Medicare in South Carolina

Medicare is a federal health insurance program for seniors aged 65 and older and individuals of all ages with certain disabilities or those receiving Social Security disability benefits. In 2020, over 760,000 South Carolinians were enrolled in basic Medicare, and close to 338,000 were enrolled in Medicare Advantage plans, which makes up about 16% of the state’s population.

Medicare has several different parts. Original Medicare includes Medicare Part A and Part B. Part A covers inpatient care in a hospital. It also covers a skilled nursing facility, hospice care and home health. Part B covers outpatient treatments, home health care and medical equipment like wheelchairs and walkers. Part B may also cover preventative services like health screenings.

 Medicare Part D covers the cost of prescription medications. There’s also Medigap, which is provided by private insurance companies. Medigap helps fill the gaps and pays for deductibles and services original Medicare doesn’t cover.

Seniors who prefer to receive all of their coverage in a single plan may choose Medicare Advantage, which is offered by private insurance companies. These plans provide all the benefits of Original Medicare, except hospice care, and can help reduce an individual’s out-of-pocket costs.In addition, Medicare Advantage may offer coverage for prescription drugs, dental and vision care.

This guide provides additional details on Medicare in South Carolina. It also offers a list of resources and organizations that can assist in making changes to health care coverage.

Options for Medicare Coverage in South Carolina

Original Medicare is a good choice for seniors who need basic coverage, but for those with special needs, it’s typically not the best option. South Carolina has other Medicare options offered by private health insurance companies for individuals who are prepared to pay to enjoy additional benefits, including dental and vision care and long-term care.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage Plans are referred to as MA plans or Medicare Part C plans. Unlike regular Medicare that’s provided by the federal government, Advantage plans are offered by private insurance companies that contract with Medicare. Medicare Advantage plans have all of the services covered by original Medicare, along with specialty services, including dental and vision coverage and wellness programs. Most MA plans offer prescription drug coverage (Part D). 

There are four main Medicare Advantage programs. These include Health Maintenance Organization Plans (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service plans (PFFS) and Special Needs Plans (SNP). Like traditional private insurance plans, Medicare Advantage plans have varying coverage amounts, copays, deductibles and premiums. They also each have different providers who accept the coverage as payment for services.

Who Should Consider Medicare Advantage

Medicare Advantage plans provide excellent coverage for a select group of seniors.

• Seniors who like to coordinate their care programs under a single insurance plan
• Individuals who have special needs and require advanced care
• Those who are generally healthy and may benefit from lower premiums
• Seniors who require long-term care in a residential facility, including nursing homes and assisted living

The Top 10 Medicare Advantage Plans in South Carolina

Seniors in South Carolina can apply for Medicare Advantage and adjust their plan options to best suit their needs. The following chart explains the top carriers and the average monthly costs of each. It also details the number of individuals who are enrolled with each provider and what type of plan is offered by each carrier. Additional information can be found at the Medicare Advantage Plans in South Carolina page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in South Carolina

Enrolling in Medicare and other public insurance plans can be difficult for seniors to understand. With so many choices, it can be helpful to get the advice of trained professionals who are familiar with the different parts of Medicare and how Medicare Advantage can help save money for those who have specialized health care needs.