Information about Medicare Advantage Plans in South Carolina

Quick links:

• Average 2022 Costs
• Eligibility & Enrollment
• Finding Top-Rated Plans
• List of Plans Available
  • Plans by Carrier
  • Plans by Type
• Local Resources

There are 73 different South Carolina Medicare Advantage (Medicare Part C) plans in 2022.¹ Not every plan is available in each South Carolina county.

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of South Carolina. Read below to learn more about Medicare in your state.

Average costs of Medicare Advantage in South Carolina

Although the average 2022 Medicare Advantage plan premiums in South Carolina are $38.38 per month, you may be able to find plans that feature $0 monthly premiums.

• Average in-network out-of-pocket spending limit: $6,234.71
• Average deductible (weighted): $239.08²

The plan premiums, deductibles and out-of-pocket costs for plans may vary greatly based on where you live and the plan you have. Learn more about your Medicare Advantage plan options and compare costs for plans that are available in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Medicare Eligibility & Enrollment

In order to enroll in a South Carolina Medicare Advantage plan, you must sign up for Medicare Part A and Part B, often referred to as Original Medicare.

In order to be eligible for Original Medicare at age 65, you must meet the following requirements:

• You must be a United States citizen (or a permanent legal resident who has lived in the U.S. for five continuous years).
  
  
• You or your spouse must be eligible for Social Security or Railroad Retirement benefits.
  
  
• You or your spouse must be government employees who have paid Medicare payroll taxes, whether or not you paid into Social Security.

You may also be eligible for Medicare benefits before you reach age 65 if:

• You receive Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.
  
  
• You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).
  
  
• You have End-Stage Renal Disease (ESRD) and you or your spouse have paid Social Security taxes for a certain length of time.

If you have ESRD, you may be able to enroll in a South Carolina Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to enroll in a Medicare Advantage Plan in South Carolina

The first time you may be able to sign up for a South Carolina Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Each Medicare beneficiary is given a seven-month Initial Enrollment Period when they first become eligible for Medicare.

Your IEP begins three months before your 65th birthday, includes the month of your birthday and continues for three more months after your birth month.

Your IEP is your first opportunity to sign up for Medicare coverage, including a Medicare Advantage plan.

If you do not enroll during your IEP, you will have to wait for one of the following:

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you are already enrolled in a Medicare Advantage plan, you may switch to a new Medicare Advantage plan or disenroll from your plan and return to Original Medicare during the Medicare Advantage Open Enrollment Period.

This period lasts from January 1 to March 31 each year.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you can typically enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your current Medicare Advantage plan and return to Medicare Part A and/or Part B.

During AEP, you may also join, switch or drop a Medicare Part D prescription drug plan. 

Medicare Special Enrollment Periods (SEP)

Depending on your situation, you could potentially be granted a Medicare Special Enrollment Period (SEP). You may qualify for a Medicare SEP at any time throughout the year if you have a qualifying circumstance.

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Top-rated Medicare Advantage Plans in South Carolina 2022

The Centers for Medicare & Medicaid Services (CMS) issues star ratings every year for all Medicare Advantage plans using a system of one to five stars.³

If a Medicare Advantage plan earns four or more stars out of five stars, it can be designated as a top-rated Medicare Advantage plan.

35.3% of Medicare Advantage plans in South Carolina are rated four stars or higher in 2022.²

Medicare Advantage plans are rated based on the five categories listed below:

• Preventive care and health maintenance (screenings, tests, vaccines, etc.)
• Management of chronic conditions
• Member experiences and ratings of the plan
• Member complaints, problems receiving services and member retention
• Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in South Carolina in 2022

You can use our plan comparison tool to view a list of plans offered in your area within South Carolina.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Private insurance companies offer Medicare Advantage plans in South Carolina

There may be multiple insurance carriers who offer Medicare Advantage plans in South Carolina, depending on the area you live in.

Private insurance companies and the Medicare Advantage plans that they offer may be unique to the program area that they service.

Call to speak with a licensed insurance agent to learn more about Medicare Advantage plans and to compare the options that may be available from carriers in your area of South Carolina.

When shopping for a Medicare Advantage plan in South Carolina, some of the following information might be helpful sources of more information about available plans and the carriers that provide them:

• Annual Medicare Star Ratings can help you understand the overall quality of plans available in your area.
  
  
• Agencies such as A.M. Best, Moody’s and Standard & Poor’s provide information about the credit ratings and financial standings of various insurance companies. This information can be helpful as you compare Medicare Advantage insurance companies in South Carolina.
  
  
• The Better Business Bureau and Consumer Reports publish information about different insurance carriers that you might find helpful.
  
  
• You can read through Medicare Advantage plan reviews and testimonials from customers.

SC Medicare Advantage enrollees by plan type

The primary types of Medicare Advantage plans include:

• HMO
  A Medicare Health Maintenance Organization (HMO) plan typically requires beneficiaries to visit certain health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies). If you have a Medicare HMO, you are also typically required to get a referral from a primary care doctor in order to see a specialist.
  
  
• PPO
  Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) can typically see providers outside of their plan’s network, though it will most likely cost more money to get out-of-network services.
  
  PPO beneficiaries will typically pay less out of pocket if they visit providers and hospitals within their plan’s network.
  
  With a PPO plan, you are usually not required to get a referral before visiting a specialist.
  
  
• PFFS
  A Private Fee-For-Service (PFFS) plan determines how much you pay for services at the point when you receive care.
  
  With a PFFS plan, you can typically visit any doctor, hospital or health care provider that accepts Medicare and your plan’s terms.
  
  
• SNP
  A Medicare Advantage Special Needs Plan (SNP) can be designed to fit the needs of people with certain chronic conditions and other specific characteristics.
  
  Except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis, you must typically visit providers in your SNP network.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2022 South Carolina Medicare Advantage plans that are available where you live.

Local health insurance resources in South Carolina

• The Insurance Counseling Assistance and Referrals for Elders program is a network of volunteers who offer free health benefits counseling to South Carolina seniors who are eligible for or enrolled in Medicare, Medicaid and related programs. The program may be reached at 800-868-9095.    
  
  
• You can also explore more information about the insurance industry in South Carolina by visiting the state’s Department of Insurance website.
  
  
• South Carolina Prescription Drug Assistance Programs
  The state of South Carolina has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

¹ Freed M. et al. (Nov. 2, 2021). Medicare Advantage 2022 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2022-spotlight-first-look.

² MedicareAdvantage.com's The Best States for Medicare report.

³ Medicare evaluates plans based on a 5-star rating system.