket maximum and doesn’t meet the Affordable Care Act’s minimum essential coverage requirement.
Yes. Many people add it on top of a Bronze or high-deductible plan to help pay their deductible. IRS Publication 969 allows coverage that pays a fixed amount per day in the hospital alongside an HSA-eligible plan.
Poston Health, a licensed independent agency at 4115 E North St, Greenville, SC 29615, compares hospital indemnity plans for individuals, families and self-employed people under 65 across the Upstate. Call (864) 526-7702.
Tell us a little about your situation. A licensed agent will compare hospital indemnity and ACA options and call you to walk through them. No obligation. Please don’t include health details in this form.
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Important: Hospital indemnity, accident, critical illness and cancer policies are limited-benefit, fixed-indemnity insurance. They are not major medical insurance, are not a substitute for it, and do not meet the Affordable Care Act’s minimum essential coverage requirement. They pay set benefit amounts regardless of what the provider charges. Benefits, exclusions, limitations, waiting periods, pre-existing condition rules and availability vary by insurance company, policy and state, and eligibility may depend on answers to health questions. See the policy and outline of coverage for complete details. If you have one of these policies, you may still need major medical coverage, and you may be eligible for comprehensive coverage through the Health Insurance Marketplace at HealthCare.gov. Premium and income figures are from public CMS and HHS data and are shown for comparison only. Examples on this page are illustrations, not quotes.
