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Medicare Advantage Plans in South Carolina


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About Medicare Advantage plans in South Carolina

Medicare beneficiaries in South Carolina have an alternative way to get their Original Medicare coverage, also known as Medicare Advantage (Medicare Part C) plans. Medicare Advantage plans offer at least the same level of hospital and medical benefits found under Original Medicare (Part A and Part B), and may also cover additional benefits, such as routine dental or vision, hearing, and prescription medications.

Medicare Advantage plans are offered through private insurance companies that are contracted with the Medicare program to provide Medicare Part C coverage. So costs, benefits, and availability of plan options will depend on your specific location.

You have a couple different options when it comes to Medicare Part C. If cost is a factor for you, Health Maintenance Organization (HMO) plans are a type of Medicare Advantage plan that generally has lower out-of-pocket costs than other types of managed-care plans. An HMO requires you to use doctors and hospitals from the plan’s provider network in order to be covered; if you go out of network, the HMO may not cover you (with the exception of medical emergencies). You’ll have a primary care doctor who will provide most of your care, and if you need specialist care, you’ll need to get a referral.

If provider choice is important to you, Preferred Provider Organization (PPO) plans are another type of Medicare Advantage plan that gives more flexibility when it comes to the doctors and hospitals you can use. While your costs will be lower if you use providers from the plan’s preferred provider network, you also have the option to use non-network providers and pay higher copayments. Unlike HMOs, you don’t have a primary care doctor and you can see specialists directly without needing referrals.

Perhaps you don’t like having provider networks at all or travel frequently and want the flexibility to use doctors and hospitals in different locations. Private Fee-for-Service (PFFS) plans don’t have provider networks. Instead, you can see any doctor who will accept the plan’s terms and conditions and agree to treat you. Keep in mind that you’ll need to find providers who are willing to contract with the plan each time that you receive a covered health-care service.

Are you a beneficiary with unique circumstances? If you live in a nursing home (or other institution), have Medicare and Medicaid, or have certain chronic conditions, you may be eligible for a Special Needs Plan if there is one available in your area. These plans cater benefits to beneficiaries with specialized health-care needs and may include benefits like care-coordination or social services; wellness programs to help you manage your illness, or provider networks with doctors who specialize in treating your condition. You’ll need to meet the eligibility requirements of the Special Needs Plan to enroll, whether that means having the chronic condition(s) that the plan is for, living in an institution, or being a dual eligible (having both Medicare and Medicaid).

If you don’t mind having higher out-of-pocket costs, a Medical Savings Account (MSA) plan may be an option. These plans combine a high-deductible health plan with a medical savings account. Your Medical Savings Account plan will deposit money into a savings account for you to use on covered medical expenses before you reach the deductible.

Medicare Advantage Prescription Drug plans in South Carolina

One notable difference between Medicare Part C and Original Medicare is that Medicare Advantage plans may include prescription drug coverage (Medicare Part D) wrapped into the plan coverage. Also known as Medicare Advantage Prescription Drug plans, these plans give South Carolina beneficiaries the convenience of having all their health and prescription medication under one plan.

If you are enrolled in a Medicare Advantage plan and want prescription drug coverage, you should get it through a Medicare Advantage plan that includes this benefit. You shouldn’t enroll in a Medicare Prescription Drug Plan if you’re already enrolled in a Medicare Advantage Prescription Drug plan. If you do, you’ll be automatically disenrolled from the Medicare Advantage plan and returned to Original Medicare. It’s important to understand your Medicare Part D options and how certain actions you take may affect your current coverage.

Comparing Medicare Advantage plans in South Carolina

As mentioned, before enrolling in a Medicare Advantage plan, it is important to compare all plan options in your area, since benefits, costs, and availability can vary from county to county. For example, some Medicare Advantage plans may have monthly premiums as low as $0; however, even if your service area has a Medicare Advantage plan with a $0 premium, you’ll need to keep paying your Medicare Part B premium. You may also have other plan costs, such as copayments, coinsurance, or deductibles. So remember that a $0 premium doesn’t mean that you won’t have any other plan costs.

As you can see, you may have many Medicare Advantage plan options in South Carolina. You can compare plans by entering your ZIP code in the box on this page and following the prompts.

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