Medicare Advantage Plans in South Carolina
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: November 6, 2020
Seniors in South Carolina can enroll in Medicare Advantage instead of Original Medicare. Medicare Advantage, also known as Medicare Part C, is offered by private government-approved insurance companies. Coverage costs vary by provider and plan type, but they have the same or better coverage than Original Medicare. Bundled coverage includes hospital insurance (Medicare Part A) and medical insurance (Medicare Part B). It may also have prescription drug coverage (Medicare Part D) and services not covered by Original Medicare, such as dental, vision, hearing, and wellness programs.
- 1 In 2019, there were 59 Medicare Advantage plans available in South Carolina.
- 2 25% of the total Medicare population in South Carolina is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $9,601 per beneficiary in South Carolina, which is 5% lower than the national average.
- 4 Available Medicare Advantage plans range from 19 to 59 across South Carolina’s 46 counties.
Seniors in South Carolina must sign up for Medicare Advantage plans through a private insurance company that’s approved by the U.S. Centers for Medicare & Medicaid Services. They provide all Medicare benefits, except for hospice care, which is still covered by Original Medicare. There are four primary types of Medicare Advantage, and Health Maintenance Organization and Preferred Provider Organization plans are the most popular. There are also Private Fee-For-Service and Special Needs Plans. All plans aren’t available everywhere, with exact availability dependent on the individual insurance providers and the beneficiary’s geographic location.
Medicare Advantage Plans in South Carolina
Types of Medicare Advantage Plans
South Carolina’s Medicare Advantage program includes numerous Medicare Advantage providers, but plan availability varies between counties and can change yearly. HMO and PPO plans are the most common, but there are some PFFS plans and a limited number of Chronic Condition SNPs. All South Carolina counties have at least one Dual Eligibility SNP available. There are specific eligibility and enrollment requirements, but seniors can ask various state and local organizations about Medicare Advantage plans.
Health Maintenance Organizations (HMO)
HMOs offer Medicare Advantage plans that are usually lower in price than other plans and often have low or no deductibles. However, these plans tend to have fewer healthcare provider options. HMO plans have a network of participating doctors and hospitals, and members must receive their care from these healthcare providers. Members who see a non-network provider must pay for the entire cost of their medical care, unless it was an emergency or critical care service. They must also choose a primary care physician and receive referrals to specialists from this physician.
Preferred Provider Organizations (PPO)
PPOs also have a network of preferred providers. Members need to use in-network doctors and hospitals to receive the lowest copays and/or coinsurance costs. However, they’re allowed to seek medical care outside of this network, and they’ll still have a portion of the cost covered by their PPO plan. PPO members usually aren’t required to choose a PCP, and they can self-refer to specialists instead of requesting a referral. While this offers greater flexibility on who they can see for services, PPO plan members tend to have higher premiums and deductibles.
Private Fee-For-Service Plans (PFFS)
Members of PFFS plans may also have a partial or full network of providers. The insurance companies have specific conditions and payment terms that network providers must agree to in advance, and providers must also agree to see any plan member. However, most plans let members see healthcare providers outside of this network if the provider agrees to the same conditions and payment terms. The insurance companies also predetermine how much they pay and how much members pay for all services received. Premiums tend to be higher compared to other plans.
Special Needs Plans (SNP)
SNPs are broken into three distinct types. Chronic Condition SNPs restrict membership to those with specific chronic illnesses or diseases, and there are usually a limited number of these plans. Institutional SNPs restrict membership to those in long-term care facilities, such as nursing homes, or those who require a nursing home level of care. These plans are also limited in South Carolina’s Medicare Advantage program. Dual Eligibility SNPs are the most common and restrict membership to those who are eligible for both Medicare and Medicaid. Unlike many states, South Carolina has at least one D-SNP plan in every county.
Enrollment & Eligibility for Medicare Advantage Plans in South Carolina
Seniors in South Carolina who are eligible for Medicare Parts A and B when they turn 65 are eligible to enroll in a Medicare Advantage plan instead. Eligible enrollees can’t be enrolled in Medigap and must be a U.S. citizen or permanent resident. They must also live in an area where Medicare Advantages are sold, and they can’t have end-stage renal disease unless they qualify for an available C-SNP. Seniors already receiving Social Security or Railroad Retirement Board will automatically be enrolled in Medicare Parts A and B when they turn 65. They must join or switch to Medicare Advantage plans during an appropriate enrollment period. Individuals receiving disability insurance must do so for 24 months in order to qualify for Medicare.
South Carolina’s Medicare Advantage program follows Medicare’s enrollment periods, which sets time frames for first-time applicants to enroll and existing members to make changes.
- Initial coverage election periods start three months before a first-time applicant turns 65 and end three months following this birthday for a 7-month enrollment window.
- Annual election periods (October 15th to December 7th) allow current Medicare recipients to switch to Medicare Advantage or current Medicare Advantage members to make plan changes.
- Annual open enrollment periods (January 1st to March 31st) allow current Medicare Advantage recipients to switch plans or switch back to Original Medicare.
- General enrollment periods (April 1st to June 30th) allow Medicare recipients who already had Part A, but enrolled in Part B for the first time during the annual open enrollment, to switch to Medicare Advantage.
- Special Election Periods: Various specific circumstances may allow you to leave an existing MA plan or enroll in a new MA plan.
During the Open Enrollment Period the following can occur:
- Anyone who has (or is signing up for) Medicare Parts A or B can join or drop a Part D prescription drug plan.
- Anyone with Original Medicare (Parts A & B) can switch to a Medicare Advantage plan.
- Anyone with Medicare Advantage can drop it and switch back to just Original Medicare (Parts A & B).
- Anyone with Medicare Advantage can switch to a new Medicare Advantage plan.
- Anyone with a Part D prescription drug plan can switch to a new Part D prescription drug plan.
Prescription Drug Coverage
SNPs are legally required to include prescription drug coverage in their plans, but this doesn’t apply to other Medicare Advantage plans in South Carolina. Many HMO, PPO, and PFFS plans include prescription drug coverage; however, some don’t. HMOs and PPOs without prescription drug coverage don’t allow members to get stand-alone Medicare prescription drug plans. Members are automatically switched back to Original Medicare if they sign up for Medicare Part D. PFFS without prescription drug coverage allows members to get coverage elsewhere without losing their plan. Medicare Advantage prescription drug plans may require a separate premium.
Medicare Advantage Resources in South Carolina
Seniors need medical coverage to ensure they receive the care they need, and Medicare Advantage provides this coverage. Choosing the best Medicare Advantage plan can be overwhelming, which is why South Carolina offers personalized Medicare counseling through various state and local agencies. Medicare-eligible seniors can usually participate in any of these programs free of charge and get the information they need about coinsurance, co-payments, and other elements of South Carolina’s Medicare Advantage program.
South Carolina Department on Aging
The South Carolina Department on Aging operates the State Health Insurance Assistance Program, which has offices throughout the state. This program provides free one-on-one Medicare insurance counseling for beneficiaries, their families, and their caregivers. Certified SHIP counselors answer Medicare questions and assist eligible seniors in getting coverage through Original Medicare, Medicare Advantage, Medicare Part D prescription drug plans, and other programs designed to help low-income seniors pay for their healthcare coverage. Counselors help them compare their options, which includes an average of 16 Medicare Advantage plans, and explain how the program works.
Contact Information: Website | 800-868-9095
I-CARE, South Carolina
The Insurance Counseling, Assistance, Referral and Education program helps Medicare beneficiaries compare their insurance options. Trained insurance counselors answer questions about Medicare, Medicare Advantage, Medicare Supplements, Medicare Part D prescription drug coverage, the Qualified Medicare Beneficiary, and Special Low Income Medicare Beneficiary programs of Medicaid, long-term care insurance, and other health insurance coverage options. Counselors can also provide guidance in evaluating Medicare benefits and costs, as well as enrollment. I-CARE is a free statewide program, and beneficiaries can receive help by contacting this office or a local Area Agency on Aging.
Contact Information: Website | 803-734-9900
Statewide ADRC Program
South Carolina’s Aging and Disability Resource Centers provide information on available long-term support options, including benefits counseling for Medicare and Medicare Advantage plans. This office oversees five ARDC offices covering all counties throughout the state. Target populations include residents aged 60 and older, adults with disabilities, and their family members and caregivers. This free community service acts as a single point of entry that enables seniors to make informed decisions about their long-term support options and provides streamlined access to services.
Contact Information: Website | 803-734-9939 or 800-898-9095
Waccamaw Regional Council of Governments
Waccamaw Regional Council of Governments provides insurance counseling to residents throughout three counties in eastern South Carolina. WRCOG operates the I-CARE program for this area, which is a free, confidential service with certified insurance counselors who can explain Medicare benefits and assist with Medicare enrollment for Parts A, B, C, and D. Counselors help with plan comparisons during Medicare Open Enrollment from October 15 to December 7 and facilitate coordination of benefits between Medicare, Medicaid, and Tricare. They also offer instruction on reading Medicare summary notices, applying for cost-savings programs, and identifying Medicare and Medicaid fraud.
Contact Information: Website | 843-436-6252
Upper Savannah Area Agency on Aging
The Upper Savannah Area Agency on Aging has SHIP counselors who serve six northwestern counties of South Carolina and help those who are eligible for Medicare choose the right plan. SHIP counselors provide free, unbiased information about available options, including Medicare Advantage plans, Medigap, Medicare Part D prescription drug coverage, Medicare Savings Programs, and eligibility for extra help programs from Medicaid and the Social Security Administration. They can also assist with billing problems, appeal rights, and choosing the right Medicare prescription plan during open enrollment from October 15 to December 7.
Contact Information: Website | 864-941-8061 or 800-922-7729
- Sources [-]
https://doi.sc.gov/DocumentCenter/View/12667/2020-Brochure—Medicare-Supp-Shop-Guide-Rev-2018-01-AR Last accessed April 2021
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/Pubs/pdf/11135-prescription-drug-coverage-with-ma-mcp.pdf Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.