South Carolina Medicare Supplement Plans (Medigap)
South Carolina Medicare Supplement Plans are for Medicare Beneficiaries. They supplement or add additional benefits to Original Medicare. These plans were created to provide coverage for what’s not covered by Original Medicare.
This includes out of pocket expenses such as deductibles, copayments and coinsurance. South Carolina Medigap plans are the same as Medicare Supplement plans; they are sold by private insurance companies. South Carolina Medicare options are broken down into parts and plans.
South Carolina Medicare Benefits Broken Down
Original Medicare consists of Parts A and B.
There are two main ways to get Medicare coverage; Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). With Original Medicare, some get additional coverage, like a Medicare prescription drug plan (Medicare Part D coverage) and/or Medicare Supplement Insurance. Original Medicare covers 80% and the Medicare beneficiary covers 20%.
- Hospital care
- Skilled nursing facility care
- Nursing home care (if custodial care isn’t the only care you need)
- Home Health services
Part B of Medicare covers:
- Preventive services
- Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
- You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
- Medically necessary services
- Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Ambulance services
- Durable medical equipment (DME)
- Clinical research
- Getting a second opinion before a surgery
- Limited outpatient prescription drugs
- Mental health
- Partial hospitalization
Part C (Medicare Advantage plans)
- Replaces Original Medicare
- Has limitations
- Is offered by a private company
- Plan can only be changed during the open enrollment period, unless the beneficiary qualifies for a special enrollment period
Part D (Medicare Prescription Drug coverage)
- Each plan has a list of covered drugs (called a formulary)
- Many plans place different drugs into “tiers” on their formularies.
- Drugs in each tier have different costs.
- You can have stand-alone Part D coverage to work alongside your Original Medicare or a Medigap policy. You can also get a Part D plan in a Medicare Advantage plan.
- This coverage is optional, however, if you don’t enroll when you are first eligible for Medicare, you might be subject to a late enrollment penalty if you decide to add this insurance later.
South Carolina Medicare Supplement Plsans
- Also known as Medigap coverage
- Optional insurance that can cover some of the Original Medicare cost, such as deductibles, copayments, or other out of pocket costs
- South Carolina Medicare Supplement Plans are offered by private insurance companies
Original Medicare does cover many benefits under Part A and Part B, like hospitalization, preventative care and medically necessary services. With Original Medicare the beneficiary would be responsible for 20% of the costs associated with the services provided by the health care practitioner.
South Carolina Medicare Supplement Plans help beneficiaries cover the 20% they would otherwise be responsible to pay. Medicare Supplements also allow beneficiaries the flexibility to go to any doctor that accepts Medicare assignment.
South Carolina Medigap Eligibility Criteria
To enroll in a Medigap plan you must be at least 65 years old and enrolled in Medicare Part B to get a Medigap policy. Beneficiaries need to enroll in Part B as soon as they are eligible to avoid the Part B late penalty.
The Medicare Part B penalty increases the beneficiaries monthly Part B premium by 10 percent for each full 12-month period the beneficiary waits before enrolling.
Medicare Supplement Eligibility in South Carolina for the Disabled, Under 65
Beneficiaries automatically get Part A and Part B after receiving disability benefits from Social Security or certain disability benefits from the Railroad Retirement Benefits for 24 months. Some carriers offer plans to those under 65 on disability in some states, but not all.
Federal law does not require insurance providers to offer South Carolina Medicare Supplement Plans for people who are disabled and under age 65, but some state laws do. If you are enrolled in Medicare under 65 due to a disability and/or end-stage renal disease, your eligibility for a Medigap policy will depend on the state you reside. Contact us for more information on plans available in South Carolina for those on disability, under 65.
The Open Enrollment Period (OEP) begins the 1st day of the month you are at least 65 years old and your Medicare Part B has become effective. For example, if your birthday was October 31st and your Medicare Part B effective date was December 1st, then your OEP begins December 1st.
The OEP is in effect for 6 months and during this time you are granted Guaranteed Issue (GI). Being granted GI means that pre-existing conditions will not affect your premium and must be covered. It also means the Insurance company can’t charge you more because of past or present health conditions.
You can enroll in South Carolina Medicare Supplement Plans at any time, even if you missed the OEP. Once the Medigap OEP passes, you may not be able to enroll in a Medigap policy as easily if you’re doing so for the first time. If you’re already enrolled in a Medigap plan, you may not be able to switch plans with guaranteed issue (except in certain situations).
Without GI, you could be subject to medical underwriting and charged a higher premium based on your health status. It is easier to find Medicare Supplement coverage during your OEP, in this period if you have disabilities or a pre-existing condition you can still get lower cost coverage.
Medigap Premiums in South Carolina
Cost is determined by the insurance company not the state. The price is determined based off many different factors including; age, gender and location. Location can play a big part; for example, a Plan G in Bluffton will not cost the same as a Plan F in Columbia. Furthermore, each carrier uses one of three rating methods; issued age, community age and attained age ratings.
The Best South Carolina Medicare Supplement Plans
Regardless of the carrier you go with, the letter plan benefits will be the same. The only difference between the plans is the cost the carrier chooses to charge. The top letter plans are F, G, and N.
Plan F in South Carolina
- Most Popular choice of all Medicare recipients
- Minimal out of pocket costs
- After Medicare pays their portion of the claim, this plan pays most of the remaining hospital and doctors cost.
- Plan F will cover 100% of Part A deductible
- Medicare Plan F will cover your coinsurance costs of days 61-90
- Statistics show 20% of seniors end up back in the hospital shortly after going home.
- If you are in the hospital longer than 90 days, Medicare Plan F will extend your hospital coverage for an additional 365 days.
- Traditional Medicare does not cover any foreign travel benefits. This supplemental health insurance will cover medical emergencies while traveling to a different country if your medical care started within the first 60 days of leaving the United States.
South Carolina Plan G
- Medicare Plan G and F are the only plans to excess charges from Medicare Part B.
- The only difference in Plan F and G, Plan G does not cover the Part B deductible
- The Part B deductible is $183 per year
- Plan G has shown to have a lower rate increase trend from year to year
- This means you can save money in the short and long term
Plan N in South Carolina
- While Plan N may not offer the fullest coverage of all the plans available, Plan N can cost less than other plans.
- Includes Medicare Part A hospitalization deductible
- Does NOT cover the Medicare part B deductible
- Requires the patient to pay a small deductible for physician visits and emergency room visits
- Does NOT cover Medicare Part B excess charges
- Plan N does cover Home Healthcare, but coverage does not start until the Medicare Part B deductible is met
- Covers 80% of any emergency care needed within the first 60 days of foreign travel.
- Co-payments include up to $20 for some office visits as well as up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission
- Plan N will pay 100% of your Part B coinsurance, minus the above co-payments
South Carolina High Deductible Plan F
- Same coverage as Plan F, just with a deductible of $2,240 for 2018
- You are responsible for any medical expenses up to your deductible
- The premium is significantly lower than Plan F
South Carolina Medicare Supplement Plans vs. Medicare Advantage
Choosing a Medicare Supplement to go with Medicare Parts A and B will give you the most comprehensive coverage. It will also give you a piece of mind when medical situations arise. You can go to any doctor or hospital that accepts Medicare assignment.
This coverage is accepted everywhere Medicare is accepted. South Carolina Medicare Supplement Plans can cost a bit more than a Medicare Advantage plan, but you get what you pay for. These plans will be in addition to your Medicare Part B premium and Part D plan costs.
Medicare Advantage or Medicare Part C, is an option that will require you to give up Original Medicare Parts A and B as your primary coverage. The insurance carrier you choose will be your primary coverage; you no longer have Medicare Part A & B because Part C will take the place of these. Instead of Medicare handling your insurance claim, the private insurance company will take on the risk.
You are required to adhere to the provider network chosen by the carrier you select, and this network can change anytime throughout the year. These plans are attractive, most of them having a much lower premium than Medigap plans, or no premium.
Most times the Medicare Advantage will already include a Prescription Drug Plan (PDP). Even though these policies can seem far less of a hassle up front, the entire picture needs to be looked at. When you start needing the coverage to work on your side, there will be an out of pocket cost. Furthermore, these OOP costs will eliminate any saving in premium you may have acquired from not having a Medigap policy.
Prescription Drug Plans (PDP)
Part D plans cover prescription drugs. Prescriptions are not covered under Original Medicare Parts A & B, purchasing a PDP will allow you to avoid paying the full cost of expensive medicine. Part D does not cover over the counter prescriptions and does not usually cover drugs for things like: cosmetic issues, weight loss or sexual dysfunction. Each PDP has a formulary that is broken down into tiers of drugs, based on their cost.
- Plans are broken down in the coverage phases. The first phase is the deductible (if there is a deductible, some Part D plans don’t have a deductible in some areas). In the Deductible phase the enrolled person pays prior to coverage kicking in.
- In the Initial Coverage phase your plan pays 75% of your prescription drug costs and you pay 25% up to the plan limit.
- The Coverage Gap also known as the donut hole, will pay 49% for generic drugs and 10% for brand name drugs. For brand name drugs, the manufacturer discounts the costs by 50%, this discount is counted as an enrollee out of pocket cost expenditure. The enrollee pays 51% of the cost for generic drugs and 40% of the cost of brand name drugs.
- The last phase is the Catastrophic Coverage, once you’ve reached the annual out of pocket maximum the plan pays for 95% of your drug costs
Part D Late Penalty
When you are first eligible for Medicare, you have a seven-month enrollment period to sign up for coverage, including Part D. The three months before your birthday, the month of your birthday and three months after your birthday.
If you do not enroll in a Part D plan you could encounter a Part D Late Enrollment Penalty. For each month without coverage, you will pay an additional premium of 1 percent of the current “national base beneficiary premium”; for 2018 the premium is $35.02. This is NOT a one-time penalty.
You will pay it every month for as long as you have Medicare prescription coverage. Since it is based on the year’s national beneficiary premium, it may go up and change each year. Furthermore, you can always check out the Part D Coverage Changes for 2018.
It is very important that you get what Medicare doesn’t cover, covered. You can compare rates online or contact an agent to customize your policy. Insurance agents have a fiduciary responsibility to make sure your health care coverage is right for you. Having an insurance agent can make getting answers and understanding your policy easier for you.
South Carolina Medicare Resources
Medicare Savings Programs (MSP) are federally funded programs administered by each individual state. These programs are for limited income Medicare recipients to help pay some or all Medicare premiums, deductibles, copayments and coinsurance.
There is also the State Health Insurance Assistance Program (SHIP) in South Carolina that can provide resources to getting insurance counseling and assistance. If you are on a fixed income, you may be able to qualify for the Medicare Savings Program and Extra Help.
Pairing South Carolina Medicare Supplement Plans with your Medicare Savings program is a good way to protect yourself from high medical bills due to chronic condition or unexpected illness or accident. Call the number above to speak to an Agent about your situation and budget, let them help you find the right plan.
Facts for Medicare in South Carolina
In 2015, 19% of the total state population was enrolled in Medicare. In 2013, 19% of residents in the state were disabled and receiving benefits. During that same year, just over 5,000 Medicare beneficiaries were enrolled with ESRD
South Carolina FAQ’s:
- Is the Aetna Medicare Essential plan available in South Carolina?
- Yes, this is a Medicare Advantage plan that’s available in the state
- Does Blue Cross Blue Shield of South Carolina offer Medicare Supplemental Insurance?
- Generally Blue Cross Blue shield specializes in Group or Employer coverage. While they might offer a Medicare Supplemental plan, it would likely not be the most competitive rate on the market.
- How much is Plan G in South Carolina?
- Premiums can start around $100. Many things can affect premium, such as; age, gender, and area.
- Where can I find a Medicare Supplement insurance agent licensed in Bluffton, SC?
- We’re licensed in the state! Call the number above and speak with an insurance agent to customize your Medicare policy today.