Written by Janice Domke
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Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital insurance) and Part B (medical insurance). Most Medicare Advantage (MA) plans also include Part D, which covers prescription drugs. In addition, many plans offer extra benefits like dental, vision, hearing, telehealth, and fitness programs.
Medicare Eligibility
To enroll in a Medicare Advantage plan, you must first be enrolled in Original Medicare Parts A and B. Most people become eligible for Medicare enrollment at age 65, but individuals under 65 may qualify earlier due to disability, ALS, or ESRD. Be sure to understand the key enrollment periods:
- Initial Enrollment Period
- General Enrollment Period
- Special Enrollment Periods
Missing your enrollment window can result in late penalties and delays in coverage.
What Types of Medicare Advantage Plans Are Available in South Carolina?
South Carolina offers several types of Medicare Advantage plans:
- Health Maintenance Organizations (HMOs): Require in-network providers and referrals to see specialists. Often have lower premiums.
- Preferred Provider Organizations (PPOs): Allow more flexibility to see out-of-network providers (usually at a higher cost) and don’t typically require referrals.
- Private Fee-for-Service (PFFS) Plans: You can see any provider who agrees to the plan’s terms. Some plans include provider networks.
- Special Needs Plans (SNPs):
- C-SNPs: Designed for individuals with chronic conditions like cancer, diabetes, or heart disease.
- I-SNPs: For those receiving institutional or nursing home-level care.
- Dual Eligible Special Needs Plans (D-SNPs): For people eligible for both Medicare and Medicaid. These plans often offer extra benefits with minimal or no cost.
- Medical Savings Accounts (MSAs): Pair a high-deductible plan with a savings account funded by the insurer to help pay for medical expenses.
Compare options HERE & start your health plan journey.
What Are Your Prescription Drug Options with Medicare Advantage?
Most MA plans include Part D drug coverage. However, some PFFS and MSA plans do not. If your plan doesn’t include drug coverage, you may:
- Enroll in a standalone Part D plan (only for some plan types like certain PFFS).
- Face a late enrollment penalty if you delay and don’t have other creditable coverage.
Always review your plan’s formulary to ensure your medications are covered.
How Do You Choose a Medicare Advantage Plan?
Before enrolling, it’s important to understand Medicare Advantage costs. Consider the following:
- Premiums: Some plans offer $0 premiums, while others may charge a monthly fee.
- Deductibles, Coinsurance & Copays: Understand what you may pay out of pocket for covered services.
- Out-of-Pocket Maximums: These caps limit how much you’ll spend per year on healthcare expenses.
- Extra Benefits: Many plans include dental, vision, fitness memberships, virtual care, and transportation assistance.
Compare each plan’s features, provider network, drug coverage, and extra services to choose one that aligns with your health and lifestyle needs.
When and How Do You Enroll in a Medicare Advantage Plan?
You can enroll in Medicare during specific enrollment periods:
- Initial Enrollment: Starts 3 months before the month you turn 65 and ends 3 months after.
- Annual Open Enrollment (Oct 15–Dec 7): Make changes or enroll in a new MA plan for the following year.
- General Enrollment (Jan 1–Mar 31): For those who didn’t sign up during Initial Enrollment.
- Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch to a different MA plan or return to Original Medicare.
- Special Enrollment Periods: Triggered by life events such as:
- Moving outside your plan’s area
- Losing employer or Medicaid coverage
- Plan changes or termination
- New health conditions (e.g., qualifying for a C-SNP)
Compare options HERE & start your health plan journey.
What If You Want to Change Your Medicare Advantage Plan?
You can switch Medicare Advantage plans during:
- Open Enrollment (Oct 15–Dec 7)
- Medicare Advantage Open Enrollment (Jan 1–Mar 31)
Plan changes usually go into effect on January 1 if made during the fall enrollment period.
Understanding Medicare Advantage Star Ratings
The CMS star ratings help you compare Medicare Advantage plans based on quality and performance. Ratings range from:
- 1 star: Poor
- 2 stars: Below average
- 3 stars: Average
- 4 stars: Above average
- 5 stars: Excellent
These ratings are updated yearly and cover both Part C (health) and Part D (drug) services.
What Are Medicare Resources in South Carolina?
South Carolina offers several support programs for Medicare beneficiaries:
- South Carolina SHIP Program: Offers free Medicare counseling and plan assistance.
- South Carolina SMP Program: Educates beneficiaries about Medicare fraud prevention.
- South Carolina Department of Insurance: Resolves insurance complaints.
- Healthy Connections: South Carolina’s Medicaid program helps cover healthcare costs for low-income residents. Call 1-888-549-0820 for assistance.
Learn more about the differences between Medicare and Medicaid.
Shop for a Medicare plan with additional benefits!
Other Medicare Plan Options to Help with Out-of-Pocket Costs
Medicare Supplement Plans, also known as Medigap, help cover deductibles, copays, and coinsurance not paid by Original Medicare.
- You must be enrolled in Medicare Parts A and B.
- Enroll during your six-month Medigap Open Enrollment Period (after enrolling in Part B) to avoid underwriting.
- These plans do not cover prescriptions—add a Part D plan separately.
- Popular options include Plans F, G, and N. Medicare Supplement Plan G had the highest enrollment in 2023 and continues to grow in popularity.
- Plan F is not available to new beneficiaries after 2020.
Learn more about Medicare Supplement plans in South Carolina.
Next Steps
If a Medicare Advantage plan in South Carolina is right for you, take time to compare available options in your area. Review premiums, out-of-pocket costs, provider networks, and extra benefits. Use trusted resources like SHIP counselors or the Medicare Plan Finder to make an informed decision when you’re eligible to enroll.
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Centers for Medicare & Medicaid Services. “Chronic Condition Special Needs Plans (C-SNPs).” cms.gov (accessed December 18, 2020).
Centers for Medicare & Medicaid Services. “Dual Eligible Special Needs Plans (D-SNPs).” cms.gov (accessed December 18, 2020).
Centers for Medicare & Medicaid Services. “Institutional Special Needs Plans (I-SNPs).” cms.gov (accessed December 18, 2020).
Centers for Medicare & Medicaid Services. “Private Fee-for-Service Plans.” cms.gov (accessed December 18, 2020).
U.S. Government Website for Medicare. “Medicare Medical Savings Account (MSA) Plans.” medicare.gov (accessed December 18, 2020).
U.S. Government Website for Medicare. “Find a Medicare Plan.” medicare.gov (accessed December 13, 2020).
Centers for Medicare & Medicaid Services. “Medicare Advantage Average Monthly Premiums, 2007-2021.” cms.gov (accessed December 23, 2020).
South Carolina Department of Health and Human Services. “Program for All-inclusive Care for the Elderly (PACE).” scdhhs.gov (accessed December 23, 2020).
South Carolina Department on Aging. “State Health Insurance Assistance Program (SHIP).” aging.sc.gov (accessed December 23, 2020).
South Carolina Department of Insurance. “Health Insurance.” doi.sc.gov (accessed December 17, 2020).
South Carolina Healthy Connections. “Getting Started.” scdhhs.gov (accessed December 23, 2020).
