Medicare in South Carolina: Plans and Coverage (2026)

Medicare in South Carolina runs on federal rules, but the state adds its own free counseling program, savings-program administration, and plan landscape that varies by region. This guide covers 2026 costs, South Carolina's own programs, and where to get free help.1

It walks through every part of Medicare for South Carolina residents: what each one covers, what it costs this year, how the state's savings programs work through SCDHHS, and how to reach I-CARE for free one-on-one counseling.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in South Carolina (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in South Carolina
• Help Paying for Medicare in South Carolina
• Medicare Enrollment Periods
• Free Medicare Help: I-CARE
• Frequently Asked Questions

About these numbers: Premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change annually. For current figures, contact Medicare at 1-800-633-4227 or reach South Carolina I-CARE through the South Carolina Department on Aging.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government. The structure and costs are identical in South Carolina and every other state.2

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health services.

The hospital deductible is per benefit period, not per year. A benefit period begins the day you're admitted and ends 60 days after you're discharged. If you're readmitted after that gap, the $1,736 deductible applies again.2

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services. It doesn't cover routine dental, vision, or hearing.2

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 for individuals or $218,000 for married couples, under the income-related monthly adjustment amount, or IRMAA)2
• Annual deductible: $2832
• After the deductible: you pay 20% of the Medicare-approved amount for most services2

Delaying Part B past your enrollment window without other creditable coverage triggers a late-enrollment penalty of 10% for every 12 months you could have had it, and that increase is permanent for as long as you keep Part B.6

Medicare Advantage in South Carolina (Part C)

Medicare Advantage plans bundle Part A and Part B coverage, usually with Part D drug coverage, into a single private plan. They must cover everything Original Medicare covers, except hospice, which Original Medicare continues to pay for. Most plans add dental, vision, and hearing benefits that Original Medicare doesn't offer.7

Plan availability varies considerably across South Carolina. The Charleston metro, Columbia metro, and Myrtle Beach area tend to have a wider selection of plans. Rural areas, including much of the Lowcountry and Upstate SC, typically have fewer options. What plans are available and at what cost changes each year by county, so the only reliable way to know what's at your address is to check the Medicare Plan Finder at medicare.gov.

How Medicare Advantage Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average MA plan premium at about $14 a month in 2026, and many plans charge $0 extra.2,7
• Most plans operate on a network (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling.
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.7
• Every plan must cap annual in-network out-of-pocket spending. The 2026 federal limit is $9,250; many plans set a lower cap. Original Medicare has no annual out-of-pocket limit.7

You can't use a Medigap policy alongside a Medicare Advantage plan. The two approaches are mutually exclusive.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or bundled into a Medicare Advantage plan.3

The old coverage gap (donut hole) was eliminated starting in 2025. Part D now has three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).8
2. Initial coverage: you pay copays or coinsurance while your plan and the manufacturer cover the rest.
3. Catastrophic: once your out-of-pocket spending hits $2,100, you pay $0 for covered drugs for the rest of the year.3

The $2,100 cap is the most significant change from previous years. Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into monthly installments across the calendar year instead of paying the full cost at the pharmacy.3 Standalone Part D premiums vary widely by plan; the 2026 national base beneficiary premium Medicare uses to set them is $38.99 a month.2

People who qualify for Extra Help pay significantly less, sometimes nothing.

Medigap in South Carolina

Medigap policies, sold by private insurers and regulated by the South Carolina Department of Insurance, fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

South Carolina follows the standard federal Medigap framework. Plans are labeled A through N, and their benefit packages are uniform across all carriers by plan letter.5 Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020, under the Medicare Access and CHIP Reauthorization Act of 2015.5

Plan G is the most popular choice for people newly eligible to Medicare. It covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing facility coinsurance; the only gap it leaves is the $283 annual Part B deductible.5,2

When to Buy

Your strongest opening is the federal Medigap Open Enrollment Period: the six months that begin when you're 65 and enrolled in Part B. During that window, any insurer must sell you any plan they offer at the standard rate, regardless of your health.5 Outside that window, South Carolina insurers may apply medical underwriting, which means they can review your health history, charge more, or decline you.

South Carolina does not have a Medigap birthday rule (which would otherwise let you switch plans once a year without underwriting). The state follows the standard federal rules.

Medigap or Medicare Advantage?

The two approaches suit different situations. With Medigap, you stay on Original Medicare and can see any provider nationwide who accepts Medicare, at a higher monthly premium. With Medicare Advantage, you trade some of that geographic freedom for a network and, often, a lower upfront cost. For a side-by-side comparison, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in South Carolina

Two programs can sharply reduce what you pay for Medicare if you have limited income and resources.

Medicare Savings Programs (QMB, SLMB, QI)

South Carolina administers the Medicare Savings Programs through SCDHHS, the state's Medicaid agency. The state uses the standard federal income tiers, not higher state-set limits.4

These income figures apply the standard $20 monthly disregard on top of the Federal Poverty Level bands SCDHHS publishes, and they update each April with the FPL.4

QMB is the most generous tier. It covers your Part B premium plus all Medicare deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.4 The 2026 resource limit for all three programs is $9,950 for one person and $14,910 for a couple.4

Apply through SCDHHS or ask an I-CARE counselor to help you with the application. Enrolling in any of the three programs automatically qualifies you for Extra Help with Part D.4

Extra Help for Part D

Extra Help, formally the Low-Income Subsidy, covers Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024, the partial-subsidy tier has been eliminated, so everyone who qualifies now gets the full benefit.9

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple9
• Resource limits: $16,590 for an individual, $33,100 for a married couple9
• Full Extra Help enrollees pay no more than $5.10 per generic and $12.65 per brand-name drug in 2026, and $0 once the $2,100 out-of-pocket cap is reached9,3

Apply through Social Security at ssa.gov or call 1-800-772-1213.9 If you already enrolled in QMB, SLMB, or QI, you're covered automatically.

Medicare Enrollment Periods

These dates are federal and identical in South Carolina and every other state. Miss a window and you can face coverage gaps or permanent penalties.10

Changes made during Annual Open Enrollment take effect January 1 of the following year.10 If you're already receiving Social Security before 65, you're automatically enrolled in Parts A and B and will receive your Medicare card by mail. If not, you sign up through the Social Security Administration.10

Working past 65 with employer group coverage lets you delay Part B without penalty. You get an 8-month Special Enrollment Period that begins the month your employment or employer coverage ends, whichever comes first. COBRA and retiree coverage don't count as current-employer coverage for this purpose.11

Free Medicare Help: I-CARE

You don't have to work through Medicare's options alone. South Carolina's State Health Insurance Assistance Program is I-CARE (Insurance Counseling Assistance and Referrals for Elders), run through the South Carolina Department on Aging (SCDOA) and delivered locally through Area Agencies on Aging.1

I-CARE counselors are trained, don't sell insurance, and provide free one-on-one help. They can assist with:

• Understanding what each part of Medicare covers
• Comparing Medicare Advantage, Part D, and Medigap plans
• Applying for Medicare Savings Programs and Extra Help
• Sorting out billing problems, denials, and appeals
• Explaining how retiree insurance coordinates with Medicare

Reach I-CARE through the South Carolina Department on Aging at aging.sc.gov or contact your local Area Agency on Aging directly. Counseling is free.1

Key South Carolina Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in South Carolina at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.