Medicare is the federally funded health insurance program that’s open to those aged 65 and over, along with younger people who have certain disabilities or health conditions. In 2023, 1,185,894 South Carolina residents are eligible for this coverage. This is 3.51% higher than the number of the state’s eligible enrollees in 2022, which is notable growth compared to the nation’s increase of 2.66%.
Original Medicare provides robust coverage for beneficiaries through Part A hospital coverage and Part B medical coverage. Part A pays for services such as hospital stays, nursing home care and hospice, while Part B covers routine medical appointments, durable medical equipment, diagnostic services and health screenings. In most cases, beneficiaries don’t have a monthly premium for Part A, although they may be subject to a $278 or $506 premium if neither they nor their spouse paid Medicare taxes for at least a decade. The standard Part B premium is $164.90 per month. Neither part provides prescription drug benefits, but seniors can add this coverage by enrolling in a Part D prescription drug plan for an additional monthly premium.
While Original Medicare is the most popular option among Medicare enrollees in South Carolina, 43% of beneficiaries have Medicare Advantage Plans instead. These plans, which are also referred to as Part C, are available through private health insurance companies and include all Medicare benefits. They may also have additional benefits and cost-saving features, such as annual out-of-pocket limits and $0 deductibles. While South Carolina’s Medicare beneficiaries have been slow to adopt Medicare Advantage, the percentage of beneficiaries enrolled in Part C increased by 8.58% between 2022 and 2023. Nationally, about 48% of beneficiaries have Medicare Advantage, an increase of 6.9% over the percentage reported in 2022.
This guide furnishes comprehensive information on Medicare in South Carolina, including insights on Medicare coverage options, Medicare Advantage, criteria for considering Medicare Advantage, top Medicare Advantage Plans, prescription drug coverage and Medigap. It also lists organizations and resources that can assist seniors in making informed changes to their health care coverage.
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 offers standardized health insurance for those aged 65 and over, as well as those with certain disabilities or who are in permanent kidney failure. This program features two parts, including Part A hospital insurance and Part B medical insurance. While Original Medicare can save beneficiaries money, enrollees are subject to some cost-sharing responsibilities in the form of annual deductibles and copays or coinsurance. In 2023, Part A has a $1,600 deductible for every hospital stay and co-pays for stays beyond 60 days. Part B has a $266 deductible and 20% coinsurance.
Who Should Consider Original Medicare
Original Medicare may be a good option for those who:
Medicare Advantage Plans, also called Medicare Part C, are serviced by private health insurance companies. There are five types of plans available, including HMOs, PPOs, PFFS, MSAs and SNPs, although not all plan types are available across all ZIP codes in South Carolina. Part C encompasses Original Medicare’s Parts A and B benefits, and many plans have money-saving benefits, such as annual out-of-pocket maximums and prescription drug, vision and dental insurance. Because plans are available through private companies, co-pays, coinsurance, deductibles, premiums and rules about seeing specialists or network providers vary.
Who Should Consider Medicare Advantage
Medicare Advantage plans provide excellent coverage for a select group of seniors.
The Top 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 Star Rating
|Monthly Cost Range
|$0 – $103
|PPO, HMO, PFFS
|$0 – $49
|$0 – $16
|$0 – $16
|$0 – $22
|$0 – $22
|$0 – $38
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:
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 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
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.
SHIP is a free service funded by the U.S. Department of Health and Human Services and the U.S. Administration for Community Living. In South Carolina, SHIP is also called the Insurance Counseling Assistance and Referrals for Elders program (I-Care). Program counselors answer questions about Medicare and the different coverage options, including original Medicare, Medicare Advantage, prescription drug coverage and the Medicare Supplement program.
The SMP is a federally funded project of the U.S. Department of Health and Human Services and the U.S. Administration for Community Living. Volunteers work to answer senior questions concerning health care, finances and fraud. The SMP holds community outreach programs where they provide one-on-one counseling to Medicare beneficiaries.
The South Carolina Department of Insurance works to ensure all of South Carolina receives adequate insurance coverage and health care services. The Department also works to protect individuals against insurance fraud by enforcing and implementing the insurance laws of the state. The Department offers details on Medicare and Medicaid and additional insurance providers.
Healthcare.gov is the official insurance exchange website operated by the U.S. federal government. Seniors may fill out a single application and have access to a wide range of health insurance plans. Through the website, they can compare plans, including premium and coverage amounts and decide on which plan best suits their needs.
AARP helps seniors understand Medicare by defining what the program covers and by giving detailed information on the different parts. The organization also assists seniors in understanding the differences in Medicare and Medicaid and covers Medicare Advantage and Medigap insurance. The AARP website features a question and answer tool that makes it easy to navigate the program and find solutions to the most common issues.
Medicare.gov is the official federal government website for Medicare coverage. Seniors may compare available plans, learn about prescription coverage and find out which physicians and health facilities accept Medicare as a payment method. By creating an account through Medicare.gov, seniors can make changes to their accounts and check the status of an application.
SC Thrive provides access to health care coverage through the online Thrive Hub. The site offers information and assistance on state Medicare, Healthy Connections Medicaid, long-term care, Medicare Savings Programs and prescription help. Seniors may also learn about medication assistance programs and coinsurance. The program is available through community donations.
The Social Security Administration South Carolina Area provides information on Medicare, including coverage amounts, premium information and details on how to make changes to an account and how to order new insurance cards. The site also offers information on Medicare Advantage plans and how private insurance differs from government-sponsored coverage.