What to know about Medicare Advantage coverage in South Carolina
If you live in or are moving to South Carolina, there are many ways to get your Medicare coverage. One alternative option to Original Medicare is Medicare Part C (or Medicare Advantage) plans. Medicare Advantage plans must give at least the same level of coverage that Original Medicare (Part A and Part B) does. They can also add in extra benefits like prescription medications, routine dental, hearing, or vision.
Private insurance companies that Medicare contracts provide these Medicare Advantage plans. Your current location determines the availability, costs, and benefits of the plan.
Medicare Part C (also called Medicare Advantage) has a couple different choices when it comes to the plan that fits your needs. If your primary concern is cost, then a Health Maintenance Organization (HMO) plan may fit your needs. Normally, you will pay less out-of-pocket expenses with this Medicare Advantage plan than others. With an HMO, you have a network of providers you are able to use and the plan will cover you when you use this network. However, if you go outside of the network the play may not cover you (unless it is a medical emergency). A primary care doctor will assist most of your care, and if you require specialist care then you’ll need a referral from your primary care doctor.
If your primary concern is free choice of providers, then a Preferred Provider Organization (PPO) plan may be a good fit for you. This is another type of Medicare Advantage plan that allows more flexibility with the providers you can use. A couple reasons why you’d want to choose this plan is if you travel frequently or have a provider preference. Like HMOs, you will get a network of providers. However, you can choose to go outside of the network and pay a higher amount for copayments. Also, a primary care doctor is not required and you don’t need a referral to see a specialist doctor.
If you don’t like provider networks at all and you still want the ability to use providers in different locations. Then a Private Fee-for-Services (PFFS) plan may be the right fit for you. These plans do not have provider networks, you can see any doctor who confirms to treat you and agrees to the plan’s terms. Be aware that every time you get a health care service that’s covered, you’ll need to find a provider who is willing to accept the plan’s terms.
If you qualify for unique conditions, then a Special Needs Plan may be the right fit for you. These conditions include:
- Live in an institution like a nursing home
- Have Medicaid and Medicare
- Have certain chronic conditions
If you qualify for one of the conditions described above and there is a Special Needs Plan in your area, then you are eligible. Individuals with these plans get specialized health care benefits which can include, but not limited to:
- A network of providers who specialize in treating your illness or injury.
- Social services or care-coordination.
- Wellness programs to assist you in healing or managing your condition.
If you fulfill the eligibility requirements of a Special Needs Plan, then you can enroll.
If higher out-of-pocket costs does not worry you then a Medical Savings Account (MSA) might be the right fit for you. You will get a medical savings account as well as a high-deductible health plan. How your Medical Savings Account Plan will work: the plan will deposit money into your savings account. You can use this money on costs that Medicare covers before you meet the deductible.
What Are Medicare Advantage Prescription Drug Plans in South Carolina?
Medicare Part C and Original Medicare have a major difference which includes prescription drugs. With Original Medicare, if you want prescription drugs, you have to enroll in a prescription drug coverage plan (Medicare Part D). With Medicare Advantage plans you can enroll in a plan that includes prescription drug coverage known as Medicare Advantage Prescription Drug plans. If you live in South Carolina, you can have your prescription drugs and your health care all in one plan.
You should get your prescription drugs through a Medicare Advantage plan if you are a Medicare Advantage enrollee. You will be automatically dropped from a Medicare Advantage plan if you enroll in a Medicare Prescription Drug Plan. So, enroll in a Medicare Advantage Prescription Drug plan if you are a Medicare Advantage enrollee. If you enroll in Medicare Part D, be aware how that may affect your current coverage.
Comparing Medicare Advantage plans in South Carolina
Costs, availability, and benefits can vary from county to county in South Carolina. When it comes to signing up for a Medicare Advantage plan, make sure you compare all the plan choices in your area. For instance, some Medicare Advantage plan premiums can be free, however, you will still need to cover your Medicare Part B premium. There are also other plan costs like deductibles, copayments, and coinsurance. So, please note that a free premium does not mean that there are other costs associated with the plan.
Enter your ZIP code on this page to start comparing Medicare Advantage plan options in South Carolina.