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 every year, and CMS announces the next year's figures each fall, so check medicare.gov for the current-year numbers.2 To reach a person, call Medicare at 1-800-633-4227 (TTY 1-877-486-2048), available 24 hours a day, 7 days a week except some federal holidays.7 For help making sense of the numbers in your own situation, reach South Carolina's SHIP counselors through the South Carolina Department on Aging.1

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 after 60 days in a row with no inpatient hospital or skilled nursing care. 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.2,8

• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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. Creditable coverage is the Part D test, not the Part B one, so a retiree drug plan alone will not spare you this.9

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.10

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. CMS also notes that some plans may help pay all or part of your Part B premium itself.2,10
• Most plans operate on a network (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling.
• Plans may require prior authorization (the plan's advance approval) for certain services, which Original Medicare generally does not.10
• 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 such cap: CMS says there is no yearly limit on what you pay out of pocket unless you have supplemental coverage such as Medigap, Medicaid, employer, retiree, or union coverage.10

You can't use a Medigap policy alongside a Medicare Advantage plan. The two approaches are mutually exclusive in any given year, but the choice isn't locked in forever. If this is your first Medicare Advantage plan and you aren't happy with it, federal law gives you a trial right to buy a Medigap policy and a separate drug plan as long as you return to Original Medicare within 12 months of joining; if you dropped a Medigap policy to join, you may be able to get that same policy back if the company still sells it, or another policy sold by a South Carolina insurer if it doesn't. Wait past that window and in most cases you can't get the old policy back, and you may not be able to get any Medigap policy.10

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).11
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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.10

South Carolina follows the standard federal Medigap framework. Plans are labeled A-D, F, G, and K-N, and their benefit packages are uniform across all carriers by plan letter.6 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 still open to people newly eligible to Medicare, and it matches Plan F's benefits except for the Part B deductible. 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.6,2

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. One limit still applies: an insurer may decline to cover your out-of-pocket costs for a pre-existing condition for up to six months, unless you had at least six months of continuous prior creditable coverage.6 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. SCDHHS publishes the same income bands SSA publishes federally, matching the standards for all states except Alaska and Hawaii, and it publishes a resource limit for all three programs, so a resource test applies here.4

These figures add the $20 monthly general income exclusion to the Federal Poverty Level bands SCDHHS publishes. SCDHHS's own QMB figures, effective 03/01/2026, are $1,330 for an individual and $1,804 for a couple, exactly $20 lower, and its QMB resource figures carry an effective date of 01/01/2026.4

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 For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple, and SCDHHS words the test as having countable resources below the limit, not everything you own. Neither SCDHHS nor SSA lists which resources count on the pages carrying these figures, so ask SCDHHS rather than assuming your home or your car puts you over.4 Those income and resource figures are not absolute cutoffs: states can disregard certain income and resources, so apply rather than rule yourself out if you are somewhat over. QI also has to be reapplied for every year.4

Apply to SCDHHS online, by mail to SCDHHS-Central Mail in Columbia, or at a local county office.4 An I-CARE counselor can help you with the application.1 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D; QDWI, the fourth savings program, does not.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. The premium help runs up to your service area's regional benchmark premium, so a plan priced above the benchmark leaves you owing the difference. Since 2024, the partial-subsidy tier has been eliminated, so everyone who qualifies now gets the full benefit.12

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii limits run higher)12
• Resource limits: $16,590 for an individual, $33,100 for a married couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses12
• 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 reached, a total that counts certain payments made on your behalf through Extra Help and not just your own copays; $5.10 and $12.65 are the ceiling, and full-benefit dual eligibles at or below 100% of the poverty level pay $1.60 and $4.90, or $0 if they are institutionalized or receiving home and community-based services12,3

Apply through Social Security at ssa.gov12 or call 1-800-772-1213 (TTY 1-800-325-0778).13 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.14

Changes made during Annual Open Enrollment take effect January 1 of the following year.14 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.14

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, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).15

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. One thing to expect: the SCDOA website lists the program simply as the State Health Insurance Assistance Program, so don't be thrown if you land there and don't see the I-CARE name.1

Counseling is free and one-on-one, and it's open to Medicare beneficiaries, their families, and their caregivers. The national SHIP program describes its counseling as objective.1 Counselors 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 by calling the South Carolina Department on Aging at 1-800-868-9095, online at aging.sc.gov, or by contacting 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.