South Carolina Medicare: Eligibility, Coverage, and Local Agents

Did you know that there are almost one million South Carolina Medicare beneficiaries? While most Medicare rules and regulations are the same nationally, Medicare plans can vary not just by state and county, but by individual zip code! This is your ultimate guide to Medicare in South Carolina.

This Guide to South Carolina Medicare Includes:

• Who is Eligible for Medicare in South Carolina?
• What Does South Carolina Medicare Cover?
• What Medicare Plans are Available in South Carolina?
• What does South Carolina Medicare cost?
• Can I have Medicare and Medicaid in SC?
• How do I apply for Medicare in South Carolina?
• Where do I apply for Medicare in South Carolina?
• South Carolina Medicare Beneficiary Resources
• Medicare Savings in South Carolina

Finding the Right Medicare Coverage in South Carolina Starts Close to Home

When you’re looking at Medicare in South Carolina, it is easy to focus on premiums, extra benefits, and everything listed on a plan brochure.

But there is a more basic question we think you should ask first:

How well will this coverage work for me where I actually live?

South Carolina has several distinct healthcare markets. Someone living in Greenville or Spartanburg may use completely different doctors and hospital systems than someone in Columbia, Charleston, Myrtle Beach, Hilton Head, or Florence.

That matters when you’re comparing Medicare coverage options.

We Look at Your Doctors Before We Look at the Extras

When we sit down with someone to compare plans, we want to know about their healthcare first.

Who is your primary care doctor? Do you regularly see a cardiologist or another specialist? Which hospital would you want to use? What prescriptions do you take? Do you spend much time outside South Carolina?

Those answers can help narrow down your coverage options considerably.

A local Medicare insurance agent can then help you compare:

• Medicare Advantage plans available in your South Carolina county
• Provider networks for your doctors, specialists, and hospitals
• Prescription drug coverage for the medications you take
• Your monthly premium, deductibles, copays, and out-of-pocket costs
• Coverage offered by different insurance companies
• Medicare Supplement and Medigap plans
• Standalone Medicare Part D prescription drug plans

We believe those details are much more important than simply choosing a plan because you saw an advertisement for it.

What Type of Medicare Coverage Makes Sense for You?

You don’t have to become a Medicare expert to make a good decision. But you should understand the basic choices you’re making.

With Original Medicare, Part A generally helps cover inpatient hospital care while Part B helps cover physician and outpatient services. Because Original Medicare doesn’t pay for everything, some South Carolina residents purchase a Medicare Supplement insurance plan to help with certain remaining costs. They may also purchase a Part D plan for prescription drug coverage.

Another route is Medicare Advantage, sometimes called Part C. Medicare Advantage plans are offered by private insurance companies and provide your Part A and Part B benefits through the plan. Many plans also include prescription drug coverage.

There are advantages and tradeoffs to each approach.

That is one reason working with an experienced Medicare broker can be helpful. Instead of trying to figure out every option on your own, a licensed Medicare agent can explain the differences and help you determine which direction fits your situation.

South Carolina Has Resources Beyond Your Insurance Agent

Insurance agents aren’t your only source of Medicare help, and we think consumers should know that.

South Carolina’s State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and assistance to Medicare beneficiaries and their families. It is an unbiased resource for people who have questions about Medicare, enrollment, prescription coverage, and other Medicare related issues.

Some South Carolina residents may also qualify for assistance through Healthy Connections Medicaid or one of the Medicare Savings Programs. Depending on eligibility, these programs can help qualifying Medicare beneficiaries with certain Medicare costs.

If you think you may qualify for additional assistance, it is worth exploring. Your eligibility for these programs can affect the Medicare insurance options you ultimately want to consider.

Medicare in the Upstate Isn’t Necessarily Medicare in the Lowcountry

This is where we think independent Medicare insurance agents can provide some of their greatest value.

South Carolina isn’t one healthcare market.

The Upstate, Midlands, Lowcountry, Pee Dee, and Grand Strand each have their own doctors, hospitals, health systems, and local considerations. The insurance companies and Medicare Advantage plans serving your county can also differ from those available elsewhere in the state.

A local Medicare insurance agent in South Carolina should understand that.

More importantly, they should take the time to understand you.

We want to know what matters to you before we start talking about plans. Then we can help you sort through your Medicare coverage options and make a decision based on your healthcare needs rather than marketing.

And once you’ve enrolled, keep your agent’s number.

Insurance companies can change benefits. Provider networks and drug formularies can change. Your doctors and prescriptions can change. Your own healthcare needs can change.

A good Medicare broker should still be there when it’s time to review your coverage during Medicare Open Enrollment or when a life event may qualify you for one of Medicare’s special enrollment periods.

Finding a Medicare plan is important.

Having someone local who knows you and can help you navigate Medicare year after year can be even more valuable.

Who is eligible for Medicare in South Carolina?

Those ages 65 and older are eligible for Medicare in South Carolina (and all 50 states). If you are not yet 65 but are diagnosed with either ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s Disease), you can still qualify.

**View our national Medicare agent locator and browse other states.

What Does South Carolina Medicare Cover?

Original Medicare in SC includes Part A, hospital coverage, and Part B, medical coverage. Part A provides coverage for hospital, nursing home, hospice, and home health services. Part B provides coverage for preventative doctor visits, emergency transportation, x-rays and labs, mental health, and durable medical equipment. Once you have A and B, you’ll need to add a form of prescription drug coverage. You can do this through a prescription drug plan (otherwise known as Part D) or through a Medicare Advantage or Medicare Supplement plan that includes prescription drug coverage.

What Medicare Plans are Available in South Carolina?

Every Medicare beneficiary will begin with Original Medicare. Then, everyone will need to select a form of prescription drug coverage. That can be either a stand-alone prescription drug plan or a Medicare Advantage plan (Part C).

Keep in mind that South Carolina provider networks are not all the same, so you’ll want to check to make sure your doctor accepts the plan that you choose.

South Carolina Medicare Advantage Plans

Medicare Advantage not only covers Parts A and B, but also adds coverage for additional items. SC Medicare Advantage plans can include prescription drugs, dental, vision, hearing, and even transportation and fitness benefits.

South Carolina Medicare Supplement Plans

If you don’t think Medicare Advantage plans in South Carolina are right for you, you can buy a Medicare Supplement plan instead, sometimes called Medigap. South Carolina Medigap plans do not cover extra benefits like dental and vision, but they can help you pay for your deductibles, coinsurance, and copayments. South Carolina Medicare Supplement plans are organized by letters A, B, C, D, F, G, K, L, M, and N. Each letter represents a different plan type with a different amount of coverage and a different cost.

What Does South Carolina Medicare Cost?

While your costs may be different based on the plan options you choose, the Part A and Part B costs are standardized. If you worked and paid your Medicare taxes for at least 39 quarters (about ten years), you can qualify for premium-free Part A. If, however, you only worked and paid your Medicare taxes for 30-39 quarters (between 7 and 10 years), you’ll have to pay $240 per month in 2019. If you paid Medicare taxes for even less than 30 quarters, you’ll have to pay $437 per month. Most Medicare Part A beneficiaries will face coinsurance for hospital stays. In 2019, the cost is $341 per day for the first 90 days, and then $682 per day.

The 2019 standard premium for Part B is $135.50 per month, but that amount can change based on your income. The standard deductible is $185 per year.

Can I have Medicare and Medicaid in SC?

If you qualify for Medicare in South Carolina but also meet the income requirements for SC Medicaid, you can get benefits from both programs. If you qualify for a DSNP (dual-eligible special needs plan), you can enroll in a Medicare Advantage plan during almost any time of the year instead of waiting for the Annual Enrollment Period to come around every fall. Your DSNP can make your Medicare coverage more affordable by covering your premiums, deductibles, and/or coinsurance and co-payments.

How do I Apply for Medicare in South Carolina?

Most people are automatically enrolled in Medicare Part A, but you’ll have to enroll in Part B. You can at your local Social Security office, the Social Security website, or by calling 1-800-772-1213 (TTY 1-800-325-0778). If you are a Railroad Retirement Board member, call the RRB directly to apply for Medicare in South Carolina at 1-877-772-5772 (TTY 1-312-751-4701). If you want more coverage than A and B, those plans are offered by private insurance companies. Our agents can help you if you want Medicare Advantage instead of Original Medicare.

Where do I Apply for Medicare in South Carolina?

You can enroll in Parts A and B at your local Social Security office or from the Social Security website, but you’ll want to speak to a licensed Medicare Plan Finder agent to enroll in a Medicare Advantage or Medigap plan.

South Carolina Medicare Beneficiary Resources

Foster Grandparents – The Foster Grandparents system pairs seniors with school-aged children to enforce positive behavior, reading, physical activity, etc. Members form mutually beneficial relationships and improve their social lives! For more information, contact the program coordinator Larrisa McDowell at lmcdowell@seniorresourcesinc.org or call 803-252-7734.

Senior Companions – Through the Senior Companion program, volunteers can visit with seniors to prevent loneliness and encourage physical activity. For more information, contact the program coordinator, Sonya Johnson, at sjohnson@seniorresourcesinc.org or 803-352-7734 ext. 245.

Meals On Wheels – This program is South Carolina’s senior meal delivery service. Seniors who have trouble keeping up with an adequate, healthy diet due to transportation or financial constraints can apply or get a referral from a doctor, agency, friend, or family member. A representative will perform a home visit to assess need. The cost of this service will vary based on need. Meals are designed to meet at least a third of a senior’s daily nutritional needs. For more information, contact Anne Shissias at ashissias@seniorresourceinc.org or 803-252-7734 ext. 234.

Wellness Centers  – South Carolina seniors have access to four South Carolina  wellness centers, located in Columbia, Blythewood, Eastover, and Hopkins. They provide classes, activities, and meals.

Emergency Rental Assistance – Applicants who are at least 150% above the federal poverty line can apply to receive temporary home rental funding.  

Pet Programs – It has been proven that pets improve quality of life. That’s why South Carolina seniors can adopt a pet and receive assistance to pay for pet food and vet bills.

Legal Assistance – South Carolina seniors in need can receive free or low-cost legal counsel through the Office on Aging!

Senior Community Service Employment Program (SCSEP) – Seniors who need money but have had a hard time going back to work can apply to work in their communities.

South Carolina Provider Search – If you want to find out if your doctor accepts a certain plan, or if you’re looking for a new doctor in your area, this provider search tool can help.

Medicare Savings in South Carolina

Looking for South Carolina Medicare savings? We can help you figure out if you’re eligible for any cost savings. We can help you set up a free appointment with an agent in your area who can come to your home and help you sort through your options.

If you’re looking for a way to save money on your premiums, copayments, and coinsurance, get in touch with us at Medicare Plan Finder. We can help you find out if you are eligible for cost savings.

To get started, give us a call at (833) 567-3163.