Medicare in South Carolina: Your Complete Guide

If you are turning 65, retiring, or losing employer coverage in South Carolina, you need to understand Medicare before you enroll. Here is what matters most: you have real choices, and the wrong one can cost you thousands of dollars per year. Medicare is not one plan. It is a system of parts, supplements, and options that fit together differently depending on your health, your doctors, your medications, and your budget. This guide covers every piece of Medicare as it applies to South Carolina residents - what it costs, when to enroll, which plans are available in the Lowcountry, and how to avoid the mistakes I see people make every week.

I am Michelle Blinco Smith, a licensed insurance agent in Summerville, SC. I help people in Charleston, Dorchester, and Berkeley counties navigate Medicare every day. This page is the starting point. From here, you can dig into detailed cost breakdowns, plan comparisons, and the best plans in Charleston County. Or you can skip all the reading and call me at (843) 594-1759 to get answers in ten minutes.

Medicare Basics: Parts A, B, C, and D

Medicare is divided into four parts. Each one covers different services, has different costs, and comes with different enrollment rules. Understanding the parts is the foundation for every other decision you will make.

Part A: Hospital Insurance

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people get Part A premium-free because they or their spouse paid Medicare taxes while working for at least 10 years (40 quarters). If you do not qualify for premium-free Part A, you can buy it for up to $518 per month in 2026. Part A has a $1,676 deductible per benefit period. A benefit period starts when you are admitted to a hospital and ends 60 days after you are discharged. If you go back to the hospital after 60 days, a new benefit period starts and you pay the deductible again. Days 1 through 60 in a hospital are covered after the deductible. Days 61 through 90 cost you $419 per day in coinsurance. After day 90, you start using lifetime reserve days at $838 per day, and you only get 60 of those in your entire life. This is why supplemental coverage matters. A single extended hospital stay without Medigap or Medicare Advantage can cost tens of thousands of dollars out of pocket.

Part B: Medical Insurance

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services. The standard Part B premium is $185 per month in 2026. If your modified adjusted gross income is above $106,000 for an individual or $212,000 for a married couple filing jointly, you pay more due to the Income-Related Monthly Adjustment Amount, known as IRMAA. Part B has a $257 annual deductible. After meeting the deductible, you pay 20 percent coinsurance for most Part B services with no out-of-pocket maximum. That 20 percent with no cap is the single biggest financial risk in Original Medicare. A $100,000 cancer treatment leaves you with a $20,000 bill. This is precisely why Medigap plans exist. For the full cost breakdown including IRMAA brackets and premium tables, see the complete guide to Medicare costs in South Carolina.

Part C: Medicare Advantage

Medicare Advantage, also called Part C, is an alternative way to receive your Medicare benefits. Instead of Original Medicare (Parts A and B) plus optional supplements, you enroll in a single plan from a private insurance company that bundles hospital, medical, and usually prescription drug coverage into one package. In the Charleston, Dorchester, and Berkeley county areas, Medicare Advantage plans are offered by Humana, Aetna, UnitedHealthcare, BlueCross BlueShield of South Carolina, Wellcare, and several other carriers. Most have $0 monthly premiums on top of your Part B premium, and many include dental, vision, and hearing benefits. The trade-off is that you must use the plan's network of doctors and hospitals, you may need referrals to see specialists, and your out-of-pocket costs for a major health event can reach $3,900 to $8,850 per year. Medicare Advantage is not better or worse than Original Medicare. It is different, and the right choice depends on your individual situation.

Part D: Prescription Drug Coverage

Part D covers prescription medications. You can get Part D coverage through a standalone prescription drug plan paired with Original Medicare, or through a Medicare Advantage plan that includes drug coverage. Standalone Part D plans in South Carolina range from $7 to $80 per month in 2026. Each plan has its own formulary, which is the list of drugs it covers, and its own tier structure that determines your copay or coinsurance for each medication. Starting in 2025 and continuing into 2026, the Inflation Reduction Act caps total out-of-pocket prescription drug spending at $2,000 per year for all Part D enrollees. This is a major change that helps people who take expensive medications. If you do not enroll in Part D when you are first eligible and do not have other creditable drug coverage, you face a permanent late enrollment penalty. The penalty is 1 percent of the national base beneficiary premium for every month you went without coverage. After a few years without Part D, that penalty adds up. For more on Part D costs and phases, visit the Medicare cost guide.

Medicare Advantage vs. Medigap in South Carolina

This is the single most important decision you make when you enroll in Medicare. It determines how much you pay, where you can go for care, and how protected you are against unexpected medical costs. I built a full comparison of Medicare Advantage and Medigap that walks through every detail. Here is the summary.

Medicare Advantage vs. Medigap: Quick Comparison
Feature Medicare Advantage Original Medicare + Medigap
Monthly premium (on top of Part B) $0 - $50 $100 - $300+
Out-of-pocket maximum $3,900 - $8,850 No cap (but predictable costs)
Doctor choice Network only Any Medicare-accepting doctor
Prescription drugs Included Separate Part D plan needed
Dental/vision/hearing Often included Not included
Referrals needed Yes (HMO plans) No
Best for Healthy, budget-focused Chronic conditions, travel

Medicare Advantage vs. Medigap: Quick Comparison

Medicare Advantage

Monthly premium (on top of Part B)
$0 - $50
Out-of-pocket maximum
$3,900 - $8,850
Doctor choice
Network only
Prescription drugs
Included
Dental/vision/hearing
Often included
Referrals needed
Yes (HMO plans)
Best for
Healthy, budget-focused

Original Medicare + Medigap

Monthly premium (on top of Part B)
$100 - $300+
Out-of-pocket maximum
No cap (but predictable costs)
Doctor choice
Any Medicare-accepting doctor
Prescription drugs
Separate Part D plan needed
Dental/vision/hearing
Not included
Referrals needed
No
Best for
Chronic conditions, travel

Costs shown are typical ranges for South Carolina in 2026. Medigap premiums vary by carrier, age, and plan letter. Medicare Advantage premiums are in addition to your Part B premium.

Medicare Advantage works well for people who are generally healthy, comfortable using a network, and want the lowest monthly cost. You get drug coverage and extras like dental and vision wrapped into one plan. The risk is that if you get seriously ill, your out-of-pocket costs can climb to nearly $9,000 in a year.

Medigap (Medicare Supplement) works well for people with chronic conditions, people who see multiple specialists, and people who want predictable costs no matter what happens. With Plan G, you pay the $257 Part B deductible and that is it for the year. You can see any doctor in the country who accepts Medicare. The cost is higher per month but lower if you actually use a lot of healthcare.

For the full side-by-side analysis with real cost scenarios, read the Medicare Advantage vs. Medigap comparison. For plans ranked by value in your area, see the best Medicare plans in Charleston County.

Medicare Enrollment Periods: When You Can Sign Up

Missing an enrollment deadline is the most expensive mistake in Medicare. Some penalties are permanent. Here are the four enrollment periods that matter for South Carolina residents.

Medicare Enrollment Periods at a Glance
Feature Initial Enrollment (IEP) Annual Election (AEP) Open Enrollment (OEP) Medigap Open Enrollment
Who qualifies Turning 65 Everyone with Medicare Current MA enrollees New to Medicare at 65
When it runs 3 months before to 3 months after 65th birthday October 15 - December 7 January 1 - March 31 Starts month you turn 65, lasts 6 months
What you can do Enroll in Part A, Part B, Part D, MA, or Medigap Switch MA plans, switch to Original Medicare, change Part D Switch MA plan or drop MA for Original Medicare Buy any Medigap plan - guaranteed issue, no underwriting
Coverage starts 1st of birthday month (if enrolled in first 3 months) January 1 of following year Month after enrollment Varies by enrollment date
Penalty for missing 10% Part B penalty per year permanently None - optional period None - optional period May face medical underwriting for Medigap later

Medicare Enrollment Periods at a Glance

Initial Enrollment (IEP)

Who qualifies
Turning 65
When it runs
3 months before to 3 months after 65th birthday
What you can do
Enroll in Part A, Part B, Part D, MA, or Medigap
Coverage starts
1st of birthday month (if enrolled in first 3 months)
Penalty for missing
10% Part B penalty per year permanently

Annual Election (AEP)

Who qualifies
Everyone with Medicare
When it runs
October 15 - December 7
What you can do
Switch MA plans, switch to Original Medicare, change Part D
Coverage starts
January 1 of following year
Penalty for missing
None - optional period

Open Enrollment (OEP)

Who qualifies
Current MA enrollees
When it runs
January 1 - March 31
What you can do
Switch MA plan or drop MA for Original Medicare
Coverage starts
Month after enrollment
Penalty for missing
None - optional period

Medigap Open Enrollment

Who qualifies
New to Medicare at 65
When it runs
Starts month you turn 65, lasts 6 months
What you can do
Buy any Medigap plan - guaranteed issue, no underwriting
Coverage starts
Varies by enrollment date
Penalty for missing
May face medical underwriting for Medigap later

Initial Enrollment Period (IEP)

This is your main window to enroll in Medicare. It spans seven months: three months before your 65th birthday month, the birthday month itself, and three months after. Enrolling in the first three months gives you the earliest possible start date. Waiting until the birthday month or after delays your Part B coverage by one to three months. If you miss the IEP entirely and do not have qualifying employer coverage, you must wait until the General Enrollment Period (January 1 through March 31) to sign up, and your coverage will not start until July 1. You will also pay a 10 percent Part B late enrollment penalty for every full 12-month period you could have had Part B but did not. That penalty is permanent and gets added to every Part B premium for the rest of your life.

Annual Election Period (AEP)

The AEP runs from October 15 through December 7 every year. During this window, you can switch from one Medicare Advantage plan to another, switch from Medicare Advantage back to Original Medicare, enroll in a new Medicare Advantage plan, or change your Part D standalone plan. Changes made during the AEP take effect on January 1 of the following year. This is the period I stay busiest helping clients in the Lowcountry review their current coverage and make changes based on plan updates, formulary changes, and network modifications for the coming year.

Medicare Advantage Open Enrollment Period (OEP)

This runs from January 1 through March 31 and is only for people who are currently enrolled in a Medicare Advantage plan. You can use this period to switch to a different Medicare Advantage plan or drop your Medicare Advantage plan and return to Original Medicare with a standalone Part D plan. You cannot use the OEP to enroll in Medicare Advantage for the first time. If you enrolled in a Medicare Advantage plan during the AEP and realize it is not working for you, the OEP gives you one chance to fix it early in the year.

Medigap Open Enrollment Period

This six-month window starts the month you turn 65 and are enrolled in Part B. During this period, you can buy any Medigap plan sold in South Carolina without medical underwriting. No insurance company can deny you or charge you more because of your health. After this window closes, Medigap insurers in South Carolina can and do use medical underwriting. If you have pre-existing conditions like diabetes, heart disease, or COPD, you may be charged a higher premium or denied coverage altogether. This is why I tell every client: even if you are leaning toward Medicare Advantage, seriously consider your Medigap options during this guaranteed-issue window. You can always switch to Medicare Advantage later. Going the other direction is much harder.

What Medicare Costs in South Carolina

Medicare is not free, and the total cost depends on which path you choose, your income, your health, and which medications you take. Here is a quick summary of what you can expect in 2026. For the complete cost breakdown including IRMAA tables, Part D coverage phases, Medigap premium comparisons, and real-dollar annual scenarios, visit the full Medicare cost guide for South Carolina.

Part A: $0 premium for most people

Premium-free if you or your spouse paid Medicare taxes for 10+ years. The $1,676 per-benefit-period deductible for hospital stays is the main cost exposure. This is covered by Medigap plans and by Medicare Advantage out-of-pocket maximums.

Part B: $185 per month (standard)

Everyone on Medicare pays this. Higher earners pay IRMAA surcharges that can push Part B premiums to $628.90 per month. The $257 annual deductible and 20 percent coinsurance with no cap is covered by Medigap plans or limited by Medicare Advantage out-of-pocket maximums.

Medicare Advantage: $0 - $50 per month (on top of Part B)

Many plans in the Charleston area are $0 premium. You pay copays and coinsurance when you use services, up to a maximum of $3,900 to $8,850 per year depending on the plan. Drug coverage is typically included.

Medigap Plan G: $120 - $180 per month (at age 65)

This is the most popular Medigap plan in South Carolina. After you pay the $257 Part B deductible, Plan G covers 100 percent of Part A and Part B cost-sharing. Premiums increase with age and vary by carrier. You also need a standalone Part D plan for drug coverage.

Part D: $7 - $80 per month

Standalone drug plans vary widely. The right plan depends on your specific medications. The 2026 out-of-pocket cap on Part D spending is $2,000 per year, which protects people with expensive prescriptions.

Total annual cost: $3,500 - $7,000+

A healthy retiree on Medicare Advantage might spend $3,500 to $4,500 per year total. A retiree on Original Medicare with Medigap Plan G, a Part D plan, and moderate healthcare use might spend $5,000 to $6,500. The cost guide includes three detailed scenarios with real numbers.

Medicare Carriers and Networks in the SC Lowcountry

South Carolina's Medicare landscape is different from other states. Knowing which carriers operate in your county and which hospitals and doctors are in their networks is critical to choosing the right plan. Here is what the market looks like in the areas I serve.

Charleston County

Charleston County has the broadest selection of Medicare plans in the Lowcountry. Medicare Advantage carriers include Humana, Aetna, UnitedHealthcare, BlueCross BlueShield of South Carolina, Wellcare by Centene, and Cigna. MUSC Health, the state's only academic medical center, is in-network for most major Medicare Advantage plans, though some HMO plans may require referrals for MUSC specialists. Roper St. Francis Healthcare, which operates Roper Hospital, Bon Secours St. Francis Hospital, and multiple outpatient facilities across the peninsula and Mount Pleasant, is also widely accepted. If you see doctors at MUSC or Roper, we verify network participation for your specific providers before recommending any plan.

Dorchester County

Dorchester County, including Summerville and the rapidly growing Nexton area, has access to the same carriers as Charleston County. Trident Health System, which operates Summerville Medical Center and Trident Medical Center, is in-network for most Medicare Advantage plans. Many residents of Dorchester County also see specialists at MUSC or Roper St. Francis in Charleston, so cross-county network coverage matters. BlueCross BlueShield of South Carolina has the broadest network reach across Dorchester County, covering virtually all major providers. Humana and Aetna also have strong network coverage in this area.

Berkeley County

Berkeley County, including Moncks Corner, Goose Creek, and Hanahan, is served by the same carriers as Charleston and Dorchester counties. Trident Medical Center in North Charleston is the closest major hospital for many Berkeley County residents. Roper St. Francis Berkeley Hospital in Moncks Corner is a newer facility that is in-network for most plans. Access to MUSC specialists typically requires a short drive to the Charleston peninsula or to MUSC satellite clinics in Mount Pleasant and North Charleston. Berkeley County residents should pay particular attention to which plans include MUSC and Roper specialists in their network, as these are the primary referral destinations for complex care.

Medigap carriers in South Carolina

For Medigap supplemental insurance, South Carolina residents can choose from carriers including BlueCross BlueShield of South Carolina, Aetna, Mutual of Omaha, United American, CIGNA, Bankers Fidelity, and others. Medigap plans are standardized by letter (Plan G, Plan N, etc.), meaning the benefits are identical regardless of which carrier you choose. The only differences are premium price and rate increase history. This is where working with a broker who knows the SC market matters. I track which carriers have the most stable premium history in South Carolina and which ones tend to raise rates aggressively after the first few years. That information is not available on any government website.

For a ranked list of the best Medicare Advantage, Medigap, and Part D plans in the area, see the best Medicare plans in Charleston County guide.

How Michelle Helps You Navigate Medicare

Medicare has more moving parts than any other type of insurance I work with. There are four enrollment periods, dozens of plan options in each county, formularies that change every year, and penalties for mistakes that last a lifetime. Most people do not need to become Medicare experts. They need someone who already is one.

Here is what I do for every Medicare client in the Lowcountry:

Full plan comparison

I pull up every Medicare Advantage, Medigap, and Part D plan available for your zip code. I compare them using your specific doctors, your specific medications, and your expected healthcare usage. You see the real numbers side by side, not marketing brochures.

Doctor and network verification

I check whether your current doctors are in-network for each plan we are considering. Provider directories are not always accurate, so I verify directly when needed. If your primary care doctor is at MUSC and your cardiologist is at Roper, I make sure both are covered before you enroll.

Prescription drug analysis

I enter your complete medication list into the plan comparison tools and show you exactly what each drug will cost under each plan option. Formulary placement, tier levels, prior authorization requirements, and quantity limits all affect your real cost. A plan with a $0 premium can cost you more than a plan with a $30 premium if it does not cover your medications well.

Annual coverage review

Every fall before the Annual Election Period, I review your current coverage against next year's plan options. Carriers change formularies, adjust networks, and modify cost-sharing every year. What was the best plan this year may not be the best plan next year. I contact every client and walk through what has changed.

Free to you

My services cost you nothing. I am compensated by the insurance carriers when you enroll through me. You pay the same premium whether you enroll through me, through another agent, or directly with the carrier. There is no extra fee, no upcharge, and no hidden cost.

Want an interactive way to explore your Medicare options? Try the Medicare Decision Helper, a tool I built to walk you through the key questions and help you figure out which direction makes sense for your situation.

Medicare Decision Helper

Choosing between Medicare Advantage and Medigap can feel overwhelming. I built the Medicare Decision Helper to simplify the process. It asks you a series of straightforward questions about your health, your doctors, your medications, and your budget. Based on your answers, it provides a recommendation with a clear explanation of why that path makes sense for your situation.

The tool is not a replacement for working with me directly. It is a starting point. If you want the full analysis with specific plan names, premium amounts, and provider verifications, that is what our one-on-one consultation is for. But if you are early in the process and just want to understand which direction you should be leaning, the Medicare Decision Helper gives you a solid answer in about five minutes.

Medicare Guides and Resources

This page is your starting point. For deeper dives into specific topics, I have written detailed guides that cover each area of Medicare in full.

Medicare Costs in South Carolina

Complete 2026 cost breakdown: Part A, Part B, IRMAA tables, Medicare Advantage premiums, Medigap Plan G and N rates, Part D phases, and real-dollar annual scenarios.

Medicare Advantage vs. Medigap

Full side-by-side comparison of Medicare Advantage and Medigap supplemental plans. Includes cost scenarios, network considerations, and enrollment rules.

Best Medicare Plans in Charleston County

Ranked list of the top Medicare Advantage, Medigap, and Part D plans available in Charleston County for 2026, with star ratings, premiums, and key benefits.

Medicare Decision Helper

Interactive tool that walks you through key questions and recommends whether Medicare Advantage or Medigap is the better fit for your situation.

Medicare Terms You Should Know

Medicare has its own vocabulary. If you have encountered terms like IRMAA, benefit period, creditable coverage, or formulary and were not sure what they meant, you are not alone. I maintain a complete glossary of insurance and Medicare terms that explains each one in plain English. Here are a few of the most important ones:

IRMAA (Income-Related Monthly Adjustment Amount)
An extra charge added to your Part B and Part D premiums if your income exceeds certain thresholds. Based on your tax return from two years ago. Can be appealed if your income has dropped due to a life-changing event like retirement.
Medigap Open Enrollment Period
The six-month window starting when you turn 65 and enroll in Part B. During this time, you can buy any Medigap plan without medical underwriting. After it closes, insurers can deny you or charge more based on your health.
Creditable Coverage
Drug coverage that is at least as good as Medicare Part D. If you have creditable coverage from an employer, you can delay Part D without penalty. COBRA does not count as employer coverage for this purpose.
Formulary
The list of prescription drugs a plan covers, organized into tiers. Each tier has a different cost. Formularies change every year, which is why annual plan reviews matter.
Benefit Period
For Part A hospital coverage, a benefit period starts when you are admitted and ends 60 days after discharge. Each new benefit period resets the $1,676 Part A deductible.

For the full list of terms, visit the insurance glossary.

Frequently Asked Questions About Medicare in South Carolina

Ready to Make Your Medicare Decision?

I help South Carolina residents compare every Medicare option available in their zip code. You get a personalized plan comparison using your doctors, your medications, and your budget. The consultation is free, and there is no obligation. Whether you are turning 65 next month or reviewing your coverage for next year, I can help.

Call Michelle at (843) 594-1759

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