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South Carolina Medicare Advantage Plans 2022

Medicare beneficiaries unsatisfied with the coverage offered by Original Medicare have the option of signing up for a Medicare Advantage plan in South Carolina for 2022. Medicare Part C is designed to offer more comprehensive health insurance than Medicare Part A and Part B alone. Medicare Advantage in South Carolina allows beneficiaries to combine routine medical care and wellness services in one plan for convenience.

What is Medicare Advantage in South Carolina?

Medicare Advantage plans are administered by private insurance companies rather than the Centers for Medicare and Medicaid Services. The insurance company provides a separate insurance card to each beneficiary, but the red, white, and blue Original Medicare card is kept for future use.

Consider some additional facts about the Medicare Advantage health plans in South Carolina:

  • Medigap plans may eliminate more out-of-pocket costs like copayments, coinsurance, and deductibles, but Advantage plans offer lower monthly premiums.
  • Medicare Advantage plans often include additional Medicare coverage like benefits for dental, vision, and hearing services. That coverage isn’t offered by any Medicare Supplement plan.
  • Medicare Advantage Prescription Drug plans, also known as MAPD, include prescription drug coverage. Beneficiaries don’t need to pay for a Part D plan separately.
  • Many Medicare Advantage plans require beneficiaries to select a primary care physician and see network providers in agreement with the plan’s payment terms.
  • An insurance agent can help beneficiaries select a Medicare Part C plan.

What is the Best Medicare Advantage plan in South Carolina in 2022?

Best for network freedom: Medicare Advantage PPO

  • PPO plans often have wider networks than HMO plans, which gives beneficiaries greater choice when selecting healthcare providers.
  • Some PPO policies allow beneficiaries to seek care from out-of-network providers.
  • $0 premium PPO plans are available, but rates may go up to $100 a month.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Most HMO plans have no monthly premium, which reduces out-of-pocket costs.
  • HMO costs are reduced by limiting services to in-network providers willing to abide by plan payment policies.

Best for low income or health conditions: Medicare Advantage D-SNIP

  • SNP insurance plans are reserved for low-income beneficiaries or those with chronic health conditions.
  • Each special needs plan is dedicated to one specific health condition. Low-income plans are limited to beneficiaries meeting income qualifications.
  • A South Carolina Medicare Advantage plan is often combined with Medicaid to minimize out-of-pocket costs.

What Medicare Advantage plans are available in South Carolina?

Three of the most popular types of Advantage plans in South Carolina include:

  • Local HMO
  • Local PPO
  • Regional PPO

Availability varies by county. Beneficiaries should compare plan options for their local area and select the one that best fits their budget and healthcare needs.

What’s changing about Medicare Advantage in South Carolina in 2022?

In June 2021, the Centers for Medicare & Medicaid Services released official policy changes for Medicare Advantage plans and Medicare Part D prescription drug plans. Start dates for those changes vary, but there are some new policies that all Medicare beneficiaries and healthcare providers in South Carolina should know about.

Enhancements to the Part C and D Programs Beneficiary Real-Time Benefit Tool (RTBT)

  • Starting January 1, 2023, Part D plans will allow beneficiaries access to a valuable plan research tool that displays information in real-time.
  • Beneficiaries may use the tool to explore their plan details and compare costs for various treatment options. That will lead to better-informed enrollees being able to visit their doctors with more knowledge about their care options.

Permitting a Second, “Preferred,” Specialty Tier in Part D

  • Starting January 1, 2022, Part D plan administrators will have the option to create a second preferred specialty tier.
  • The second preferred specialty tier will present more treatment options to beneficiaries while lowering out of pocket expenses for many.

Medicare Advantage (MA) and Part D Prescription Drug Program Quality Rating System

  • Medicare star ratings help drive enrollment for the top plans by informing beneficiaries on the quality of each plan option in an understandable way.
  • In 2022, rules regarding the determination of those ratings may change the way beneficiaries view some plans in their service area.
  • Changes to the rating system will address data integrity and other critical issues with the current system.

Establishing Pharmacy Performance Measures Reporting Requirements

  • The Centers for Medicare & Medicaid Services will require Part D plans to report their pharmacy evaluation criteria, starting January 1, 2022.
  • Improved transparency may help curb unfairness in the pharmacy contracting process.

Implementing Several Opioid Provisions of the SUPPORT Act

  • Part D plans will start educating Medicare beneficiaries on the dangers of opioid addiction.
  • The training will include instructions for disposing of unused opioids safely.

Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements

  • The Centers for Medicare & Medicaid Services will codify the Medicare Managed Care Manual plus other policies that relate to supplemental benefits.
  • The codification process will clarify definitions of key terms and make some elements of Medicare policy easier to understand.

How much does Medicare Advantage in South Carolina cost?

The average monthly premium for a South Carolina Medicare Advantage plan was $15.02 in 2021. Most services areas have at least one $0 premium HMO plan. PPO plans are trending away from $0 premiums, but some are still available in select counties.

When can you enroll in a South Carolina Medicare Advantage plan?

Initial Enrollment Period

  • All beneficiaries are given seven months to enroll in Medicare Part A and Part B and select an Advantage, Part D, and/or Medigap plan.
  • Starts three months before the beneficiary’s 65th birthday month. Starts on the first day of the month.
  • Ends three months after the beneficiary’s 65th birthday months.

Open Enrollment Period – AKA Annual Election Period

  • October 15 – December 7 every year
  • Switch between Advantage plans, go back to Original Medicare, or select a Medicare Part D plan
  • Takes effect January 1 of the following year

Medicare Advantage Open Enrollment Period

  • January 1 – March 31 every year
  • Limited to beneficiaries already enrolled in a Part C plan
  • Switch to a new Advantage plan or go back to Original Medicare

Special Enrollment Periods – Special Circumstances

  • Occur at unique times for each eligible beneficiary
  • Allows late enrollment in Original Medicare and/or Advantage plans due to special circumstances
  • Common Qualifying Events: losing health care coverage from an employer and moving to a new service area

5-star Special Enrollment Period

  • November 30 – December 8 every year
  • Switch to a 5-star Advantage plan

Special Enrollment Periods if you get “Extra Help”

  • Changes are permitted during three annual periods: January – March, April – June, and July – September
  • Beneficiaries eligible for Medicaid and Medicare can make changes to Advantage plans and/or Part D plans
  • Beneficiaries receiving Extra Help to pay for prescription drug coverage may make changes to Plan D policies.

When can I make changes to my Medicare Advantage plan?

The best time to make changes to a Medicare Advantage plan in South Carolina is during the annual general election period. It takes place from October 15 to December 7 and allows all Medicare beneficiaries to make changes to Advantage and Part D plans.

Another option is the annual Medicare Advantage open enrollment period, which takes place from January 1 to March 31. Eligibility is limited to those already enrolled in Medicare Part C.

Are Medicare Advantage plans in South Carolina “bad”?

No Medicare Advantage plan in South Carolina is bad. They may not fit the needs of some beneficiaries, but they are quite popular in South Carolina as well as nationally. Many beneficiaries are interested in comprehensive health care plans that provide additional coverage options not available with Original Medicare or Medicare Supplement plans. A Medicare Advantage plan can fill that need.

In 2021, 31% of South Carolina beneficiaries were enrolled in a South Carolina Medicare Advantage plan. Enrollment is expected to rise even more in years to come.

Common Questions on Medicare Advantage in South Carolina

Are there disadvantages to Medicare Advantage?

There are a lot of advantages to enrolling in Medicare Part C, but South Carolina beneficiaries shouldn’t ignore the following potential disadvantages.

  • Networks limit the service providers available to beneficiaries. HMO plans are the most restrictive because they have the narrowest networks and don’t allow out-of-network providers.
  • Out of pocket costs like copays and the Part B premium can add up over time. Medigap plans have higher monthly premiums but eliminate most of those out-of-pocket expenses.
  • Medicare Advantage plans are sometimes time-consuming. Beneficiaries must track plan changes from year to year and make changes to ensure they receive the best benefits package and lowest monthly payment.
  • Medicare Part C plans can change every year. They aren’t as predictable as Medicare Supplement plans.

What are the four types of Medicare Advantage policies available in South Carolina?

1. Health Maintenance Organization Plans (HMO)

HMOs are the most restrictive Advantage plans because they require the following:

  • Preferred providers on a limited network list
  • Referrals for specialized care
  • Primary care physicians to manage care

2. Preferred Provider Organization Plans (PPO)

While they have networks that may limit provider choice, PPOs are a bit less restrictive than HMO plans. They typically have larger networks. Most allow out-of-network providers if the beneficiary is willing to pay more out of pocket. Referrals aren’t required. Most plans include prescription drug coverage.

3. Private Fee-for-Service Plans (PFFS)

These plans may seem to offer greater freedom of choice, but that isn’t always the case. Some have lists of preferred providers that have agreed to the plan’s payment structure. Others leave it up to beneficiaries to find providers willing to follow the plan’s rules.

4. Special Needs Plans (SNP)

SNP Medicare Advantage plans are dedicated to beneficiaries diagnosed with a specific medical condition like end-stage renal disease or arthritis. Other plans cater to low-income beneficiaries. Plan types vary, but PPOs and HMOs are offered in many service areas. Most plans include preferred specialists that offer valuable services to enrollees.

Which companies are the top three Medicare Advantage plan providers?

Every beneficiary must select the Medicare Advantage plan in South Carolina that best fits their personal needs. Plan availability and rates vary by county, but there are a few insurance companies that routinely offer the best plans in South Carolina and many other states:

  • United Healthcare – Carried 26% of policies nationwide in 2020
  • Humana – Carried 18% of policies nationwide in 2020
  • Blue Cross Blue Shield – Carried 15% of policies nationwide in 2020

What are Medicare SNPs?

Whether they’re HMOs or PPOs, special needs plans provide centralized care for beneficiaries with a select chronic medical condition. All enrollees in a plan must meet eligibility criteria, which means that they have shared health care needs. That allows the plan to offer coverage options of value to all enrollees.

There are also SNP policies dedicated to low-income beneficiaries. All enrollees must meet income qualifications and many combine Medicare with Medicaid. The care provided under the plan is often substantially more affordable than Medicare Part A and Medicare Part B alone.

Do Medicare Advantage plans include prescription drug coverage?

Yes, many Medicare Advantage plans do include prescription drug coverage. That eliminates the need for a separate Part D drug plan.

Do Medicare Advantage plans cover the SilverSneakers program in SC?

Certain Medicare Advantage plans do include a SilverSneakers membership as one of their extra benefits. Other plans may offer similar programs instead of Silver Sneakers.

Related Topics

South Carolina State Links

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In South Carolina, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.