Medicare Advantage plans in South Carolina provide optional health insurance to Medicare beneficiaries already enrolled in Original Medicare. The policies offer extended coverage that doesn’t come with Medicare Part A and Medicare Part B. Medicare Advantage in South Carolina is best suited to beneficiaries who want to combine prescription drug coverage and wellness benefits with enhanced medical coverage.
What is Medicare Advantage in South Carolina?
Medicare Part C is often described as a replacement for Original Medicare, but that doesn’t mean beneficiaries are no longer enrolled in the federal Medicare program. Once enrolled in a South Carolina Advantage plan, beneficiaries use an insurance card provided by the insurance company to obtain medical services. The red, white, and blue Medicare card is still valid and is kept for future use as needed.
All beneficiaries should understand the following facts about Medicare Part C:
- All plans are issued by and administered by a private insurance company rather than the Centers for Medicare and Medicaid Services.
- Medicare Advantage health plans may include wellness benefits like Silver Sneakers memberships and added health benefits like coverage for dental, hearing, and vision services.
- Medicare Advantage Prescription Drug plans, also known as MAPD, include prescription drug and medical coverage in one plan.
- An insurance agent can sign beneficiaries up for Part C plans once they’re enrolled in Original Medicare.
What is the Best Medicare Advantage plan in South Carolina in 2022?
Best for network freedom: Medicare Advantage PPO
- Larger provider networks allow greater freedom when selecting healthcare providers.
- Some plans may allow out-of-network providers with higher out of pocket costs.
- Premiums range from $0 to $100 per month.
Best for lowest out-of-pocket: Medicare Advantage HMO Plan
- Most Medicare beneficiaries have access to $0 premium HMO plans.
- Narrow networks allow for lower monthly premiums.
- Beneficiaries have fewer options when selecting medical providers.
Best for low income or health conditions: Medicare Advantage D-SNIP
- Select South Carolina insurance plans are reserved for beneficiaries with specific chronic health conditions or income limitations.
- Additional coverage is offered to help beneficiaries manage their chronic health conditions.
- Medicaid is often combined with Medicare coverage to minimize out of pocket expenses for low-income beneficiaries.
What Medicare Advantage plans are available in South Carolina?
South Carolina Medicare Advantage plan options for 2022 vary by county. Some of the most popular plan types include the following:
- Local HMO
- Local PPO
- Regional PPO
How much does Medicare Advantage cost in 2022?
In 2020, the average monthly premium for a South Carolina Medicare Advantage plan with a Part D plan was just over $15. 41, and the percentage of MAPD plans had a star rating of 4 or 5. With average premiums going over $70 a month in some states, South Carolina is one of the more affordable states for Part C plans.
In addition to the monthly premium, beneficiaries must pay the following out of pocket costs when enrolled in an Advantage plan:
When can I make changes to my Medicare Advantage plan?
The best time to make changes to a Medicare Advantage plan in South Carolina is during the annual Open Enrollment Period. It takes place from October 15 to December 7, and new coverage starts on July 1.
The following options are available during the Advantage Open Enrollment Period:
- Switch to a new South Carolina Medicare Advantage plan
- Switch back to Original Medicare with or without a Part D prescription drug plan
There are special circumstances that can unlock eligibility for Advantage plan enrollment outside of the annual election period. Most beneficiaries are locked into their plan choices until the next open enrollment period.
When can you enroll in a South Carolina Medicare Advantage plan for 2022?
Initial Enrollment Period
South Carolina beneficiaries enrolling in Medicare at the age of 65 have an initial enrollment period that lasts seven full months. It includes the 65th birthday month plus the three months before and the three months after the birthday month.
This is the best time to enroll in a Medicare Advantage plan because there are no penalties for late enrollment and beneficiaries can select from Medicare Supplement plans, Advantage plans, and Original Medicare with Medicare Part D.
Open Enrollment Period – AKA Annual Election Period
From October 15 to December 7 each year, Medicare beneficiaries have the chance to switch to a new plan. That includes going from an Advantage plan to Original Medicare or vice versa. Beneficiaries may also change or pick up prescription drug plans if they aren’t satisfied with their current plans or didn’t enroll in Part D before.
Medicare Advantage Open Enrollment Period
Medicare Advantage plans have their own open enrollment period from January 1 to March 31 each year. Only beneficiaries already enrolled in a Part C plan can make a change at this time unless they qualify for a special enrollment period.
Special Enrollment Periods – Special Circumstances
There are some special circumstances that allow select beneficiaries to enroll in Medicare advantage plans outside of the initial enrollment period and the two open enrollment periods. These periods are personalized to the beneficiary and can take place at any time in the year.
Some of the most common reasons for special enrollment include:
- Moving outside of the service area for the current plan
- Losing private medical coverage from an employer or another reputable source
5-star Special Enrollment Period
From November 30 to December 8 each year, beneficiaries enrolled in an Advantage plan have the option of switching to a 5-star plan in their service area. That allows beneficiaries to enroll in the best plan for their needs even as new plans are started in each county.
Special Enrollment Periods if you get “Extra Help”
Medicare beneficiaries who receive Extra Help and qualify for Medicare and Medicaid can join, drop, or switch an Advantage plan one during each of the following periods:
- January – March
- April – June
- July – September
Beneficiaries aren’t allowed to change Medigap plans during these periods. The extra help enrollment periods are open only to those with an Advantage plan or Part D prescription drug plan.
Are Medicare Advantage plans in South Carolina “bad”?
Not every beneficiary is a good fit for a Medicare Advantage plan in South Carolina, but that doesn’t make it bad health care coverage. Many South Carolina beneficiaries prefer a Medicare Advantage plan to Medigap or Original Medicare alone because it offers more health and wellness benefits like coverage for vision, hearing, and dental services.
The following statistics show that many South Carolina beneficiaries do find Advantage plans valuable:
- In 2021, 42% of Medicare beneficiaries nationwide enrolled in Medicare Advantage plans.
- While Original Medicare experienced a significant decline in 2021, the Medicare Advantage program grew with more than two million new enrollees.
- In South Carolina, the Advantage program grew by 15% from 2020 to 2021.
- Experts predict that about half of all Medicare beneficiaries will enroll in Advantage plans by 2025.
Frequently Asked Questions about Medicare Advantage in South Carolina
What's the downside to Medicare Advantage plans?
There are many benefits to enrolling in a Medicare Advantage plan in South Carolina for 2022, but all beneficiaries should understand the potential downsides before selecting a plan.
Some of the biggest downsides include:
- Network Restrictions – HMO and some PPO plans require beneficiaries to select from participating network providers rather than choosing from all providers in their area. That makes Advantage plans more restrictive than Medicare Supplement plans.
- Higher Out of Pocket Costs – Medicare Advantage plans may look cheaper than Medigap when you compare monthly premiums, but out of pocket expenses are just as big of a concern. While Medigap policies are designed to eliminate those expenses, Advantage plans typically come with copayments, coinsurance, and other expenses in addition to the premium.
- Time Consumption – Beneficiaries spend more time comparing, selecting, and managing their plan options than they would with a Medicare Supplement plan.
- Annual Changes – Medicare Advantage plans tend to change from year to year. Beneficiaries must keep up with the changes to ensure they maintain the best coverage.
What are 4 types of Medicare Advantage plans in South Carolina?
1. Health Maintenance Organizations (HMO)
HMO plans require each beneficiary to select a primary care physician and secure a referral before seeing specialists. They often offer the lowest monthly premiums, and most beneficiaries have access to $0-premium plans.
2. Preferred Provider Organizations (PPO)
PPO plans tend to have larger provider networks and may allow out-of-network service providers with higher out of pocket costs. Premiums are a bit higher than HMO premiums, but many beneficiaries have access to no-premium PPOs in South Carolina.
3. Private Fee-for-Service Plans (PFFS)
Beneficiaries have more options when selecting their health care providers with a PFFS, but many Medicare providers won’t participate in this type of plan. The plan determines the payment rules, and all providers must accept those rules in order to take the beneficiary on as a patient. Some PFFS plans will have network providers already in agreement with the plan rules.
4. Special Needs Plans (SNP)
Special needs plans are reserved for low-income beneficiaries or those with chronic health conditions. Each SNP is dedicated to a specific health condition and offers additional coverage that is valuable to people with the focus health condition.
What are the top 3 Medicare Advantage plans?
There are some great insurance companies offering highly competitive Medicare Advantage plans in South Carolina for 2022, but there are three that stand out as the most popular in the nation. The following list introduces these insurance companies along with their percentage of the Medicare Advantage market nationwide:
- UnitedHealthcare – 26%
- Human – 18%
- Blue Cross Blue Shield – 15%
What Are Medicare Special Needs Plans?
Special needs plans, otherwise known as SNP, are specialized policies that serve low-income beneficiaries and those with chronic health conditions like end-stage renal disease. These plans offer all the benefits that come with Medicare Part A and Part B along with additional coverage that is directly related to the chronic condition shared by all enrollees.
Does Medicare Advantage cover drugs?
Many Medicare Advantage plans include a Part D drug plan. They’re known as Medicare Advantage Prescription Drug plans or MAPD. The most comprehensive plans allow beneficiaries to pay one monthly premium for all of their healthcare needs, including prescription drug, dental, vision, and hearing coverage.
These comprehensive Advantage plans eliminate the need for a separate drug plan but still require beneficiaries to pay out of pocket for some expenses like the premium for Part B.
Do Medicare Advantage plans use the SilverSneakers program in South Carolina?
Some Medicare Advantage plans do include SilverSneakers membership benefits. That’s one of the most popular extra benefits that South Carolina Advantage plans can offer.
South Carolina Medicare Resources
South Carolina Medicare Resources
South Carolina Medicare Plan Statistics:
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
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