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Medicare in South Carolina

What you need to know about Medicare plans in South Carolina

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Aaron Garcia.

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.

 

From some of the world’s most beautiful beaches to the thousands of miles of golf courses — both mini and full-sized — there are plenty of reasons to settle down in South Carolina. But to enjoy these Palmetto State perks, you’ll want to tap into the healthy living resources available to you.

That’s where Medicare in South Carolina comes in.

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 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:

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 [1]
  • Call the SSA at 1-800-772-1213
  • Apply online through the SSA website [2]
  • Call GoHealth at 1-855-792-0088. Our licensed insurance agents will guide you through the process and answer your questions as you go.

If you worked for a railroad, you might need to enroll in Medicare in South Carolina through the Railroad Retirement Board (RRB). For more information, call the RRB at 1-877-772-5772.

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. [3]

Do You Get Medicare at Age 65?

Yes, but if you’re working at 65 and receiving group coverage from an employer with 20 or more employees, you don’t need to. 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 Plans 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)
Part A and Part B Medicare in South Carolina Provides some coverage for specific hospital and medical care 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) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Have Original Medicare in South Carolina? Don’t forget these.

Since Original Medicare itself 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.

What Is the Most Popular Medicare Advantage Plan?

A plan’s popularity doesn’t matter; its effectiveness depends on you and your needs. After all, a popular Medicare Advantage plan in Kiawah Island may not work for someone in Clover. You can, however, look at how the different plans work when shopping for Medicare Advantage plans. That’ll help determine if your choice will be popular with the most important person: You. Here’s a breakdown of the types of Medicare Advantage in South Carolina.

  • 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. [4] 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 or 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.

If you need help figuring out what these advantages and disadvantages mean for you, give GoHealth a call. We’ll discuss your needs and see how your options line up. After all, wouldn’t it be nice to be the one with the advantage when selecting your Medicare in South Carolina?

Medicare in South Carolina by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,004,401 people are enrolled in Medicare in South Carolina. The total number of beneficiaries enrolled in Medicare Advantage in South Carolina is 307,280. The previous year,280,951 enrolled in Medicare Advantage. Medicare Advantage participation in South Carolina went from 28.85% to 30.59% year over year. If you’d like to see a deeper dive into how Medicare in South Carolina breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of South Carolina
1,004,401
Beneficiaries with Part A & Part B
307,280
Medicare Advantage Beneficiaries
30.59%
Medicare Advantage Participation Rate
54.75%
% Female
45.25%
% Male
0.93
Average HCC Score
$9,386.64
Actual Per Capita Costs
11.77%
% Eligible for Medicaid
30.33%
% of Beneficiaries with an Emergency Department Visit
16.91%
Hospital Readmission Rate
78.33%
% Non-Hispanic White
18.22%
% African American
1.01%
% Hispanic
2.43%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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 Medicare Resources & Contacts

Beneficiaries spend an average of $9,386.64 each year on Medicare in South Carolina. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which South Carolina-based resources, like these, may be able to help:

South Carolina Department of Aging

1-803-734-9900

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)

1-888-549-0820

https://www.scdhhs.gov/

What should I know about the Healthy Connections?

Apply for and manage your Medicaid benefits from the State of South Carolina

South Carolina Department of Health and Environmental Control

1-855-472-3432

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)

1-843-473-3991 (Low Country)

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 an insurance agent that is licensed in South Carolina about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in SC, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA 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

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.

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Low Income & Medicare Guide

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