Around 20% of the South Carolina residents are enrolled in Medicare plans, who become eligible for Medicare either because of their age or due to a disability. In South Carolina around 82% of Medicare beneficiaries were eligible for Medicare due to their age. All the Medicare beneficiaries in South Carolina have the option to choose from a variety of Medicare options. Medicare beneficiaries residing in this state are entitles to receive free, one-on-one unbiased health insurance counseling from the Insurance Counseling Assistance and Referrals for Elders program. Such program helps educate and empower individuals to identify, protect themselves against possible healthcare fraud and abuse.
Original Medicare in South Carolina
Original Medicare is a federal program having same rules all over the country and so the Original Medicare plans available in South Carolina is same as the rest states of the U.S. Original Medicare plan is designed for U.S. citizens and permanent legal residents of age 65 years or older and for individuals who qualify due to disability and some people with permanent kidney failure. Most of the residents are automatically enrolled in Original Medicare as soon as they attain 65 years of age. Original Medicare comprises of Medicare Part A and Part B. Medicare Part A provides coverage for inpatient hospital stays and limited in-patient nursing facility along with home health care. Medicare Part B provides basic doctor and laboratory costs along with some outpatient medical services such as medical equipment and supplies, hoe health care and physical therapy.
Individuals automatically get enrolled in Medicare Part A, if they have worked at least ten years and paid Medicare taxes otherwise they may owe a premium for their Part A coverage. However,individuals enrolled in this plan need to pay a yearly deductible for Part A and Part B coverage and may also pay copayments for extended hospital stays. Under Part B coverage, Medicare generally pays 80% of the insured’s healthcare bill after they meet their deductible. Medicare Part B has a monthly premium, which insured have to pay in order to be covered under this plan.
Medicare Advantage Plans in South Carolina
Medicare Advantage plans are available in South Carolina as an alternative of Original Medicare, with the exception of hospice care which remains covered only under Part A benefits. Some of the Medicare Advantage plans even have extensive coverage offering additional benefits that make these plans extremely popular among the medicare beneficiaries. Most of the Advantage plans include additional benefits like routine dental and vision care, hearing aids, wellness programs, nutrition and dietary counseling, and prescription drug coverage. Another benefits of Medicare Advantage plan is that these plan limit beneficiaries’ out-of-pocket expenses for healthcare services covered under Original Medicare. All Advantage plan include a yearly out-of-pocket spending limit and once insured reach their out-of-pocket costs limit including the deductible, their Advantage plan will pay 100% of the covered health-care cost for the remaining year. In order to enroll in Medicare Advantage plan, individuals should have Original Medicare and they select a plan available in the area in which they are living. Medicare Advantage plans available in South Carolina are offered by private insurance companies having contract with CMS.
Some of the Medicare Advantage Plans available in South Carolina include:
- Health Maintenance Organization
- Preferred Provider Organization
- Private Fee-for-Service Plans
- Special Needs Plan
- Medical Savings Account
Medicare Advantage Prescription Drug Plan in South Carolina
Medicare Advantage plans with prescription drug coverage are known as Medicare Advantage Prescription Drug (MA-PD) plans. Medicare Advantage Plan may have prescription drug coverage included into the plan, which give beneficiaries the convenience of having health and prescription medication under one plan, instead of enrolling in a separate plan for Medicare Part D coverage. Thus, residents of South Carolina enrolled in Medicare Advantage plan who also wish to have prescription drug coverage can get it through Medicare Advantage Prescription Drug plan. These plans are offered by private insurance companies having contract with Medicare. People looking to obtain this plan must have Part A and Part B plan. Medicare Advantage Prescription Drug plans cover everything that are covered under Original Medicare with the only exception of Hospice care. before enrolling in these plans, people must make sure that all of their current prescriptions are included in the plan’s formulary, since medications covered and costs of plan varies. Besides, two plans may cover the same prescription drugs but with different out-of-pocket costs, so people must properly research about the plan options in order to save some money. Every Medicare Advantage Prescription Drug plan covers only a documented list of prescription medications, which is called a formulary. These plans are required to offer at least two medications within each category.
Medicare Part D Plans in South Carolina
Medicare Part D or Prescription Drug Plans are stand-alone prescription drug plans available through Medicare-contracted private insurance companies. Medicare beneficiaries, who wish to add Part D prescription drug coverage to their Original Medicare coverage can sign up for this plan. In order to obtain help in the prescription drug cost, Medicare beneficiaries enroll in this plan, which work alongside the Original Medicare benefits. Thus, the costs and availability of Part D plan may differ between insurance companies, and location. Medicare beneficiaries are eligible for Part D coverage if they are enrolled in Part A and/or Part B and if they are living in the plan’s service area. Beneficiaries can enroll in Medicare Part D during the Initial Enrollment Period for Part D, which is the seven month period when individual first become eligible for Medicare, which start three months before their birthday month and ends three month later after the birthday month. Each Medicare Part D plan has its own formulary, or list of covered medications.
Medicare requires all Part D plan to cover prescription drugs in all six protected classes that are, Immunosuppresants, Antiretrovirals, Anticancer drugs, Antidepressants, Antipsychotics, Anticonvulsants, and Antiretroviral (HIV) drugs. However Medicare Part D doesn’t cover certain medications like over-the-counter drugs, fertility drugs, and medications to treat hair growth. Since every Part D plan can cover different prescription drug plan therefore it is essential to evaluate all Medicare Part D coverage options available in one’s area to ensure that their prescription drugs are covered. People should also keep in mind that the formulary may change at any time, though they will receive notice regarding the change when necessary.
Medicare Supplement Plans in South Carolina
Since out-of-pocket expenses are not covered by Original Medicare, private insurance companies offer Medicare Supplement plans to cover the out-of-pocket costs like coinsurance, copayments, and deductibles. Medicare beneficiaries in order to save their money can enroll in a Medicare Supplement insurance plan, which allow them fill the gaps left by Original Medicare. Residents of South Carolina must know that Supplement plans don’t work with Medicare Advantage plans, so Medicare beneficiaries enrolled in Medicare Advantage plan won’t be allowed to enroll in this plan. It is not necessary for the insurance companies offering Supplement plans to offer all ten types of Supplement plans, as they may offer only some types of the plans. In South Carolina there are ten standardized Medicare Supplement insurance plans, denoted by the letters A through N and plans E, H, I, and J are no longer sold. These plans are offered by private insurance companies and every company offering Supplement plans has to offer at least Plan A. Every Medicare Supplement plan offers certain basic benefits, but the same letter plan covers the same standardized basic benefits, irrespective of the insurance company and the location.