Medicare in South Carolina

In this article...
  • Discover more about Medicare in South Carolina today. This guide covers the plans offered, who is eligible and how you can enroll.

Medicare in South Carolina is administered under the umbrella of the Department of Insurance. There are several components to this program qualified individuals can choose from. 

What South Carolina Medicare Plans Are Available?

Medicare is broken up into several different parts and cater to different populations and needs. 

Part A

The Part A segment of Medicare is the original component of the larger program. It offers coverage to eligible individuals for hospital-related costs. This form of Medicare insurance also covers inpatient stays in hospice or skilled nursing facilities and surgical centers. It is the one component of Medicare that is entirely free to those who qualify for coverage. 

Qualification is designated by participation in the payroll tax system; those who did not pay into this system must pay for coverage. The caveat for doing so, however, is that these individuals must purchase Parts A and B. 

Part B

This segment of Medicare is a form of insurance most people are more familiar with. It covers preventative care measures, such as annual physicals, routine check-ups and other in-office visits. It also covers specialist visits and even some necessary medical equipment. 

Those eligible are required to sign up during predetermined enrollment periods. Missing the sign up without being part of the exception group (those who had other coverage and suddenly lost it) incurs a penalty levied every 12 months. 

There are premiums associated with Part B, the amount of which is based on personal income. 

Part C

Part C plans are also known as Medicare Advantage plans. It is a privatized element of Medicare that allows covered individuals to take advantage of health maintenance organization (HMO) or preferred provider organization (PPO) options. It functions very similar to that of employer coverage. 

Part C covers services not eligible under Parts A and B, including vision and dental. Those interested in a Medicare Advantage plan must already be enrolled in Medicare Parts A and B. Plans are administered through private entities.

Part D

Medicare Part D is the prescription drug plan. Similar to Part B, there is a monthly premium for this option, which is also based on income. There are designated enrollment periods for this part of Medicare as well, which means there may be a penalty for those who don't enroll on time. 

Medigap

Because there are other costs associated with the provision of health care, Medigap insurance is necessary for those with limited incomes. It covers things like coinsurance and copays. Those interested in this coverage must be enrolled in the original components before signing up for Medigap. 

Roughly 21% of the population in South Carolina is enrolled in Medicare, with about a third of these individuals enrolled in Advantage programs. There are 29 Part D providers in the state and 63 insurers offering Medigap plans. 

Who Is Eligible for South Carolina Medicare?

Those age 65 and up are eligible for Medicare in South Carolina. Automatic eligibility rests on payroll tax participation. The Social Security Administration has also designated some disabilities and chronic conditions for eligibility, a determination made when applying for Medicare. 

Those already receiving benefits from the Social Security Administration are eligible for automatic enrollment four months before their 65th birthday. The initial enrollment period for those manually enrolling is three months prior to their 65th birthday extending through a period of three months thereafter. 

While enrollment after this point is an option, it may be accompanied by a penalty. 

Medicare has designated enrollment periods annually. The first is between January 1 and March 31, with coverage for this period beginning July 2. The fall enrollment period is between October 15 and December 7, with coverage beginning January 1. There are also special enrollment options. For instance, those with Parts A and B may switch to a Medicare Advantage plan or drug plan anytime a five-star plan opens up between December 8 and November 30. However, this switch can only be made one time during this period.

Additionally, those who were covered through other policies and suddenly lost coverage may enroll at any time. 

How Do I Enroll in Medicare in South Carolina?

Upon becoming eligible for coverage, individuals may enroll via the Social Security Administration website at www.SocialSecurity.gov. Enrollment may also take place via phone at (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m. 

Finally, those in need of in-person assistance may visit their local Social Security Administration office to sign up. 

Contact Information for South Carolina Medicare, Medicaid and Insurance Help

For more assistance with Medicare, Medicaid and other forms of insurance, visit https://www.helpadvisor.com/medicaid/south-carolina-medicaid

Those in need of local resources can find help with Medicare in South Carolina through the Insurance Counseling Assistance and Referrals for Elders program. They can be reached online or by phone at (800) 868-9095. 

There are also several South Carolina Prescription Drug Assistance programs for those who need help paying for prescription drug medications. 

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