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

At a glance: Medicare health insurance in South Carolina

Medicare enrollment in South Carolina

As of mid-2020, there were 1,096,084 people enrolled in Medicare in South Carolina. That’s about 21 percent of South Carolina’s population enrolled in Medicare, compared with a little less than 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.

A quarter of South Carolina’s Medicare beneficiaries were enrolled in 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 mid-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 19 plans in Darlington County to 59 in Greenville County. There are significantly more Medicare Advantage plans available in 2020; 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 a new Medicare Advantage plan 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. 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.

In 2020, there are 28 stand-alone Medicare Part D plans for sale in South Carolina, with premiums that range from about $13 to $191/month.

478,857 Medicare beneficiaries in South Carolina were enrolled in stand-alone Medicare Part D plans as of mid-2020, and an additional 339,551 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.

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.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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