Medicare in South Carolina: Quick Facts
| Medicare Beneficiaries | 1,120,000 |
|---|---|
| Medicare Advantage Plans Available | 36 |
| Average MA Plan Premium | $7.20/month average premium |
| Average MA Star Rating | 3.8 / 5.0 stars |
| Part D Plans Available | 23 |
| Average Medigap Plan G Premium | $118/month |
| Medicaid Expansion Status | Not Expanded |
| Medicaid Nursing Home Income Limit | $2,982/month |
Medicare Options in South Carolina
South Carolina residents on Medicare have three primary coverage paths: Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Supplement (Medigap) insurance paired with a Part D prescription drug plan. With 1,120,000 Medicare beneficiaries, South Carolina is one of the larger Medicare markets, which means strong plan competition and generally lower premiums.
Medicare Advantage in South Carolina
South Carolina has 36 Medicare Advantage plans available, with an average star rating of 3.8 out of 5.0. The average monthly premium across all MA plans in the state is $7.20/month average premium. Medicare Advantage plans in South Carolina typically include prescription drug coverage, dental, vision, and hearing benefits not available through Original Medicare.
2026 Medicare Advantage Star Ratings in South Carolina
CMS rates Medicare Advantage plans on a 1–5 star scale based on quality measures including preventive care, managing chronic conditions, member experience, and customer service. Plans rated 4 stars or higher receive bonus payments from CMS, which they typically pass on to members through lower premiums or enhanced benefits. The average MA plan star rating in South Carolina is 3.8 stars.
| Star Rating | What It Means | Bonus Payments |
|---|---|---|
| 5 Stars | Excellent — top-performing plan | Yes — highest bonus |
| 4.5 Stars | Above average quality | Yes |
| 4 Stars | Good quality | Yes |
| 3.5 Stars | Average quality | No |
| 3 Stars or below | Below average — consider switching | No |
Medicare Part D in South Carolina
South Carolina has 23 standalone Part D prescription drug plans available. In 2026, the maximum out-of-pocket cap for Part D drugs is $2,100 — a major change from prior years that eliminates catastrophic drug costs. The maximum Part D deductible is $615.
2026 Part D Key Numbers for South Carolina Residents
| 2026 Part D Limit | Amount |
|---|---|
| Out-of-pocket maximum | $2,100/year |
| Maximum deductible | $615/year |
| National base beneficiary premium | $38.99/month |
| Late enrollment penalty (per month uncovered) | 1% × $38.99 |
| Coverage gap (“donut hole”) | Eliminated as of 2025 |
Medicare Supplement (Medigap) in South Carolina
Medigap Plan G is the most popular Medicare Supplement plan in South Carolina, with an average monthly premium of $118. Plan G covers the Part A deductible ($1676 in 2026), Part B coinsurance (20% of all covered services), skilled nursing facility coinsurance, and foreign travel emergency coverage. The only cost Plan G does not cover is the Part B deductible ($240 in 2026).
Medigap Plan Comparison for South Carolina
| Plan | Part A Deductible | Part B Coinsurance | SNF Coinsurance | Estimated Monthly Premium |
|---|---|---|---|---|
| Plan G (most popular) | Covered | Covered | Covered | $118/month |
| Plan N | Covered | Covered (with copays) | Covered | $97/month |
| Plan F (pre-2020 enrollees only) | Covered | Covered | Covered | $136/month |
| Plan K (high-deductible) | 50% covered | 50% covered | 50% covered | $53/month |
Medicaid in South Carolina
South Carolina has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 67% FPL ($18,304/year for a family of three) may qualify.
Medicaid Income Limits in South Carolina (2026)
| Medicaid Program | Income Limit (Single) | Notes |
|---|---|---|
| Nursing Home / Institutional Medicaid | $2,982/month | Nearly all income goes toward cost of care |
| HCBS Waiver (home-based care) | $2,982/month | Recipient keeps income for living expenses |
| Regular Medicaid (Aged, Blind, Disabled) | $994/month | For seniors and disabled individuals |
Medicare Savings Programs in South Carolina
Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries pay their premiums, deductibles, and copays. South Carolina residents may qualify for one of four programs based on income:
| Program | Individual Income Limit | Couple Income Limit | Benefit |
|---|---|---|---|
| QMB (Qualified Medicare Beneficiary) | $1,255/month | $1,704/month | Pays Part A and B premiums, deductibles, and copays |
| SLMB (Specified Low-Income MB) | $1,478/month | $1,992/month | Pays Part B premium only |
| QI (Qualifying Individual) | $1,660/month | $2,239/month | Pays Part B premium only, limited slots |
| QDWI (Qualified Disabled Working) | $4,945/month | $6,659/month | Pays Part A premium for working disabled under 65 |
SSDI Recipients and Medicare in South Carolina
Social Security Disability Insurance (SSDI) recipients in South Carolina automatically become eligible for Medicare after a 24-month waiting period from their disability onset date. This means that if you were approved for SSDI in South Carolina, your Medicare coverage begins in month 25 of your disability. During the 24-month waiting period, South Carolina residents may qualify for Medicaid to bridge the coverage gap.
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