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Medicare Plans in South Carolina – Coverage and Benefits

Odds are that if you’ve lived in South Carolina for a while, you know about the Federal Medicare Program. Basically, it’s a low-cost form of health insurance which is provided by the government for retired seniors 65 and older who are living on a fixed income. This way, you don’t have to worry about your retirement savings being jeopardized by the expensive health care costs common for people who are in their golden years. You can relax, knowing that the majority of your health care needs are covered by Medicare Part A and Medicare Part B – commonly referred to as Traditional Medicare – at a relatively affordable price.

Part B, which takes care of most basic needs (including doctor visits, outpatient procedures, and physical therapy) does charge premiums and fees for all beneficiaries. But, as you can see from the link above, these are based on income and designed to be as affordable as possible. Part A, on the other hand, covers most of your hospital visit expenses and might be free, provided you have a sufficient employment history of 10 years (or 40 quarters). If not, then you may be required to pay a deductible.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different Medicare Plans in South Carolina

As of this writing, there are 820,947 South Carolina senior citizens currently protected by some form of Medicare health coverage. For those who choose to supplement their health care benefits personally, it is a nearly even split between Medigap supplement insurance and Medicare Advantage. 22% of beneficiaries (180,608 people) chose an Advantage policy, whereas 21% (or 170,566 seniors) opted for Medigap. But the majority of them – which includes 57% of beneficiaries – are either supplementing their Original Medicare with some sort of benefit plan, potentially from an employer, or with no supplemental insurance at all. And that could be very risky.

Remember: you have to be enrolled in Medicare before you can start supplementing your benefits for Parts A & B. If you have not yet enrolled, or if you aren’t sure whether you’re enrolled in Medicare, click the link to find out.

What are the Risks Associated with Original Medicare?

Original Medicare, as comprehensive as it tries to be, doesn’t pay for everything. And these gaps in coverage can produce very expensive medical bills very quickly if you don’t protect yourself with some sort of supplemental coverage. Just look at some of the more common coverage gap expenses below:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Even if you’re newly retired and have good health, you can still benefit from purchasing supplemental coverage now. In fact, getting it done sooner rather than later can actually save you money in the long run. The younger and healthier you are, the lower your premiums will be starting out. You won’t have to worry about being charged higher rates for advanced age or chronic conditions that will likely pop up if you wait to start shopping until you need a supplement.

Should South Carolina Residents Consider a Medigap Policy?

Even though it isn’t the most popular choice in the state currently, any senior without Medicare supplement coverage absolutely should take a closer look at a Medigap supplement insurance policy. These policies are specifically crafted to give you exactly what you need – protection from Medicare coverage gaps – and nothing that you don’t. This keeps each plan simple and easily affordable. And they’re uniform across all 50 states, so someone shopping for Plan D in South Carolina can expect the exact same benefits as someone from Alaska. The only differences are the provider, and the expected cost.

Take a look at what each of these 10 plans have to offer below:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $117 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $103 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $90 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $78 $0 $147 Not Covered Not Covered Not Covered Request Info
N $0 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $84 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $143 $1 $147 Not Covered Not Covered Not Covered Request Info
L $71 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $42 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $0 $608 $147 Not Covered 100% Covered 100% Covered Request Info

What About Medicare Advantage Plans in South Carolina?

Medicare Advantage is certainly a reasonable option for any South Carolina resident who wants to supplement their Traditional Medicare benefits. There are a few reasons why someone might choose an Advantage plan over a Medigap policy. For starters, it is one single, simple policy offered through a single private company which handles all of your health care needs. And we do mean all – because if you want extra coverage options, such as prescription drugs, they are available for you (for an additional cost, of course).

Conversely, there are reasons why an Advantage policy might not be the right strategy for certain individuals. The most common reason people shy away from Medicare Advantage has to do with the restricted provider networks. If you like your current doctor and don’t want to switch, then make sure that your physician is included in your Medicare Advantage network before you sign the dotted line.

Medicare Advantage plans provide members with health care through two different types of provider networks. These networks are referred to as PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks.

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$0 Humana Gold Plus H2012-096 (HMO) Health and Drug $0.00 $200

Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$0 HumanaChoice R5826-064 (Regional PPO) Health Only $0.00 $0
$672 HumanaChoice H8707-001 (PPO) Health and Drug $56.00 $0
$924 HumanaChoice R5826-077 (Regional PPO) Health and Drug $77.00 $150

Medigap vs. Medicare Advantage

For more information on the difference between these two forms of coverage, consult these common questions, and their associated answers:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional South Carolina Medicare Resources

We hope that this article has been informative. Unfortunately, we cannot answer all of the important questions you are likely to have right here and now. But the good news is that we know people who can. Take a look at our directory of Medicare experts located near you. Don’t be afraid to get in touch with your local offices and ask a few questions.

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Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

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