If you qualify for Medicare Part A and B, or Original Medicare, you may know it doesn’t fully cover your costs for health services or limit your out-of-pocket costs. Many South Carolina residents choose Medicare Advantage plans. Medicare Advantage (MA), or Medicare Part C, provides more comprehensive coverage through private insurers while giving you the same protections as Original Medicare.
What You Need to Know
There are several enrollment periods during the year when you can sign up.
You can save money on a Medicare Advantage plan by staying within your network of doctors and facilities.
Most MA plans offer prescription drug coverage, which isn’t included in Original Medicare.
What Types of Medicare Advantage Plans Are Available?
There are several different types of Medicare Advantage plans in South Carolina. Choosing the right plan depends on your needs. Standard plan types are:
HMO: Health Maintenance Organization
HMOs generally offer the lowest monthly premiums and the most restrictive network. You need to choose a primary care physician (PCP) and get referrals to see a specialist. Going outside your network increases your costs.
PPO: Preferred Provider Organization
PPOs offer a broader network than HMOs. Many plans don’t require you to choose a PCP or to get referrals to see a specialist, although monthly premiums are often higher.
SNP: Special Needs Plans
SNPs are for people who use more medical services than the general public. There are different types:
D-SNP: Dual-eligible special needs plans, for people who are eligible for Medicare and Medicaid.
I-SNP:3 Institutional special needs plans, for those receiving care in a skilled nursing facility or another type of institution.
PFFS: Private Fee-for-Service plans
These plans allow you to see any eligible provider at preset rates. You don’t need to select a PCP and most don’t have a network.4
MSA: A Medicare Medical Savings Account
A Medicare Medical Savings Account plan combines a high-deductible MA plan with a plan-funded savings account you can use for healthcare costs.5
What Are Prescription Drug Options With Medicare Advantage?
Insurers in South Carolina offer many Medicare Advantage plans that include Medicare Part D prescription drug coverage. Check your plan’s drug formulary, or list of approved medications, to make sure your prescriptions are included.
If your plan doesn’t include prescription drug coverage, you may be able to purchase a separate Part D plan (only PFFS plans allow this).
How Do You Choose Medicare Advantage Plans?
Monthly costs can vary by insurer, so check the details when you’re choosing a Medicare Advantage plan in South Carolina.
Costs to consider are:
The monthly amount you pay for an insurance plan. Costs vary by plan and coverage. There are zero-premium options that don’t charge you a monthly cost beyond the Medicare Part B premium ($148.50 in 2021), but your out-of-pocket costs may be higher.
The set amount you pay for a covered service. You pay a $0 to $25 copay for primary care visits and $0 to $50 for specialists. Coinsurance
The percentage of costs you pay for a covered service after you’ve met your deductible, if there is one. You pay up to 20% coinsurance for primary care visits and 20% coinsurance for specialists and other services.
The amount you pay each year out-of-pocket before your insurer starts to pay for covered services.
Maximum Out-of-Pocket Costs
You pay a certain amount of costs that aren’t covered before the cap kicks in. Out-of-pocket maximums range from $2,500 to $7,550 for in-network services. Out-of-network services have out-of-pocket maximums as high as $10,000.
Other Plan Benefits
- Dental: Many plans include coverage for teeth cleaning, annual exams and other services.
- Vision: Many plans include coverage for eye exams and glasses or contact lens fittings.
- Telemedicine: Many plans cover virtual doctor visits and other remote services.
- Other perks: Many plans include coverage for fitness programs and transportation help.
In addition to prescription drug coverage, many MA plans offer vision and dental benefits.
When and How to Enroll in Medicare Advantage?
You can sign up for Medicare Advantage as soon as you’re eligible for Original Medicare. Your Initial Enrollment Period begins three months before the month you turn 65 years old, and ends three months after you turn 65.
The Annual Election Period, or Open Enrollment Period, runs October 15 through December 7 and allows you to change plans for the following year. Plan changes go into effect January 1. Enrolling in a new plan will generally cancel your current plan on December 31.
The Medicare Advantage Open Enrollment Period runs January 1 through March 31. You can change your Medicare Advantage plan or return to Original Medicare.
The General Enrollment Period runs January 1 to March 31 each year. If you missed the Initial Enrollment Period for Medicare Part A and/or B, you can sign up then. Your coverage won’t begin until July 1, though.
You may qualify for a Special Enrollment Period based on your circumstances. Qualifying events include: you move out of your service area, you lose or gain coverage eligibility, your current plan changes, or you’re diagnosed with a condition that qualifies you for a C-SNP.
Medicare Advantage plans are required to offer the same basic coverage as Original Medicare.
How Do You Sign Up?
There are generally three ways you can sign up for a Medicare Advantage plan in South Carolina:
- Contact the insurance company directly.
- Work with a Medicare-certified insurance agent, who can help you pick a plan and get enrolled.
- Contact Medicare online or by phone.
How Much Do Medicare Advantage Plans Cost in South Carolina?
Costs in South Carolina can vary by location. In Columbia, Lancaster, and Walhalla,6 plans range from $0 to $90 per month. The average monthly premium for 2021 is expected to be $13.49.7 Out-of-pocket costs vary by premium.
What If You Want to Change Your Medicare Advantage Plan?
You can change your plan during the Medicare Annual Election Period, October 15 to December 7, or the Open Enrollment Period, January 1 to March 31.
What Are Alternatives to Medicare Advantage?
- Medicare Part A and B: You can stick with Original Medicare if it offers enough coverage for your needs.
- Medicare Supplement: These plans, also known as Medigap policies, help you pay the costs not covered by Original Medicare.
- Medicare Supplement plus Medicare Part D: You can purchase a separate Part D prescription drug plan to combine with your Medicare Supplement plan.
- Program of All-Inclusive Care for the Elderly (PACE):8 This federal program offers comprehensive, community-based health services to those who qualify.
What Are Medicare Resources in South Carolina?
The State Health Insurance Assistance Program (SHIP) offers free counseling and help with Medicare and Medicare Advantage.9
For general information on what Medicare is and how it works, the South Carolina Department of Insurance offers definitions and other information.10 It also offers an “Insurance Finder” tool to connect you with local agents.
Healthy Connections, South Carolina’s Medicaid program, helps pay medical costs for those with low income or disabilities.11 Your county public health department can help you find resources as well.
If a Medicare Advantage plan is the right choice for you, choose the plan you want and compare plan details from different insurers. Make sure you’re getting the right amount of coverage at the right cost.