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Best Medicare Advantage Plans in South Carolina

Just about one-quarter of a million local Medicare beneficiaries feel they have chosen the best Medicare Advantage plan in South Carolina for their needs. Even though Medicare Part A and Medicare Part B will pay most of the cost of many medical, temporary nursing home care 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 an included Medicare prescription drug plan and membership to fitness centers. We can help you shop for a plan through a company with top star ratings, such as BlueCross BlueShield of South Carolina. We can also talk to you about Medigap as an alternative to signing up for Medicare Advantage.

Best Times to Enroll in Medicare Advantage 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 enrollees 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 often get the best flexibility when using your Medicare Advantage plan. 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 be best suited for 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 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 means that you will need to choose health care providers within your insurance company’s provider network if you choose a stand-alone Medicare Advantage plan.

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 or a low monthly 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 for your needs and to help you keep out of pocket costs to a minimum.

There are also other health insurance options like PFFS/private fee or fee-for-service plan, an MSA savings account plan and more. We can talk to you about the different plan options and can help you choose one that is a good fit.

Best South Carolina Medicare Resources

If you have Original Medicare or other Medicare insurance, these South Carolina resources may help you manage your benefits. You can also use these resources if you want to read a complete description of benefits or if you need information about signing up for Medicare coverage for the first time. After all, before you can sign up for Medicare Supplement insurance or a Medicare Advantage program, you will need to sign up for Medicare.

Once you sign up and start paying your Medicare Part B premium, we can help you take a look at the different health plans that are available, such as a Medicare Advantage plan in South Carolina that includes Medicare Part D prescription drug coverage. Whether you want help with signing up for a Medicare Supplement or if you’re interested in Medicare Advantage, one of our licensed insurance agents will be more than happy to help you. Give us a call so that we can help you shop for a plan today!

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