Odds are that if you’ve lived in South Carolina for a while, you know about the Federal Medicare Program. Basically, it’s a low-cost form of health insurance which is provided by the government for retired seniors 65 and older who are living on a fixed income. This way, you don’t have to worry about your retirement savings being jeopardized by the expensive health care costs common for people who are in their golden years. You can relax, knowing that the majority of your health care needs are covered by Medicare Part A and Medicare Part B – commonly referred to as Traditional Medicare – at a relatively affordable price.

Coverage and Benefits

Part B, which takes care of most basic needs (including doctor visits, outpatient procedures, and physical therapy) does charge premiums and fees for all beneficiaries. But, as you can see from the link above, these are based on income and designed to be as affordable as possible. Part A, on the other hand, covers most of your hospital visit expenses and might be free, provided you have a sufficient employment history of 10 years (or 40 quarters). If not, then you may be required to pay a deductible.

As a resident of South Carolina, once you’re over the age of 65 you qualify for a Medicare plan. Any residents that worked 10 years or more, or 40 quarters throughout their lifetime can get Medicare Part A without paying a premium for it each month. When you are enrolled into Medicare you are enrolled into Part A that includes common inpatient care, some outpatient care and covers some hospice and nursing facility care.

For more coverage you can expand your South Carolina Medicare to Part B as well for additional outpatient services, better home medical equipment and more home health care coverage. Part B does come with an added premium though, so it’s important to plan for this.

For additional coverage that isn’t offered by Medicare parts A and B, residents can add on Parts C or D as well. They are only available to those that have both Medicare A and B already and offer additional coverage items. Medicare Part C is known as Medicare Advantage and is offered from private insurance companies with all sorts of optional coverage options, like vision or dental. And Medicare Part D is known as prescription coverage and helps cover the cost of most prescription medications.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different Medicare Plans in South Carolina

As of this writing, there are 820,947 South Carolina senior citizens currently protected by some form of Medicare health coverage. For those who choose to supplement their health care benefits personally, it is a nearly even split between Medigap supplement insurance and Medicare Advantage. 22% of beneficiaries (180,608 people) chose an Advantage policy, whereas 21% (or 170,566 seniors) opted for Medigap. But the majority of them – which includes 57% of beneficiaries – are either supplementing their Original Medicare with some sort of benefit plan, potentially from an employer, or with no supplemental insurance at all. And that could be very risky.

Remember: you have to be enrolled in Medicare before you can start supplementing your benefits for Parts A & B. If you have not yet enrolled, or if you aren’t sure whether you’re enrolled in Medicare, click the link to find out.

What are the Risks Associated with Original Medicare?

Original Medicare, as comprehensive as it tries to be, doesn’t pay for everything. And these gaps in coverage can produce very expensive medical bills very quickly if you don’t protect yourself with some sort of supplemental coverage. Just look at some of the more common coverage gap expenses below:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Even if you’re newly retired and have good health, you can still benefit from purchasing supplemental coverage now. In fact, getting it done sooner rather than later can actually save you money in the long run. The younger and healthier you are, the lower your premiums will be starting out. You won’t have to worry about being charged higher rates for advanced age or chronic conditions that will likely pop up if you wait to start shopping until you need a supplement.

Many South Carolinians need additional medical coverage on top of their base Medicare plan because the cost of quality healthcare is higher than it has ever been before. With costs rising, traditional Medicare often leaves behind serious additional costs that patients are expected to pay for.

Patients pay around $1,200 per year for the annual deductible just on Medicare Part A, and Part B comes with a monthly premium amount near $147 per month, and that doesn’t include all the uncovered costs that patients are expected to deal with. Long-term hospital stays can be very expensive for patients, which is why many are turning to supplemental health insurance. There are insurance plans to help cover these additional costs to make getting good healthcare more affordable.

There are serious gaps in most Medicare plans in terms of coverage and investing in additional insurance is often the best way to go about filling your Medicare coverage gaps. Doing so will help you make sure that you don’t have to pay so much for things like deductibles, hospital stays and medical equipment costs, and all these benefits can be had for an additional monthly premium that’s easier to manage.

If you’re thinking of getting a supplemental insurance plan for your Medicare, Medicare Advantage or a Medicare Supplement (Medigap) plan are the two best options available today. They both work through private insurance companies, but they work in very different ways. It’s important to understand those differences to make sure you’re getting the right policy for you.

Should South Carolina Residents Consider a Medigap Policy?

Even though it isn’t the most popular choice in the state currently, any senior without Medicare supplement coverage absolutely should take a closer look at a Medigap supplement insurance policy. These policies are specifically crafted to give you exactly what you need – protection from Medicare coverage gaps – and nothing that you don’t. This keeps each plan simple and easily affordable. And they’re uniform across all 50 states, so someone shopping for Plan D in South Carolina can expect the exact same benefits as someone from Alaska. The only differences are the provider, and the expected cost.

Take a look at what each of these 10 plans have to offer below:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $117 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $103 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $90 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $78 $0 $147 Not Covered Not Covered Not Covered Request Info
N $0 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $84 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $143 $1 $147 Not Covered Not Covered Not Covered Request Info
L $71 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $42 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $0 $608 $147 Not Covered 100% Covered 100% Covered Request Info

What About Medicare Advantage Plans in South Carolina?

Medicare Advantage is certainly a reasonable option for any South Carolina resident who wants to supplement their Traditional Medicare benefits. There are a few reasons why someone might choose an Advantage plan over a Medigap policy. For starters, it is one single, simple policy offered through a single private company which handles all of your health care needs. And we do mean all – because if you want extra coverage options, such as prescription drugs, they are available for you (for an additional cost, of course).

Conversely, there are reasons why an Advantage policy might not be the right strategy for certain individuals. The most common reason people shy away from Medicare Advantage has to do with the restricted provider networks. If you like your current doctor and don’t want to switch, then make sure that your physician is included in your Medicare Advantage network before you sign the dotted line.

Medicare Advantage plans provide members with health care through two different types of provider networks. These networks are referred to as PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks.

Medigap vs. Medicare Advantage

There are many differences between Medicare Advantage and Medicare Supplement (Medigap) policies, but one of the most notable ones is how insurance claims are handled by each of the types. When you have a Medigap plan, the plan doesn’t pay any medical costs until after Medicare does its thing. First Medicare pays for its portion of your medical costs and then Medigap comes in and helps pay off some more of what you owe, and you pay anything left over after that.

Both Medigap and Advantage plans come from private insurance companies, but they are handled differently. Medigap policies are very standardized between insurance companies. If you get a Medigap Plan K at one company, it will be nearly identical to the same plan at another company. Each plan is designated by a letter, and you can easily compare different plans just by looking at the letter and the cost they are charging. This makes shopping around quick and convenient.

Medicare Advantage plans, also known as Medicare Part C are more complicated. They are very different from one insurance company to the next, and they offer a wider range of benefits than a Medigap policy does. To begin, an Advantage plan completely replaces Medicare Parts A and B with its own coverage. With an Advantage plan you’ll also often have the opportunity to choose additional insurance riders to add protection for your vision, dental, prescription medication or other items. Different companies offer different types of coverage as well, furthering the confusion of using these plans.

If you’re searching for a policy with the easiest pricing option to understand, Medigap comes out ahead in that regard. When you have a Medigap policy you pay a monthly premium and anything that the policy doesn’t cover that’s left over from treatment you receive. With a Medicare Advantage policy there are more deductibles to worry about, different coverage items and a whole lot more confusion. You will pay variable rates depending on your health, and things can change over time in unexpected ways.

The above summarizes the key differences between Medigap policies and Medicare Advantage policies, but those are just some of the differences. To help you further understand the differences we break them down in the table below. If you have additional questions or need help deciding between supplemental insurance policies, contact one of our representatives today and we’ll be happy to help answer all your questions and even help you get a free quote.

Questions Medicare Advantage Medicare Supplement
How do these plans cover my expenses? With an Advantage policy your insurance company pays the costs of your healthcare, then Medicare pays some of those costs and you pay the fees laid out in your policy. Those fees are calculated based on average costs for medical coverage in your area. A Supplement policy will wait to pay for any of your medical costs until after Medicare pays its portion. Medicare pays some of your costs, the Supplement policy pays its portion and you pay the remaining balance.
Am I still expected to pay for Medicare Part B? Yes Yes
How much will this policy cost me? Since Medicare Part C offers such a range of benefits there are variable costs associated with different policies. The deductibles and fees are adjusted based on what sort of care you need. With this type of policy, you will pay the premium and remaining costs after all insurances pay their portion. With a comprehensive policy you just pay the premium every month and all the covered healthcare is taken care of.
What coverage can I expect using this insurance plan? With your Advantage plan you’ll enjoy all the coverage from Medicare Parts A and B plus any additional coverage items that are included with the policy. A Supplement policy only offers the same coverage that comes with Medicare Parts A and B, but it covers an added portion of any costs that are left over once Medicare is finished.
Is budgeting with this plan simple to do? No, budgeting can be difficult to do with this type of plan. Costs change, and you have a range of fees to worry about depending on the type of services that you require. Yes, a Supplement policy is much easier to budget for. If you get a comprehensive policy you only have to worry about paying your premium every month, and with other policies you pay your premium and any uncovered medical costs.
Am I guaranteed to be able to keep this plan, or can it be cancelled on me? No, you are not guaranteed to keep the policy. Your plan can be cancelled during the annual renewal period. Yes, you are guaranteed to keep your policy if you can pay the premium and the insurance company remains in business.
Is there a pre-approval process for me to go through for this policy? Yes, you will likely need to go through a pre-approval process to get onto an Advantage policy. No, anyone that qualifies for a Medicare policy can get a Supplemental insurance policy as well.
Must I visit specific hospitals or doctors using this type of supplemental insurance? Yes, you are limited to a network of providers when you use an Advantage policy. No, you are free to use any provider that accepts Medicare.
Which of the two options is right for me specifically? For younger individuals in good health, or individuals that live in an urban environment with more medical facility options to choose from, Medicare Advantage is often the best plan. For someone that lives in a rural environment with few medical options to choose from, or someone that requires frequent medical care, a Medicare Supplement policy is often the best option to go with.

Additional South Carolina Medicare Resources

We hope that this article has been informative. Unfortunately, we cannot answer all of the important questions you are likely to have right here and now. But the good news is that we know people who can. Take a look at our directory of Medicare experts located near you. Don’t be afraid to get in touch with your local offices and ask a few questions.

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Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.