South Carolina Medicare Guide

Get free advice from licensed South Carolina Medicare Advisors! Schedule a free consultation or call us today at (888) 604-0055.

The guide below will walk you through the basics of Medicare in South Carolina. Get a better understanding of what your Medicare options are and how to make the best Medicare decisions for your specific health and financial needs.

Use this table of contents to jump to specific sections:

South Carolina Medicare Eligibility and Enrollment Steps

American citizens who are 65 or older are eligible for Medicare. Additionally, if you have certain disabilities, including ALS and End-Stage Kidney disease, you are eligible for Medicare.

Three key steps for South Carolina Medicare enrollment:

Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage
- Medicare Supplement (Medigap)
- Medicare Advantage (Part C)
- Part D (drug coverage)
Set yourself up for success by finding doctors, sharing your plan information with your pharmacy, and accessing additional benefits that come with your coverage.

South Carolina Medicare Advantage Plans

After enrolling in Original Medicare, you can either add supplemental coverage to go alongside your Original Medicare or you can switch to a Medicare Advantage (Part C) plan. Medicare Advantage replaces Original Medicare and provides coverage for Part A, Part B, and often Part D. In addition to bundling together multiple parts of Medicare, these plans also generally come with extra benefits, like dental, vision, and hearing coverage and fitness perks.

Medicare Advantage plans add to your coverage, but they also have big downsides. To offer extra benefits at a low premium, Medicare Advantage plans limit you to provider networks, which is particularly unfavorable for snowbirds who may see doctors in two different states. Many Medicare Advantage plans also often require prior authorization for covered treatments (and many claims are denied), making it more difficult for beneficiaries to get the care they need. Finally, when compared to coverage from Original Medicare + a Medigap plan, out-of-pocket costs are much higher for Medicare Advantage planholders.

63% of South Carolina Medicare beneficiaries choose to enroll in one of the 73 Medicare Advantage plans available statewide. Note that insurance carriers and the pricing and availability of plans is unique to the county you live in. For example, in 2023, Charleston County has 44 plans available from nine insurance carriers. McCormick County, on the other hand, has 38 plans available from seven insurance carriers.

South Carolina Medicare Supplement Plans

Medicare Supplement (Medigap) plans pair with Original Medicare (OM) to help cover the 20% of costs that OM doesn’t. Supplement plans don’t provide additional benefits like Medicare Advantage plans, but they allow you to see any doctor that accepts Medicare (about 90% of doctors nationwide) and don’t require prior authorization for covered services. They also significantly reduce your out-of-pocket costs. On a Plan G, for example, after you meet your Part B deductible, you don’t owe anything else for Medicare covered services that year.

There are ten types of Medigap plans that are labeled by letter. Each plan of the same letter (all Plan Ns) provide the same coverage, although pricing may vary between insurance companies.

The best time to enroll in a Medigap plan is during the Medigap Open Enrollment Period. This period has a six-month duration that starts the month after your Part B coverage goes into effect. During the Medigap Open Enrollment Period, you have a guaranteed issue right. This means that insurance companies must accept your application for any Medigap plan without asking any questions about your medical history. Outside of this period (and a handful of other guaranteed issue periods), you will likely be asked questions about your health, and insurance companies can deny you coverage for a Medigap plan.

South Carolina Part D (Prescription Drug Coverage) Plans

South Carolina Medicare beneficiaries can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage or through one of 25 stand-alone Part D plans available in South Carolina. In South Carolina, the average monthly premium for a Part D stand-alone plan is $40.88. Like Medicare Advantage, the pricing and availability of prescription drug plans varies by county.

We recommend enrolling in a plan with Part D coverage even if you don’t currently need it to avoid the Part D late enrollment penalty later on.

Getting help paying for prescription drug coverage

Medicare Extra Help Program

Medicare’s Extra Help program helps those with limited incomes and resources pay for Medicare Part D premiums and out-of-pocket costs. You qualify for Extra Help automatically if you get:

Full Medicaid coverage from South Carolina
Help from South Carolina to pay your Part B premium
Supplemental Security Income (SSI) benefits

If you automatically qualify, you’ll receive a letter telling you things like how much you’ll pay for your Medicare drug plan.

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed South Carolina Medicare Advisors who can help you determine if you should apply and assist with the application process.

Other ways to save on Medicare prescription coverage in South Carolina

Check prices for your prescriptions at other local pharmacies as well as mail order pharmacies.
Check to see if a generic or a different form of your drug (e.g., capsule vs. tablet) can save you money.
Medicare plans change, and your healthcare needs may too! Review your drug plan and other available plans during the Medicare Open Enrollment Period, which occurs every year from October 15 - December 7. During this time you can switch your Medicare Advantage and Part D plans without consequence.

Get help paying for Medicare in South Carolina

The Medicare Extra Help Program only helps Medicare beneficiaries with prescription costs. There are two additional programs that can help you cover the cost of your Medicare and other healthcare related expenses: Medicaid and SSI.

Medicaid

Medicaid is a joint federal and state program that helps low-income individuals pay for medical costs. Each state operates its own Medicaid program, and eligibility and benefits can vary.

South Carolina’s Medicaid program is called Healthy Connections. Healthy Connections has a specific program for residents who are 65 or older, are blind, or have a disability (ABD Medicaid).

South Carolina Medicare Savings Programs

In addition to ABD Medicaid, Medicare beneficiaries may also be eligible for one of three South Carolina Medicare Savings Programs.

1. The Qualified Medicare Beneficiaries (QMB) Program

If you qualify, Medicaid will pay your Part B premium as well as copayments and deductibles.

2. Specified Low-Income Medicare Beneficiaries (SLMB) Program

Medicaid will pay your Part B premium. Individuals eligible for SLMB are not entitled to any other Medicaid benefits, so they will not receive a Medicaid card.

3. Qualifying Individuals (QI) Program

Medicaid will pay your Part B premium. Because individuals eligible for the QI Medicare Savings Program are not entitled to any other Medicaid benefits, they will not receive a Medicaid card.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

A Snapshot of Medicare in South Carolina

There are 1.3 million Medicare beneficiaries in South Carolina, making up 22% of South Carolina’s total population. 15% of South Carolina’s Medicare beneficiaries are also receiving full or partial Medicaid support. When it comes to choosing Original Medicare or Medicare Advantage, 63% of South Carolina Medicare enrollees choose Original Medicare and 37% choose Medicare Advantage (source).

Ready to enroll and not sure which options to choose or if you’re eligible for financial support from the government? We’re here to help! Our South Carolina Medicare Advisors will walk you through your options, help you compare the details of specific plans, and assist with enrollment and financial support.

Schedule a free consultation or give us a call today at (888) 604-0055.

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