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

2020 Medicare enrollment datesAs of November 2018, there were a little over a million Medicare beneficiaries in South Carolina. A little more than 20 percent of South Carolina’s population is enrolled in Medicare, compared with a little more than 18 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, 18 percent of Medicare beneficiaries were eligible due to a disability as of 2017, while 82 percent were eligible due to their age. Nationwide, the split was 16 percent and 84 percent, although it varies quite a bit by state.

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.

As of 2017, 24 percent of Medicare beneficiaries in South Carolina were enrolled in Medicare Advantage plans, compared with an average of 33 percent nationwide. More than three-quarters of South Carolina Medicare beneficiaries had instead opted for Original Medicare.

There are Medicare Advantage plans for sale in all 46 counties in South Carolina in 2019, although plan availability ranges from six plans in Darlington County, to 41 in Greenville County.

Each fall, the Medicare annual election period, from October 15 to December 7, gives Medicare beneficiaries the option to switch between Medicare Advantage and Original Medicare. And as of 2019, Medicare Advantage enrollees 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 250,385 people enrolled in private Medigap plans in South Carolina in 2016, according to an AHIP analysis. There are 57 insurers that offer Medigap plans in South Carolina in 2019.

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 57 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 two guaranteed-issue Medigap plans (Plan A and Plan C) through the high-risk pool, for Medicare beneficiaries who are under age 65. 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 2019, Plan A is $940.05 per month, and Plan C is $1,194.83 per month (note that 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 it’s common to see premiums that are maybe $50-$100/month more expensive, whereas 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, 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 Part D prescription drug coverage.

In 2019, there are 26 stand-alone Part D plans for sale in South Carolina, with premiums that range from about $14 to $137/month.

487,438 Medicare beneficiaries in South Carolina were enrolled in stand-alone Part D coverage, an additional 269,846 had Part D coverage as part of their Medicare Advantage plans.

Medicare spending in South Carolina

In 2016, per-beneficiary spending in Original Medicare averaged $9,014 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 $9,533 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 $11,399, while Hawaii had the lowest, at just $6,441.

You can read more about Medicare in South Carolina in our state Medicare guide. You can also 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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