How Much Does Medicare Cost in South Carolina in 2026?

Part A: Hospital Insurance Costs

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. For the vast majority of South Carolina residents turning 65, Part A is premium-free.

Part A premiums: most people pay $0

If you or your spouse worked and paid Medicare taxes for at least 10 years - that is 40 quarters of covered employment - you pay no monthly premium for Part A. This applies to most Americans and most South Carolinians I work with in the Charleston and Summerville area. The 40-quarter requirement is based on your total work history, not just consecutive years, so even if you had gaps in employment, you likely qualify for premium-free Part A.

If you have between 30 and 39 quarters of Medicare-covered employment, you pay a reduced Part A premium of $285 per month in 2026. If you have fewer than 30 quarters, the full Part A premium is $518 per month. These situations are uncommon but they affect some people who worked primarily in government positions not covered by Social Security, people who immigrated later in life, or people who had long periods of self-employment where Medicare taxes were not paid. If you are unsure whether you qualify for premium-free Part A, you can check your Social Security statement at ssa.gov or call me and I can help you verify your eligibility.

Part A deductibles and coinsurance

Even with premium-free Part A, you still pay when you use hospital services. The Part A inpatient deductible for 2026 is $1,676 per benefit period. A benefit period starts when you are admitted to a hospital and ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days. If you are readmitted after 60 days, you pay the deductible again. This is one of the key reasons many people in South Carolina choose either a Medicare Advantage plan or a Medigap supplement - to protect against paying that $1,676 deductible multiple times in a year.

For hospital stays longer than 60 days, you pay $419 per day coinsurance for days 61 through 90. Beyond 90 days, you use your 60 lifetime reserve days at $838 per day. After all reserve days are used, you pay 100 percent of the cost. For skilled nursing facility care, days 1 through 20 are covered in full after a qualifying hospital stay. Days 21 through 100 cost $209.50 per day in coinsurance. After day 100, Medicare does not cover skilled nursing costs at all.

These out-of-pocket costs are why Original Medicare alone - without a Medigap plan or Medicare Advantage - leaves you exposed to significant financial risk. A single 10-day hospital stay costs you $1,676. Two hospital stays in different benefit periods cost you $3,352. A stroke followed by 60 days in a skilled nursing facility could cost you $1,676 for the hospital stay plus $8,380 for 40 days of skilled nursing coinsurance. This is not a scare tactic - it is arithmetic, and it is why I walk every client through supplemental coverage options before they finalize their Medicare enrollment.

Understanding Your Part B Costs

Beyond the monthly premium, Part B has its own cost-sharing structure. The annual Part B deductible for 2026 is $257. Once you meet that deductible, you pay 20 percent of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. Medicare pays the other 80 percent.

That 20 percent coinsurance has no annual cap under Original Medicare. If you have a $200,000 cancer treatment, your 20 percent share is $40,000. If you need a $50,000 knee replacement and follow-up therapy, your 20 percent is $10,000. This unlimited coinsurance exposure is the single biggest financial risk in Original Medicare, and it is the primary reason Medigap plans exist. Plan G covers 100 percent of Part B coinsurance after you pay the $257 annual deductible. Without a supplement, one major medical event can create tens of thousands of dollars in out-of-pocket costs.

Part B late enrollment penalty

If you do not sign up for Part B when you are first eligible and you do not have qualifying employer coverage, you face a late enrollment penalty of 10 percent for each full 12-month period you could have had Part B but did not. This penalty is permanent - it is added to your monthly premium for as long as you have Part B. If you delayed Part B for three years without qualifying employer coverage, your premium increases by 30 percent for life. At the 2026 standard rate, that means paying $240.50 per month instead of $185.00 - an extra $666 per year, every year, forever. If you are still working at 65 and have employer coverage, you are protected. But COBRA, retiree coverage, and VA benefits do not count as employer coverage for avoiding the Part B penalty. This is one of the most common and costly mistakes I see, and it is entirely preventable with proper planning.

What Part B covers

Part B covers a wide range of services including doctor office visits, specialist appointments, outpatient surgery, diagnostic tests, lab work, mental health services, ambulance services, durable medical equipment like wheelchairs and walkers, and preventive services such as annual wellness visits, flu shots, and cancer screenings. Most preventive services are covered at 100 percent with no deductible or coinsurance. Doctor visits and other covered services are subject to the $257 deductible and 20 percent coinsurance. Understanding what Part B covers and does not cover is essential to choosing the right supplemental coverage.

How Medicare Advantage Works in the Lowcountry

Medicare Advantage plans in the Charleston area offer an attractive deal on paper: $0 monthly premium (beyond your Part B premium), drug coverage included, and dental, vision, and hearing benefits that Original Medicare does not cover. Many plans also include gym memberships through SilverSneakers or similar programs, over-the-counter allowances, and transportation to medical appointments.

The trade-off is that you use a provider network. HMO plans require you to choose a primary care doctor, get referrals for specialists, and stay in network for all non-emergency care. PPO plans give you more flexibility to see out-of-network providers, but your costs are higher when you do. In Charleston County, MUSC Health and Roper St. Francis physicians are available in most Medicare Advantage networks, but you should always verify your specific doctors before enrolling.

The maximum out-of-pocket limit on Medicare Advantage plans is $7,550 for in-network services in 2026. This is actually a safety net that Original Medicare alone does not provide - remember, Original Medicare has no out-of-pocket maximum at all. For people who are relatively healthy and comfortable working within a network, Medicare Advantage can be the most affordable path with the broadest extra benefits. But if you have complex health needs, see multiple specialists, or travel frequently, the network restrictions can become a real limitation.

$0 premium does not mean $0 cost

One of the most common misconceptions I address with clients is that a $0 premium Medicare Advantage plan means free healthcare. You still pay the $185 Part B premium. You still pay copays every time you see a doctor or specialist. You pay coinsurance for hospital stays. And if you have a serious medical event, your costs can reach $5,000 to $7,550 before the plan's out-of-pocket cap kicks in. For a healthy year, Medicare Advantage can cost as little as $2,220 (just Part B premiums). For a year with a major hospitalization, it can cost $9,770 or more ($2,220 in Part B premiums plus up to $7,550 in plan cost-sharing). Understanding this range is essential to making an informed choice.

Understanding Part D Drug Costs in South Carolina

The 2026 Part D changes are the most significant improvement to Medicare drug coverage in years. The new $2,000 annual out-of-pocket cap means that no matter how expensive your medications are, your total drug costs are capped at $2,000 per year plus your monthly premium. For people taking specialty medications that previously cost $5,000 to $10,000 or more per year out of pocket, this is a dramatic reduction.

In South Carolina, you have 20 to 25 standalone Part D plans to choose from, with monthly premiums ranging from $0 to about $80. The best plan for you depends entirely on which medications you take. A plan with a $0 premium might have your specific brand-name medication on Tier 4 with 40 percent coinsurance, while a plan with a $25 premium might have the same medication on Tier 2 with a $15 copay. The premium difference of $300 per year is nothing compared to the potential savings of $2,000 or more in drug costs. This is why I always run a drug cost comparison using your specific medication list before recommending a Part D plan.

Part D IRMAA surcharge

Just like Part B, Part D has its own IRMAA surcharge for higher-income beneficiaries. The income brackets are the same as Part B. At the lowest surcharge tier (individual income $106,001 to $133,500), you pay an additional $13.70 per month on top of your plan premium. At the highest tier (individual income above $500,000), the surcharge is $85.80 per month. These surcharges are paid directly to Medicare, not to your Part D plan, and they are in addition to whatever premium your chosen Part D plan charges.

Part D late enrollment penalty

If you go 63 or more consecutive days without creditable prescription drug coverage when you could have had it, you face a Part D late enrollment penalty. The penalty is calculated as 1 percent of the national base beneficiary premium ($36.78 in 2026) multiplied by the number of months you went without coverage. If you delayed Part D for 24 months, your penalty would be approximately $8.83 per month, added to your premium permanently. Like the Part B penalty, this is entirely avoidable with timely enrollment. Even if you do not take any medications today, enrolling in a low-cost Part D plan protects you from this penalty and ensures you have coverage if your medication needs change.

Choosing the Right Medigap Plan in South Carolina

Plan G is the gold standard of Medigap coverage since Plan F became unavailable to new enrollees. Plan G covers everything Plan F covered except the Part B deductible of $257 per year. After you pay that $257, your out-of-pocket costs for the year are essentially zero - Plan G covers 100 percent of Part A deductibles, Part B coinsurance, skilled nursing coinsurance, Part B excess charges, and foreign travel emergencies. For people who want complete cost predictability, Plan G is the clear winner.

Plan N is a lower-premium alternative that works well for people who are comfortable with small copays. With Plan N, you pay up to $20 for office visits and up to $50 for emergency room visits that do not result in admission. Plan N does not cover Part B excess charges, which means if a doctor charges more than the Medicare-approved amount, you pay the difference. In South Carolina, most doctors accept Medicare assignment, which means excess charges are uncommon, but they do happen. Plan N saves you $30 to $50 per month in premiums compared to Plan G, which means $360 to $600 per year. If you visit the doctor four to six times per year, the copay costs roughly offset the premium savings, making Plan N and Plan G roughly equivalent in total cost for moderate healthcare users.

High-Deductible Plan G requires you to pay a $2,800 deductible before the plan covers anything. After that deductible, it covers everything Plan G covers. The monthly premium is significantly lower - often $40 to $70 at age 65 in South Carolina. If you are healthy and rarely use healthcare beyond preventive services (which Medicare covers at 100 percent), High-Deductible Plan G can save you $1,000 to $1,500 per year in premiums compared to standard Plan G. The risk is that if you have a major health event, you pay up to $2,800 out of pocket before coverage kicks in. For retirees with a solid financial cushion who are comfortable self-insuring the first $2,800 in costs, this plan offers excellent value.

When to enroll in Medigap

Your Medigap Open Enrollment Period is the six months starting the first day of the month you turn 65 and are enrolled in Part B. During this window, South Carolina insurers must sell you any Medigap plan they offer at the standard rate, regardless of your health. They cannot deny you, charge you more, or impose waiting periods for pre-existing conditions. After this period, insurers in South Carolina can use medical underwriting to decide whether to sell you a Medigap plan and at what price. If you have health conditions, you may be denied coverage entirely. This is not a deadline to take lightly. I have seen clients who waited until seven months after enrollment and were unable to get Medigap coverage at any price because of a pre-existing condition. Enroll during your open enrollment period even if you are healthy today, because you cannot predict what your health will look like in the future.

Understanding the Cost Scenarios

The healthy retiree on Original Medicare with Plan G pays $4,717 per year - about $393 per month all in. That covers Part B, Medigap, standalone Part D, and all out-of-pocket costs including the Part B deductible and minimal drug costs. The appeal of this path is certainty. You know what your costs will be within a narrow range, and a surprise diagnosis or accident does not change your financial picture significantly because Plan G covers virtually everything.

The moderate-needs retiree on Medicare Advantage pays $3,670 per year - about $306 per month. That is $1,047 less than the Medigap path. The savings come from the $0 plan premium and having drug coverage built in. But notice that doctor visit copays, hospital costs, and higher drug spending eat into the savings. If this person's health deteriorates - another hospital stay, a new specialist, a more expensive medication - the costs climb toward the plan's out-of-pocket maximum. In a bad year, the Medicare Advantage path could cost $9,770 ($2,220 Part B plus $7,550 plan maximum), while the Medigap path would still cost roughly $5,000 to $5,500.

The high-needs retiree on Original Medicare with Plan G pays $6,577 per year - about $548 per month. Despite heavy healthcare use including multiple hospitalizations, the costs are remarkably contained because Plan G eliminates coinsurance and deductible exposure (except the $257 Part B deductible). The same person on Medicare Advantage could easily hit the $7,550 out-of-pocket maximum, pushing total costs to $9,770 or higher. For people who know they will use a lot of healthcare, Medigap provides a clear financial advantage despite the higher monthly premium.

The bottom line: Medicare Advantage saves money in healthy years. Medigap saves money in expensive years and provides cost certainty in all years. Which path is right for you depends on your health today, your risk tolerance, and whether cost predictability is worth the higher monthly premium.

IRMAA Planning for South Carolina Retirees

IRMAA catches many new retirees off guard because it is based on income from two years ago. If you retired in 2025 but earned $150,000 in 2024, your 2026 Part B premium is $370.20 per month instead of $185.00 - an extra $2,222 per year. If your income dropped to $50,000 after retirement, you can file form SSA-44 with documentation of your retirement to have your premiums recalculated based on your reduced income. This is one of the most impactful financial moves a new retiree can make, and I walk clients through the SSA-44 process regularly.

IRMAA also creates planning opportunities. If you are approaching 65 and your income is near an IRMAA threshold, strategic decisions about Roth conversions, capital gains harvesting, or the timing of retirement account distributions can keep you below the threshold and save hundreds or thousands of dollars per year in premiums. For example, if your MAGI is $108,000, you are paying $259 per month for Part B instead of $185 - an extra $888 per year. Reducing your MAGI by just $3,000 through timing of income or deductions drops you back to the standard premium. Work with your financial advisor or CPA two to three years before Medicare eligibility to plan your income around these thresholds.

Income that counts toward IRMAA

IRMAA uses your Modified Adjusted Gross Income, which includes adjusted gross income plus tax-exempt interest income. That means municipal bond interest, which is normally tax-free, still counts toward your IRMAA threshold. Social Security benefits, pension income, 401(k) and IRA distributions, capital gains, rental income, and any other taxable income all count. Roth IRA distributions do not count toward MAGI because they are tax-free and not included in adjusted gross income. This is one reason many financial advisors recommend strategic Roth conversions before age 65 - you take the tax hit now to avoid both income taxes and IRMAA surcharges later.

Key Medicare Enrollment Dates for South Carolina Residents

Missing a Medicare enrollment deadline can cost you money for the rest of your life. Here are the critical dates and periods you need to know.