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Medicare in South Carolina

October 6, 2016

As a South Carolina Medicare beneficiary, you’re eligible for a number of important health benefits under Original Medicare, Part A and Part B, which includes hospital and medical insurance, respectively. In addition, in South Carolina, as elsewhere in the United States, Medicare beneficiaries may enroll in Medicare plans offered by Medicare-approved private insurance companies  available where they live and of their choosing under Medicare Advantage (Medicare Part C) and may receive prescription drug coverage under Medicare Part D from Medicare-approved private insurers who offer Medicare plans providing prescription drug coverage .

Original Medicare for South Carolina beneficiaries

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You’re eligible for Medicare if:

  • You’re 65 or older; and.
  • You’re a US citizen or legal permanent resident of at least five continuous years; or
  • You receive disability benefits, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals may be able to get Medicare regardless of age, if they’re collecting disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board for a certain period of time.

In South Carolina, as in other states, you can sign up for Original Medicare during the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. This is the seven-month Medicare Initial Enrollment Period (IEP). If you don’t sign for up Original Medicare during your IEP, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late-enrollment penalty in the form of higher premiums.

In general, enrollment in Medicare Part A is premium-free for qualifying people who worked at least 10 years (40 quarters) and paid Medicare taxes during that time (or whose spouses did), but others may have to pay a premium. As a South Carolina Medicare beneficiary, you’re Medicare Part A coverage includes:

  • Hospital care
  • Skilled nursing facility (SNF) care
  • Nursing home care (non-custodial)
  • Hospice care
  • Home health services

Medicare Part B is medical insurance, and most people have to pay a monthly premium upon enrollment. You may also have to pay an income-related monthly adjustment fee if your income is higher than a certain limit set by Medicare. South Carolina Medicare beneficiaries, like Medicare beneficiaries in other states, receive the following benefits under Medicare Part B:

  • Doctors’ services, including preventive care
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Outpatient services, such as surgery
  • Radiology and laboratory services

Medicare plan options in South Carolina

South Carolina Medicare beneficiaries can sign up for Medicare Advantage plans as an alternative to their Original Medicare coverage. Medicare Advantage plans are offered by Medicare-approved private insurance companies in South Carolina, and they cover the same hospitalization and medical benefits offered by Original Medicare (with the exception of hospice care, which remains covered by Part A). In addition, South Carolina Medicare Advantage plans may offer extra benefits such as routine vision, hearing, and dental coverage.

Many Medicare Advantage plans in South Carolina also include prescription drug coverage. These plans, known as Medicare Advantage Prescription Drug plans (MA-PDs), combine health and prescription drug coverage into one private insurance plan.

A stand-alone Medicare Part D Prescription Drug Plan can work alongside your Original Medicare (Part A and Part B) benefits. If you decide on this option, instead of getting your Medicare benefits through a Medicare Advantage plan (described below), you may also be able to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.

If you’re seeking Medicare prescription drug coverage but you are not interested in enrolling in a Medicare Advantage Prescription Drug plan, you may want to consider a stand-alone Medicare Part D Prescription Drug Plan, which is insurance designed to help Medicare beneficiaries cover prescription drug costs and offered by private insurance companies contracted with Medicare. Costs for each Medicare Prescription Drug Plan in South Carolina vary, but most require you to a pay a monthly premium, annual deductible, and copayment or coinsurance.

Various Medicare plans in South Carolina may be available in South Carolina. Therefore, you’ll want to customize your research of Medicare plans  not only based on your individual health and prescription coverage needs but also the county in which you reside.

South Carolina resources for Medicare beneficiaries

There are a number of resources designed to help South Carolina Medicare beneficiaries with Medicare-related issues and concerns. Here are some resources that may be helpful:

  • State Department of Insurance website.
  • State Health Departments, website.
  • State Health Insurance Assistance Program (SHIP), website.
  • State Hospice Organization, website.

Learn more about how Medicare plans work in South Carolina including:

The product and service descriptions, if any, provided on these PlanPrescriber Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.