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Medicare Advantage Plans in South Carolina

Just about one-quarter of a million local Medicare beneficiaries have joined Medicare Advantage plans in South Carolina. Even though Medicare Part A and Part B will pay most of the cost of many medical and hospital bills, they won’t pay for everything. Besides helping people manage Medicare coinsurance, co-payments, or deductibles, a Medicare Advantage plan in South Carolina might provide some other valuable benefits, like coverage for prescription drugs and membership to fitness centers.

When to Enroll in Medicare Plans in South Carolina

If you’re enrolled in Medicare Part A and Part B, you qualify for a Medicare Advantage plan in South Carolina. The only exception is for a Medicare beneficiary who has previously been diagnosed with End Stage Renal Disease ESRD. People who have Original Medicare and ESRD may join special plans that were developed to help manage this disease.

Even though your enrollment in Original Medicare qualifies you for a Medicare Advantage plan, you still need to join at certain times:

  • Initial Coverage Election Period: The best time to join an MA plan might be right when you first become enrolled in Medicare Part A and Part B.
  • Annual Election Period: You get a chance to change Medicare Advantage and Part D plans every year in the fall..
  • Special Election Periods: Moving to another city or losing prior coverage might trigger a Special Election Period.
  • Medicare Advantage Dis-enrollment Period: At the beginning of each year, you can choose to leave your Medicare Advantage plan in South Carolina and continue on with Medicare Part A and Part B. If you need prescription benefits, you can also enroll in a Part D plan.

Enrollment Stats for Medicare Advantage Plans in South Carolina

These enrollment statistics are for South Carolina Medicare Advantage plans:

  • Enrolled in a Medicare Advantage plan in South Carolina: 243,000
  • Percent of South Carolina Medicare recipients: 2%

These are the most populated counties in South Carolina:

  • Greenville County, South Carolina: 506,837
  • Richland County, South Carolina: 411,592
  • Charleston County, South Carolina: 401,438
  • Horry County, South Carolina: 333,268
  • Spartanburg County, South Carolina: 306,854

Popular Choices for Medicare Advantage Plans in South Carolina

If you are used to Medicare Part A and Part B, you know it is the same everywhere in the United States. On the other hand, one Medicare Advantage plan may work very differently than another one.

This list highlights features of common South Carolina Medicare Advantage plans:

Health Maintenance Organization HMO plans

You will generally find that an HMO plan will have the lowest cost but most network restrictions. About 27% of MA plan enrollee’s in South Carolina choose an HMO. These are most likely to offer $0 premium rates to join.

Preferred Provider Organization PPO plans

You may pay higher rates for a PPO than an HMO, but in return for somewhat higher premiums, you get more flexibility. Almost 71% choose an MA PPO over other kinds of Medicare Advantage plans.

Special Needs Plans SNPs

People who need to deal with chronic health conditions, like diabetes or institutional conditions might enroll in Special Needs Plans.

Dual-Eligible Plans

A Medicare beneficiary with Medicaid can enroll in one of these plans.

End Stage Renal Disease ESRD plans:

These are the special Medicare Advantage plans for people with ESRD.

How Medicare Advantage Plans in South Carolina Cover Prescriptions

Medicare Part A and Part B only cover prescriptions in specific cases. For instance, Original Medicare will typically cover drugs you get in the hospital or in certain outpatient centers, but it won’t cover prescriptions that you pick up at the pharmacy. Most Medicare Part C plans in South Carolina include prescription benefits, and these are called Medicare Advantage Prescription Drug plans.

These are a couple of important things you should know to help you compare Medicare Advantage plans and choose the best one for your prescription needs:

  • Drug formulary: Each insurance company will publish a list of the drugs that will typically cover for each Medicare Part C plan in South Carolina.
  • Prescription Drug tiers: The insurance company may also cover different classes of drugs at different levels. For instance, they may cover more of the cost of generic drugs than of brand-name drugs.

Network Restrictions for Medicare Advantage Plans in South Carolina

Beneficiaries are used to Medicare Part A and Part B may not be familiar with the network restrictions that most Medicare Part C plans in South Carolina have. While Original Medicare doesn’t use networks, almost all Medicare Advantage plans in South Carolina will.

This briefly highlights the restrictions that HMO and PPO Medicare Advantage plans have:

  • HMO: With an HMO, you must almost always visit in-network providers in order to get services covered at all. They should make exceptions for emergencies or other very unusual circumstances. You also need to get your PCP, or primary care doctor, to give you referrals to get a covered visit with a specialist.
  • PPO: With a PPO, you will pay less if you stick to the list of in-network medical providers. However, the insurer will cover out-of-network services at a lower rate. You also don’t have to get PCP referrals for specialist doctor visits.

Either way, you will benefit the most if you check the network for the doctor, hospital, and other providers that you would prefer to use. For instance, you may benefit from a Medicare Advantage plan in South Carolina with a $0 premium if the network includes nearby providers. If not, a PPO might suit you best. You should compare the network lists of a few different plans to see which one will work out better.

South Carolina Medicare Resources

If you have Original Medicare or other Medicare insurance, these South Carolina resources may help you manage your benefits:

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