- In 2019, there were 59 Medicare Advantage Plans available in South Carolina.
- 25% of the total Medicare population in South Carolina was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $9,601 per beneficiary in South Carolina, which is 5% lower than the national average.
- Available Medicare Advantage Plans range from 19 to 59 across South Carolina’s 46 counties.
Depending on which Medicare Advantage Plan you select, you may be required to follow certain rules, such as choosing a primary care doctor, getting a referral to see a specialist, or only getting care from in-network providers. Cost-sharing responsibilities, such as premiums, deductibles, copays, and maximum out-of-pocket limits vary. In most cases, your premium will be at least as high as the Original Medicare Part B premium, and it may be higher if you have additional benefits, such as vision or prescription drug coverage.
Medicare Advantage Plans in South Carolina
Types of Medicare Advantage Plans
There are four main plan types in South Carolina’s Medicare Advantage program, including HMOs, PPOs, PFFS plans, and SNPs. Before signing up for a plan, it’s important to find one that has affordable monthly premiums and copays and includes coverage for services you’re most likely to use. Some plans limit you to in-network providers, so if you don’t want to change primary care doctors, you may want to review a plan’s network before enrolling.
Health Maintenance Organizations (HMO)
HMO plans generally only cover your care when you go to doctors who are contracted with your specific plan. If you go to an out-of-network physician, specialist, or hospital, you should expect to pay for your entire bill, except in the event of a medical emergency. HMOs are usually limited to a certain geographic area, which may be a consideration if you often travel or split your time between South Carolina and a home in another state. You’re generally required to choose a primary care physician, and if you need to see a specialist, you must first get a referral from your doctor.
Preferred Provider Organizations (PPO)
If you had insurance through your employer before retirement, then you likely had a PPO plan. These plans provide more flexibility than HMOs because you can visit out-of-network providers, although you pay less if you get medical care in-network. Most plans don’t require you to choose a primary care doctor, and if you need to see a specialist, you can schedule an appointment without getting a referral.
Private Fee-For-Service Plans (PFFS)
PFFS plans are similar to Original Medicare, setting rules for what is covered and what you pay a health care provider for a given service. With a PFFS plan that doesn’t have a preferred provider network, you can go to any doctor or hospital that agrees to your plan’s payment terms. If your plan has a network, you pay less money out of pocket when you use an in-network provider, but your plan still covers services at any provider that accepts it.
Special Needs Plans (SNP)
SNPs limit their enrollment to individuals who meet the plan’s criteria. For example, some plans are exclusively for those dually eligible for Medicare and Medicaid, while others cover those with chronic conditions, such as diabetes or dementia. These plans build their networks, drug formularies, and benefits around members’ needs. Some plans require you to choose a primary care doctor, and in most cases, you have to get a referral to see a specialist.
Enrollment and eligibility for Medicare Advantage Plans in South Carolina
You can join a Medicare Advantage Plan in South Carolina if you have or qualify for Original Medicare Parts A and B. In most cases, eligibility is determined by age — over 65 — or a disability. Because most plans are limited to specific geographic areas, you must live in the service area of the plan you choose. Some plans have special rules for those who live in one state for part of the year and another for the rest of the year, so if you often travel or only live in South Carolina during certain seasons, find out what your plan’s rules are.
You can enroll in, switch, or drop Medicare Advantage Plans during these scheduled enrollment periods:
- Initial Enrollment Period: This period opens when you first become eligible for Medicare. If you’re newly eligible because you’re turning 65, this period begins three months before your birth month, includes your birth month, and closes three months after.
- Medicare Advantage Open Enrollment Period: This period runs from January 1 through March 31 and is exclusively for Medicare Advantage enrollees. During this time, you can switch to a different Medicare Advantage Plan or back to Original Medicare one time.
- Open Enrollment Period: From October 15 through December 7, you can join, switch, or drop your Medicare Advantage Plan.
- Special Enrollment Periods: These periods open when you experience certain life events, including moving to a new home, losing your current coverage, or becoming eligible for another Medicare Advantage Plan.
Prescription drug coverage
Even if you don’t take prescription medications when you first sign up for Medicare, it’s a good idea to purchase this coverage when you enroll. Add-on prescription coverage is called Part D. Without it, you’ll pay the full price of prescribed medications out-of-pocket, and if you add the coverage later, you’ll pay a penalty for as long as you have it. HMOs and PPOs typically have prescription drug coverage as an additional benefit, and Part D coverage can’t be added to plans that don’t. Many PFFS plans cover prescription drugs, but if yours doesn’t, you can purchase a separate Medicare Part D plan. All SNPs include prescription drug coverage and have formularies that are specific to the conditions covered.
Medicare Advantage Resources in South Carolina
As you’re researching available Medicare Advantage Plans, knowing where to get help can make the process much easier. South Carolina is home to a network of counselors who can answer all of your Medicare questions and assist you in enrolling in a plan that fits your health care needs. Through the following agencies, you can get help with recognizing and preventing Medicare fraud.
Senior Health Insurance Assistance Program
The South Carolina Department on Aging administers the statewide Senior Health Insurance Assistance Program. SHIP is primarily offered through volunteers who undergo training on insurance options for retirees and those with disabilities. This program is free and can help you get answers to questions you have regarding your benefits, find Medicare Advantage Plans available in your region, sign up for Medicare Advantage, or switch to another plan. Counselors can help you determine your eligibility for financial assistance programs and connect with other services and benefits that you’re eligible for.
Contact Information: Website | 800-868-9095
Trident Area Agency on Aging
Trident Area Agency on Aging, one of 10 Area Agencies on Aging in South Carolina, serves seniors residing in the Charleston region. It has SHIP counselors who can help you make informed decisions about your health insurance. While counselors aren’t licensed to sell insurance policies, they can help you identify the Medicare Advantage Plan that has the coverage you need. They can help you determine whether you qualify for financial assistance programs, such as the Specified Low-Income Medicare Beneficiary Program, the Qualified Medicare Beneficiary Program, and the Low-Income Subsidy.
Contact Information: Website | 843-554-2275
South Carolina Department of Insurance
The South Carolina Department of Insurance helps you compare and shop for Medicare Advantage Plans by providing you with information regarding your coverage choices, telehealth benefits, when you can sign up for a plan, and whether your policy covers you when you’re traveling. The site offers answers to frequently asked questions about Medicare Supplement Insurance, Medicare Advantage Plans, and prescription drug coverage.
Contact Information: Website | 803-737-6160
Learn More from Our Sources
- Medicare | Medicare Advantage Plans
- Medicare | Cost for Medicare Advantage Plans
- Medicare | Health Maintenance Organization (HMO)
- Medicare| Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Medicare | Special Needs Plans (SNP)
- Medicare | Who Can Join a Medicare Advantage Plan?
- Medicare | Joining a Health or Drug Plan
- Medicare | Special Circumstances (Special Enrollment Periods)