Thanks to more options and expanding coverage, Medicare Advantage (MA) has nearly doubled in popularity over the past decade. Also known as Medicare Part C, the program now has over 30 million enrollees, with most beneficiaries having 43 Advantage plans to choose from. On this page, we explain Medicare Advantage plans in South Carolina, how the program works, and how to compare your options.
What is Medicare Advantage in South Carolina?
At a minimum, Medicare Advantage plans must provide the same coverage that you'd have with Original Medicare. This includes:
- Medicare Part A covers inpatient services that you receive in a hospital or skilled nursing facility (SNF) as well as hospice care
- Medicare Part B covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more
Prescription drug coverage is provided by Medicare Part D, not Original Medicare.
One reason Medicare Advantage keeps growing in popularity is that most plans offer additional benefits. These vary from plan to plan, but the most common are:
- Prescription drug coverage
- Routine vision and dental care
- Fitness programs
- Hearing aids
Please note that, even if you join a Medicare Advantage plan in South Carolina, you'll still have to pay the Medicare Part B premium.
South Carolina Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) are often called all-in-one plans, because they combine your Original Medicare and Part D benefits into a single plan.
The extra benefits you get with an MA-PD plan could save you money, even if your plan has a monthly premium. That's because you don't have to buy a standalone Medicare Part D plan or pay out-of-pocket for prescription medications. Plans that cover additional services, like vision care and prescription lenses, could save you even more money.
Who is eligible for Medicare Advantage in South Carolina?
If you have Medicare Parts A and B, you are eligible for Medicare Advantage in South Carolina.
American citizens and permanent legal residents aged 65 and older qualify for Medicare. However, you are only automatically enrolled in the program if you began collecting Social Security benefits at least 4 months before your 65th birthday.
You may qualify for Medicare before you turn 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment in Parts A and B is automatic.
Finally, if you have either amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) or end-stage renal disease (ESRD), you may also qualify for Medicare before turning 65.
When can you sign up for a Medicare Advantage plan in South Carolina?
Medicare limits enrollment to specific times. The first, appropriately enough, is your Initial Enrollment Period (IEP). It begins 3 months before you become eligible for Medicare and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits occurs in January, your IEP begins on October 1 and extends through April 30.
If you did not sign up for Medicare Part A and/or Part B during your IEP, you may do so during the General Enrollment Period from January 1 through March 31. After General Enrollment ends, you can join a Medicare Advantage plan between April 1 and June 30.
The Medicare Annual Enrollment Period (AEP) lasts from October 15 through December 7 and allows current Medicare beneficiaries to make any desired changes to their coverage. This includes signing up for an MA plan.
If you already have Medicare Part C, you can take part in the Medicare Advantage Open Enrollment Period. It lasts from January 1 through March 31 and allows you to switch to a new MA plan or return to Original Medicare. But, if making that change means you'll lose your prescription drug coverage, you may also enroll in a standalone Part D plan.
Certain life changes may qualify you for a Special Enrollment Period (SEP). The most common are moving and losing your current coverage, but there are dozens of ways to qualify. The full list is on Medicare.gov.
Types of Medicare Advantages plans in South Carolina
There are four common types of Medicare Advantage plans in South Carolina.
Health maintenance organization (HMO) plans use a provider network to help manage costs. If you receive non-emergency care from an out-of-network provider, your HMO plan probably won't cover the service. HMOs also require members to choose a primary care doctor, who coordinates your care and writes specialist referrals.
Preferred provider organizations (PPO) also use a provider network. However, members may receive out-of-network care for a higher copay. PPO plans do not require members to choose a primary doctor or get a referral to see a specialist.
A private fee-for-service (PFFS) plan determines how much it and its members will pay for any covered service. Most use a provider network but do allow members to receive out-of-network care for a higher price. Like PPOs, PFFS plans do not require you to choose a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) are restricted to certain populations. To join, you must meet one of the following qualifications:
- Have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
- Require in-home care or live in an institution like a nursing home
- Qualify for both Medicare and Medicaid (known as dual eligibility)
SNPs members must choose a primary doctor who coordinates care and provides specialist referrals.
How to choose a Medicare Advantage plan in South Carolina
If you're looking for a South Carolina Medicare Advantage, consider the following:
- Costs: May include an annual deductible, monthly premium, and copays or coinsurance.
- Coverage: Benefits vary widely, so look closely at coverage to be sure you're comparing apples to apples. Don't forget to check the drug formulary of an MA-PD plan.
- Network: Anyone who provides healthcare services may be included in the provider network.
- Ratings: Medicare rates all Advantage plans on a 5-point scale and releases their findings each fall before Annual Enrollment.
It's easy to compare Medicare Advantage plans in South Carolina with our Find a Plan tool. Just enter your location information and coverage start date to review Medicare plans in your area.
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