Medicare in South Carolina

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.

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 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:

• 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, 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.

• 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 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 2023 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.