Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
The original Medicare program was designed as a federally operated health insurance system for U.S. citizens and lawful immigrants aged 65 and older as well as younger citizens who have qualifying medical conditions.
Medicare Advantage combines all the benefits of Medicare Parts A and B, also called Original Medicare, into a single plan provided by a private insurer. It’s also known as Medicare Part C. All Medicare Advantage plans must provide the same coverage as Original Medicare as a baseline, but plan providers can also choose to offer additional coverage benefits. Many Medicare Advantage plans include dental, vision and wellness program benefits, as well as prescription drug coverage, none of which are included under Original Medicare.
Beneficiaries are responsible for paying their Medicare Part B premium and the premium of their Advantage plan unless they choose a zero-premium plan. The federal government administers the original Medicare, but not Medicare Advantage, so plan providers can set their own policies around eligibility, cost and physician networks.
This guide is designed to help South Carolina residents understand what Medicare Advantage plans are available in their state, as well as how much each plan costs and what it covers.
The Top 10 Medicare Advantage Plans in South Carolina
The table below lists the Top 10 most popular Medicare Advantage Plans in South Carolina. Total enrollment numbers are included for each plan to help seniors better understand how many beneficiaries are enrolled. Additional cost info and star ratings provide further context to help differentiate plans from one another. Because many plan providers offer multiple Medicare Advantage plans, costs are displayed as a range rather than a set median number.
All plan information in the table below is accurate as of April 2022. South Carolina residents can go to Medicare.gov to find the most up-to-date information about Medicare Advantage plans in their area. Residents need to note that plan availability can depend on whether they live within the plan’s service area.
HMO, PPO, PFFS
Blue Cross Blue Shield of South Carolina
Wellcare by Allwell
Molina Healthcare of South Carolina
Blue Cross Blue Shield of Michigan
How Medicare Advantage Plans Work in South Carolina
South Carolina’s eligible Medicare beneficiaries have the ability to choose between various different Medicare Advantage plans. There are four main types of Medicare Advantage plans in South Carolina: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plan (SNP). Plan providers often offer more than one plan type. The table below contains information about each of the four most popular plan types.
What Medicare Advantage Plans Cover in South Carolina
Medicare Advantage plans cover all of the same services as Medicare Part A, such as hospital care and nursing home stays, and Medicare Part B, which includes services like preventative screenings and durable medical equipment. The only exception is hospice care, which is covered under Medicare Part A but not under Medicare Advantage.
Medicare Advantage plans also offer additional coverage for things like vision screenings, dental cleanings, hearing aids and prescription drugs. These extra coverage offerings vary depending on the plan.
The table below includes several common medical services and explains if they’re covered under Original Medicare or Medicare Advantage.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in South Carolina
All South Carolina residents aged 65 or older (or younger if they have a qualifying disability) who are U.S. citizens or lawful immigrants are eligible for Medicare Advantage. However, they must enroll in Original Medicare before applying for Medicare Advantage.
Some Medicare Advantage plans have additional eligibility requirements established by the plan provider. For example, Medicare Special Needs Plans (SNP) are only available to individuals living with specific diseases or chronic conditions.
Medicare Advantage enrollment is only available during specific periods throughout the year. Once the enrollment periods are over, there’s no way to sign up for a plan or change coverage, except in rare situations. Medicare Advantage enrollment periods include:
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in South Carolina
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Also called the Insurance Counseling Assistance and Referrals for Elders, or I-CARE program, South Carolina’s State Health Insurance Assistance Program provides free health benefits counseling for Medicare beneficiaries. Families and caregivers of Medicare-eligible seniors can also utilize SHIP services. SHIP is funded solely through federal agencies, and the program is not affiliated with any insurance companies, plans or service providers. Services include assistance with Medicare enrollment for parts A, B, C and D. I-CARE counselors also explain Medicare benefits to seniors, offer Medicaid fraud prevention education and facilitate benefit coordination between various providers. I-CARE counselors also help seniors compare plans during Medicare Open Enrollment and assist clients with applications for cost-saving programs, including the Low Income Subsidy (LIS).
South Carolina’s SHIP/I-CARE program is administered through the statewide network of Area Agencies on Aging. You can find your local Area Agency on Aging by calling the South Carolina Department on Aging at 1-800-434-0222. You can also locate your closest Area Agency on Aging using the search tool on the GetCareSC website.
Seniors enrolled in South Carolina’s Healthy Connections Prime program, an enhanced health care plan that combines benefits of Medicare and Healthy Connections Medicaid, can contact the Healthy Connections Prime Ombudsman for help with Medicare. Because the coordination of benefits between Medicaid and Medicare can be somewhat confusing and fragmented, some Prime members struggle with inconsistent care and overuse of emergency room services. The Ombudsman’s office assists Prime members with appeals and grievances, Medicare eligibility and continuity of care issues. The Ombudsman also provides ongoing member education, particularly with regard to member rights and the benefits Healthy Connections Prime members are entitled to. Successful resolutions achieved through the Healthy Connections Prime Ombudsman’s office include prevention of inappropriate discharge from inpatient facilities, assisted members with the Medicaid recertification process and settlement of overdue claims.
South Carolina Department of Aging – Legal Assistance
South Carolina seniors age 60 and older can access no-cost legal assistance through Area Agencies on Aging Statewide. Funding for these services is provided through the South Carolina Department on Aging, in accordance with Title III-B of the Older Americans Act. The Department on Aging has long-standing partnerships with various legal groups and agencies that provide legal advocacy for seniors, including assistance with Medicare and health care services. Seniors can connect with state-sponsored legal services in their region by contacting the local Area Agency on Aging or by calling the South Carolina Department on Aging at 1-800-868-9095.
The Department on Aging has long-standing partnerships with various legal groups and agencies that provide legal advocacy for seniors, including assistance with Medicare and health care services. Seniors can connect with state-sponsored legal services in their region by contacting the local Area Agency on Aging or by calling the South Carolina Department on Aging at 1-800-868-9095.
Serving Berkeley, Charleston, Dorchester, Orangeburg and Williamsburg counties, AccessAbility is a federally funded nonprofit organization that works to empower people with disabilities. Free services include information and referrals and access to medical equipment through two programs: the Equipment Loan Program and the Fee for Service Program. Seniors who have experienced changes to their mobility can borrow durable medical devices through the Equipment Loan Program. The service can help seniors who are evaluating their future medical needs decide if they need a Medicare Advantage plan that includes coverage for mobility aids and accessibility accommodations.
Based in Greenville, Senior Action is a nonprofit organization that provides a variety of services throughout the City of Greenville, Greenville County and the City of Greer. The organization operates a number of activity centers where seniors can participate in wellness, social and recreational classes. Senior Action also hosts a number of financial planning programs and workshops that can help seniors decide if Medicare Advantage enrollment is right for their particular financial situation. Senior action offers free tax preparation assistance, insurance seminars, budgeting seminars and one-on-one insurance counseling and multiple locations.