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Medicare in South Carolina

South Carolina's solution to Medigap for people under 65 is the state's high-risk pool, but coverage is very expensive

Photo credit: Dave Chillycub | Flickr

Key takeaways

Medicare enrollment in South Carolina

As of September 2020, there were 1,102,905 people enrolled in Medicare in South Carolina. That’s about 21 percent of South Carolina’s population enrolled in Medicare, compared with about 19 percent of the United States population enrolled in Medicare.

People become eligible for Medicare either due to their age (turning 65) or due to a disability. In South Carolina, 17 percent of Medicare beneficiaries were eligible due to a disability as of 2017, while 83 percent were eligible due to their age. Nationwide, 85 percent of all Medicare enrollment is due to age.

Medicare Advantage in South Carolina

In most areas of the country, Medicare beneficiaries have the option to get their coverage through Original Medicare (directly from the federal government) or from a private Medicare Advantage plan. Medicare Advantage plans provide all of the same covered healthcare benefits as Original Medicare (hospital coverage and medical/physician coverage), but the out-of-pocket costs can be very different, as Advantage plans set their own coinsurance, deductibles, and copays.

Most Advantage plans provide members with integrated Part D coverage for prescription drugs, as well as extra programs like dental and vision coverage. But Advantage plans also tend to have local service areas and much more limited provider networks than the nationwide provider access that Original Medicare offers. In short, there are pros and cons to either option.

Time to sign up for Medicare?A quarter of South Carolina’s Medicare beneficiaries were covered by Medicare Advantage plans as of 2018, compared with an average of 34 percent nationwide. The other three-quarters of South Carolina Medicare beneficiaries had instead opted for Original Medicare. But enrollment in Medicare Advantage plans has been steadily increasing, nationwide and also in South Carolina. As of the fall of 2020, a third of South Carolina Medicare beneficiaries had private coverage and two-thirds had Original Medicare.

There are Medicare Advantage plans for sale in all 46 counties in South Carolina in 2020, with plan availability ranging from 29 plans in Darlington County to 66 in Greenville County. Medicare Advantage plan availability has increased significantly in some parts of the state in recent years; as of 2019, there were only six plans available in Darlington County, and 41 in Greenville County.

Medicare Advantage enrollment is available when beneficiaries first become eligible for Medicare, and also during the annual Medicare annual election period, which runs from October 15 to December 7. This window gives Medicare beneficiaries the option to switch between Medicare Advantage and Original Medicare. People who are already enrolled in Medicare Advantage plans also have access to a Medicare Advantage open enrollment period (January 1 to March 31) during which they can switch to any other Medicare Advantage plan that offers service in their area, or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medigap in South Carolina

Original Medicare beneficiaries have the option to purchase Medigap plans (also known as Medicare supplement plans), with the Medigap plan covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that they would otherwise have to pay themselves when they need healthcare services. Original Medicare does not cap out-of-pocket costs, making Medigap coverage particularly valuable if a person ends up with extensive medical conditions. Medigap plans are issued by private insurers, but are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N), making it fairly easy for consumers to compare one plan to another.

There were 276,067 people enrolled in private Medigap plans in South Carolina in 2018, according to an AHIP analysis. There are 63 insurers that offer Medigap plans in South Carolina in 2020.

But unlike Medicare Advantage and Medicare Part D plans, there is no annual open enrollment period for Medigap plans. Instead, federal regulations allow for a six-month guaranteed-issue window that begins when a person is 65 and enrolled in Medicare Part B. After that window has closed, Medigap insurers can use medical underwriting to determine an applicant’s premium and eligibility for coverage, unless the person qualifies for one of the limited guaranteed-issue rights.

And federal rules do not guarantee access to Medigap plans for people who are under 65 and enrolled in Medicare due to a disability. The majority of the states that have rules ensuring at least some access to private Medigap plans for enrollees who are under the age of 65, but South Carolina is not among them.

Because Medigap insurers in South Carolina are not required to issue coverage to people under 65, nearly all of them only make their plans available to applicants who are 65+. But, United American Insurance, one of the 63 insurers that offer Medigap plans in South Carolina, does offer coverage to people who are under 65 and enrolled in Medicare as a result of a disability. United American confirmed this in a phone call, but pricing would depend on the enrollee’s specific circumstances.

Instead of requiring private insurers to offer Medigap plans to people under 65, South Carolina has maintained its high-risk pool and offers three guaranteed-issue Medigap plans through the high-risk pool, for Medicare beneficiaries who are under age 65. The high-risk pool offers Plan A, Plan C, and Plan D; note that under federal rules, Plan C is only available to people who became eligible for Medicare prior to 2020. The South Carolina Health Insurance Pool (SCHIP) allows these enrollees to purchase Medigap coverage when they would otherwise be unable to do so, but at a very high cost: In 2020, Plan A is $940.05 per month, Plan C (only available to beneficiaries who became eligible for Medicare prior to 2020) is $1,194.83 per month, and Plan D is $1,060.45 per month. Although Blue Cross Blue Shield of South Carolina is the administrator for SCHIP, these are not BCBSSC plans; SCHIP is providing the coverage, and only using BCBSSC to administer the policies.

For perspective, the average private Medigap plan in South Carolina had a premium of about $135/month in 2018, according to a Business Insider analysis. In states that have enacted laws requiring private Medigap insurers to offer plans to people under the age of 65, the prices are typically higher, if the state allows it. But the high-risk pool Medigap premiums in South Carolina are several times more expensive than the average private Medigap plan sold in the state. Several other states — AlaskaIowaNebraskaNew MexicoNorth Dakota, Washington, and Wyoming — have maintained their high-risk pools to provide coverage to people with Medicare who are unable to obtain private Medigap plans, although pricing on high-risk pool supplemental coverage varies considerably across those states.

People enrolled in SCHIP Medigap plans prior to turning 65 are granted the normal six-month guaranteed-issue open enrollment period for Medigap when they turn 65, and can switch to a much lower-priced plan at that point, selecting from among all of the available Medigap options in the state.

Medicare Part D in South Carolina

Original Medicare provides fairly comprehensive coverage, but it does not pay for outpatient prescription drugs. Medicare beneficiaries who have supplemental coverage from an employer (via a retiree plan or a plan sponsored by a current employer) often have prescription drug coverage integrated with the employer plan. But without a supplemental employer-sponsored plan or Medicaid, Medicare beneficiaries need coverage under a Medicare Medicare Part D plan. These can either be obtained as stand-alone coverage or as part of a Medicare Advantage plan that includes Medicare Part D prescription drug coverage.

For 2021, there are 29 stand-alone Medicare Part D plan options for sale in South Carolina, with premiums that range from about $7 to $205/month.

478,745 Medicare beneficiaries in South Carolina were covered under stand-alone Medicare Part D plans as of the fall of 2020, and an additional 345,084 had Medicare Part D coverage as part of their Medicare Advantage plans.

Medicare Part D enrollment is available on the same schedule that applies to Medicare Advantage plans. Beneficiaries can pick a Medicare Part D plan when they’re first eligible for Medicare, and can switch to a different plan during the fall enrollment window, from October 15 to December 7. Beneficiaries who have creditable drug coverage from another source can delay enrollment in Medicare Part D, but a delay without other creditable coverage in place will result in a late enrollment penalty once the beneficiary eventually enrolls in a Part D plan.

Seven rules for shopping for Medicare Part D plans

Medicare spending in South Carolina

In 2018, per-beneficiary spending in Original Medicare averaged $9,601 in South Carolina, based on data that were standardized to account for regional differences in payment rates (the data did not include costs for Medicare Advantage enrollees).

Nationwide, average per beneficiary Original Medicare spending was $10,096 per enrollee, so Medicare spending in South Carolina was lower than the national average. On the ends of the spectrum, Louisiana had the highest average per-beneficiary Original Medicare costs, at $11,932, while Hawaii had the lowest, at just $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in South Carolina?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in South Carolina includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Medicare in South Carolina: Resources for beneficiaries and their caregivers

If you need help with Medicare eligibility in South Carolina or Medicare enrollment in South Carolina, you can contact South Carolina’s Insurance Counseling Assistance and Referral for Elders, the state’s State Health Insurance Assistance Program (SHIP), with questions related to Medicare coverage in South Carolina.

The South Carolina Department of Insurance can provide customer service and assistance with a wide range of insurance-related issues. The Department is responsible for regulating and overseeing Medigap insurers, and also licenses the insurers that sell Medicare Advantage and Part D plans in the state (but most regulatory oversight of Advantage and Part D plans is conducted at the federal level, by CMS). The South Carolina Department of Insurance has a resource called “Making sense of health insurance after retirement,” which provides some useful information to people with Medicare and people who aren’t yet eligible for Medicare.

The Medicare Rights Center is a nationwide service that can provide a wide range of information and assistance related to Medicare enrollment, eligibility, and benefits.

This page will provide detailed information about how South Carolina Medicaid can help Medicare beneficiaries who have limited financial means.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

 

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