Medicare Advantage Plans – South Carolina

Medicare Advantage Plans – South Carolina

Call Michael Crocker (864) 214-4261

What is a Medicare Advantage Plan?

A Medicare Advantage plan is basically your Medicare administered by a private insurance company. In exchange for “managing” your Medicare for you, this company is usually able to offer benefits and features that Medicare alone does not. Here is how it works:

“Original” Medicare, which was enacted by Congress in 1965, contains two main “parts:” Part A & Part B. When you look at your Medicare card, you will usually see a Part A effective date and a Part B effective date. Each of these “parts” is responsible for a different aspect of your medical care. Part A is to cover hospital stays. To help you remember, think “A” for “admissions.” If you are admitted to a hospital, Part A takes over. Part B covers routine medical care like visits to your family doctor and outpatient surgery. Think “B” for “basic” medical care.

However, neither Part A nor Part B cover 100% of your hospital/doctor bills. In fact, each covers roughly 80%, meaning you are responsible for 20%. Furthermore (and most troubling) there is no cap on your personal liability, meaning you could be responsible for tens or even hundreds of thousands of dollars in medical care. Finally, “original” Medicare offers no prescription drug coverage at all, no routine dental, no routine hearing, and no routine vision benefits.

This is where Medicare Advantage comes in. Private insurers are contracted with the federal government to manage Medicare plans, with the stipulation that those plans must offer, at a minimum, the same coverage that an individual could get with A&B alone. Because the private insurers negotiate the costs of various procedures with a network of doctors and hospitals, they are able to reduce the cost of care and also often offer some dental, vision, and hearing benefits. Many include drug coverage and even gym memberships as well. Best of all (and perhaps most important of all), they cap your annual out of pocket liability so that you aren’t responsible for a potentially unlimited medical bill.

There are quite a few Medicare Advantage plans in South Carolina, and these are administered by a number of major carriers. Each has its own strengths and weaknesses, so it is important to speak to a knowledgeable advisor when selecting a plan. Not all plans cover all drugs or all doctors/hospitals. Some plans are available in some counties but not in others.