Medicare in South Carolina
Key Takeaways
- Who can enroll in Medicare in South Carolina? All legal U.S. citizens, or legal residents of five years, who are 65 and older. Some younger than 65 may also be eligible based on certain health conditions.
- You can choose between Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in South Carolina.
- Original Medicare helps cover hospital and medical costs, but other services need to be added separately. Medicare Advantage often bundles these services together.
You may know that Medicare is health insurance for Americans aged 65 and older. But do you know what the different Medicare plans in South Carolina are? Do you know how to enroll or how it works? Have you ever thought about Medicare Advantage options in South Carolina?
If you or a loved one have questions like these, here is GoHealth’s guide to Medicare in South Carolina.
Who Qualifies for Medicare in SC?
You qualify for Medicare in South Carolina if you’re 65 or older and either a legal U.S. citizen, or have been a legal resident for at least five years. There are also cases when people younger than 65 qualify for Medicare, including:
- You’re living with:
- End-stage renal disease (ESRD)
- Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease.
- You have received disability-based Social Security benefits, or Railroad Retirement Board (RRB) benefits for 24 or more months.
Your Ideal Medicare Plan is out there.
How Do I Apply for Medicare in South Carolina?
There are several ways to sign up for Medicare in South Carolina. If you’re approaching your Initial Enrollment Period, you’ll need to enroll through the Social Security Administration. Here’s how:
- Visit your local SSA office.
- Call the SSA at 1-800-772-1213.
- Apply online through the SSA website.
- Call GoHealth at 1-855-792-0088. Our licensed insurance agents will guide you through the process and answer your questions as you go.
What Is the Income Limit for SC Medicaid?
Medicaid is not Medicare. It’s a state and federal program that helps low-income seniors, adults, families, and children receive healthcare. To see if you’re eligible for assistance, visit Health Connections, South Carolina’s Medicaid program.
Find the Medicare Plan that works for you.
Do You Have to Get Medicare at Age 65?
If you’re working at 65 and receiving group coverage from an employer with 20 or more employees, you don’t need to enroll in Medicare right away. Instead, your private coverage will serve as your primary policy. When you lose that coverage, a special enrollment period will open up for you to enroll in Medicare in South Carolina without a late enrollment penalty.
If your employer has fewer than 20 employees, you’ll need to enroll as your Medicare will become your primary coverage.
What Are the Different Parts of Medicare?
You can receive Medicare in two ways: Original Medicare (Parts A and B) and Medicare Advantage (Part C). There are some key differences you’ll need to know. Here’s an overview of the types of Medicare plans in South Carolina.
Original Medicare (Parts A and B)
Provides coverage for hospital care and for medical and preventive services. You can see any doctor that accepts Medicare, but out-of-pocket costs can be high. Original Medicare doesn’t include Medicare Part D for prescription drugs or cover dental, vision, or hearing, so you’ll need additional coverage.
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering the same Part A and B benefits. Medicare Part C usually bundles additional services like dental, hearing, vision, and prescription drug coverage.
Medicare Part D and Medigap
Since Original Medicare is limited to Parts A and B, enrollees often also purchase a Medicare Prescription Drug Plan (Part D) and Supplement Insurance (Medigap) to boost their coverage and control costs. Here’s how they work:
Medicare Prescription Drug Plan (Part D)
Part D covers prescription drugs. Private insurance companies provide part D plans, and their costs are separate from Original Medicare. Medicare Advantage in South Carolina, on the other hand, often includes Part D coverage.
Medicare Supplement Insurance (Medigap)
To help cover the high out-of-pocket costs that come with Parts A and B, South Carolinians often purchase Medigap. These are a group of plans you can add to Parts A and B that cover costs like premiums, copays and deductibles. Medigap plans are sold by private insurance companies and have their own premiums.
Medicare in South Carolina: Costs and When to Enroll
There’s still plenty more to learn about the different Medicare plans in South Carolina, including how much you can expect to pay and the various enrollment periods. GoHealth has the resources you need to make sense of the process. Of course, you can always give us a call at 1-855-792-0088. You’ll connect with a licensed insurance agent that can explain your options and answer questions when you have them.
Find the Medicare Advantage plan that meets your needs.
How Do I Choose the Righ Medicare Advantage Plan?
You can compare how different Medicare Advantage plans work to find the choice that best fits your healthcare needs and financial situation:
- Health Maintenance Organization (HMO): HMOs use primary care physicians to manage your health and refer you to other providers within your network.
- Preferred Provider Organization (PPO): PPOs typically allow you to see out-of-network providers but still use a primary care physician.
- Private Fee-for-Service (FFS): PFFS plans pay your providers each time you receive a service.
- Special Needs Plans (SNPs): SNPs are specialized plans for patients living with certain health conditions or diseases.[i]D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
What are the Disadvantages of Medicare Advantage Plans?
There are advantages and disadvantages to both Medicare Advantage and Original Medicare, and you’ll want to know the pros and cons of each. Here is a high-level comparison:
- Original Medicare allows you to see any doctor that accepts Medicare but can have high out-of-pocket costs. You may also need to add other policies like Part D and Medigap.
- Medicare Advantage typically has lower costs and usually bundles other services like Part D, but Part C plans limit which doctors you can see using provider networks.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,068,914 people are enrolled in Medicare Part A and B in South Carolina. The total number of beneficiaries enrolled in Medicare Advantage increased from 343,372 to 391,486 year over year. Medicare Advantage participation in South Carolina went from 33.13% to 36.62% year over year. If you’d like to dive deeper into how Medicare in South Carolina breaks down across the state, we provide a glance at who is using Medicare and how.
1,068,914 Beneficiaries with Part A & Part B
391,486 Medicare Advantage Beneficiaries
36.62% Medicare Advantage Participation Rate
54.75% Female
45.25% Male
79.38% Non-Hispanic White
16.77% African American
1.06% Hispanic
2.79% Other/Unknown
9.86% Eligible for Medicaid
0.93 Average HCC Score
$9,738.92 Actual Per Capita Costs
17.26% Hospital Readmission Rate
25.83% % of Beneficiaries with an Emergency Department Visit
343,372 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
33.13% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
South Carolina Department of Aging
https://aging.sc.gov/
What should I know about the South Carolina Department of Aging?
Find local resources to help with finances, caregiver resources and legal assistance.
South Carolina Healthy Connections (Medicaid)
https://www.scdhhs.gov/
What should I know about Healthy Connections?
Apply for and manage your Medicaid benefits from the state of South Carolina.
South Carolina Department of Health and Environmental Control
https://scdhec.gov/
What should I know about the South Carolina Department of Health and Environmental Control?
Find local clinics, get healthy living info, and research local public health data.
Area Agencies on Aging (AAA)
https://www.lowcountrycog.org/aging_and_disability_resources/index.php
1-864-242-9733 (Upstate)
https://resources.caregiver.com/listing_reports.php?report=website&id=2192
What Should I know about the South Carolina Area Agencies on Aging?
Resources for long-term patients and caregivers, plus legal assistance and other support programs.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in South Carolina about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Social Security Office Locator. SSA.gov.
- Apply for Benefits. SSA.gov.
- Am I eligible? SCDHHS.gov.
- Special Needs Plans (SNP). Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.