South Carolina residents depend on the state Department of Insurance to manage the Medicare program. Medicare in South Carolina consists of both Medicare and Medicare Supplemental Insurance or “Medigap.” Medicare is available for most people ages 65 and older and those who are under 65 and receive Social Security benefits. If a person or their spouse has paid into Medicare taxes for a total of 10 years, then that person qualifies for Medicare. However, Medicare leaves “gaps.”
Medigap requires a monthly premium for Plans lettered A – L. The cost of these premiums depends on the applicant and which insurance provider is providing the plan. All Medigap policies include the exact same benefits, but premiums vary depending on the insurance provider so it’s critical to shop around.
No Medigap Plan covers all of the “gaps.” Some examples of gaps that are covered include skilled nursing facility stays, hospital stays, the Medicare Part B deductible, and additional pints of blood per year. Examples of gaps that aren’t covered are long-term care, vision, dental, and hearing aids. Consider what’s covered, talk to a qualified insurance agent, and decide if Medigap monthly premiums are worth the benefits.
Every qualified person who is eligible for both Medicare Parts A and B has an open enrollment period. This period begins after a person has turned 65 and is enrolled in Medicare Part B. Note that Medicare Part A usually requires no premium while a person must apply and pay premiums for Medicare Part B.
A person’s open enrollment period is six months after being approved for Medicare Part B. During this time, an applicant cannot be charged higher premiums for a pre-existing condition. This can potentially save applicants a lot of money. However, if a person has been diagnosed or treated with a pre-existing condition within the six months prior to applying for Medigap, a six-month waiting period might be enforced. This means the person will not be covered for related treatments for an additional six months.
A law passed in 1990 ensures that no person can be “dropped” from Medigap. The only way a person is unable to renew Medigap coverage is if premium payments stop. However, every year the policy has a renewable period which is the best time for beneficiaries to shop around for better prices. Take advantage of this sixty day window to see if there is another company that offers the same policy at lower premiums.
MedicareAdvantage is not part of Medigap. This program gives beneficiaries the same benefits as Medicare, plus additional benefits that may include prescription drug coverage, for additional fees. Some South Carolina residents prefer this program over Medigap or in conjunction with Medigap. If a person has costly, necessary prescriptions, this might be the best avenue.
Medicare Select is similar to a preferred provider organization (PPO). It offers the same benefits as Medicare Parts A and B but at a much lower premium. However, beneficiaries must see doctors within certain networks in order to enjoy these benefits.
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