Medicare in South Carolina: A practical, coverage‑facts guide for 2026

You are not the first South Carolinian to ask, “Will this actually cover me?” Two decisions drive almost everything else: whether you stay on Original Medicare with a Medigap and Part D plan, or move to a Medicare Advantage HMO or PPO. The prices, the bills you’ll see, and even which hospitals you can use in Columbia, Greenville, or the Lowcountry change based on that choice. Below is the plain‑English, South Carolina‑specific version of how it really works in 2026, with the exact places to call or visit when you need a straight answer fast.

What you pay in 2026, and who sends the bills here

Medicare is federal, so your baseline costs match your neighbors in Charlotte or Savannah. In 2026, the standard Part B premium is $202.90 per month and the Part B annual deductible is $283. Part A’s inpatient hospital deductible is $1,736 per benefit period. If you enroll in a standalone drug plan, the defined standard Part D deductible is $615, and your out‑of‑pocket costs for covered Part D drugs stop for the year once you hit the $2,100 annual threshold. After that point, covered Part D prescriptions are $0 for the rest of the calendar year.

If you need help sorting which bill came from where, start with South Carolina’s free SHIP program, branded locally as I‑CARE. The statewide I‑CARE number is 1‑800‑868‑9095, staffed Monday–Friday, 8:30 a.m.–5:00 p.m. Their office is at 1301 Gervais St., Suite 350, Columbia, SC 29201. This is unbiased counseling. No sales, no commissions, just answers.

When your question is about Medicaid paying some or all of your Medicare costs, call the Healthy Connections Member Contact Center at 1‑888‑549‑0820, open Monday–Friday, 8:00 a.m.–6:00 p.m. That is the South Carolina Department of Health and Human Services (SCDHHS), which runs the state’s Medicare Savings Programs and dual‑eligibility coordination.

If what you need is to enroll in Medicare itself or fix a Part B premium issue, Social Security remains the front door. The National 800 Number is 1‑800‑772‑1213, with live agents Monday–Friday, 8:00 a.m.–7:00 p.m. local time. Automated help runs 24/7. For in‑person matters in the Midlands, the Columbia field office is in the Strom Thurmond Federal Building at 1835 Assembly St., 11th Floor, Columbia, SC 29201.

Have a dispute with an insurer or broker? The South Carolina Department of Insurance, Office of Consumer Services takes Medicare‑related complaints that involve sales conduct or Medigap marketing. You can reach a consumer analyst at 803‑737‑6180 or toll‑free 1‑800‑768‑3467, Monday–Friday, 8:30 a.m.–5:00 p.m. The office is downtown at 1201 Main St., Suite 1000, Columbia, SC 29201.

Two common ways South Carolinians set up coverage, side by side

Most people here land in one of these setups. Use this to match what you want to pay each month with how you want to see doctors and fill prescriptions.

Approach	What you carry	Typical costs you’ll see in 2026	Doctor/hospital access in SC	Who it often suits
Original Medicare + Medigap + Part D	Medicare Parts A and B, a Medigap plan (like G or N), plus a standalone Part D drug plan	Monthly: $202.90 Part B premium, plus your Medigap premium and your Part D premium. Annual deductibles: $283 for Part B and up to $615 for Part D (plan rules vary). Very low out‑of‑pocket for Part B services after Medigap pays.	Any provider nationwide that takes Medicare, including large South Carolina systems such as Prisma Health and MUSC, without network referrals. Pharmacies depend on your Part D plan’s network.	People who travel, split time across states, or want predictable costs when seeing specialists without network rules.
Medicare Advantage (HMO or PPO)	Part C plan that replaces A and B and usually includes drug coverage	Monthly: many SC counties have $0 premium plans on top of Part B. Copays at the point of care, a plan‑set medical out‑of‑pocket maximum, and no drug costs after $2,100 total Part D out‑of‑pocket for the year.	Use the plan’s network. Before enrolling, call your doctor’s office and your hospital of choice in your county to confirm in‑network status. For example, check whether your specific Prisma Health clinic in Greenville or your MUSC practice in Charleston is listed under that exact plan’s network.	People who want consolidated ID cards and are comfortable with HMO or PPO rules in exchange for lower monthly premiums and extras like dental or vision.

Need a neutral walkthrough of those tradeoffs? In the Midlands, the Central Midlands Area Agency on Aging provides I‑CARE counseling by appointment at 220 Stoneridge Dr., Suite 350, Columbia, SC 29210. Call 803‑376‑5390 (ask for I‑CARE; extensions vary by counselor). Upstate residents can reach the Appalachian Council of Governments AAA at 864‑242‑9733, open Monday–Friday, 8:00 a.m.–5:00 p.m., at 30 Century Circle, Greenville, SC 29607.

One other South Carolina‑specific signal when comparing plans: in 2026, $0‑premium Medicare Advantage plans are available statewide. That does not make them universally “cheaper,” because network and copay math still apply, but it does mean most residents can compare at least one HMO or PPO with no added monthly premium beyond Part B.

Medigap in South Carolina: timing, rights, and the under‑65 reality

Your one guaranteed, no‑underwriting window for Medigap starts the month you are both 65+ and enrolled in Part B and runs for six months. In that window, a Medigap insurer cannot decline you for health reasons and cannot charge more due to your health history. Outside of that window, companies can ask health questions and can decline or rate up applications.

South Carolina follows the federal baseline on “trial rights” and other guaranteed‑issue protections. If you first tried a Medicare Advantage plan at age 65 and decide within 12 months to return to Original Medicare, you can buy certain Medigap plans with guaranteed issue. If your MAPD or employer coverage ends, you generally have 63 days to use guaranteed‑issue protections to pick a Medigap policy allowed in those scenarios.

For residents who qualify for Medicare before 65 due to disability, availability is more limited. Some South Carolina insurers offer Medigap to people under 65, but not all do, and premiums can be higher. The state’s 2026 Medicare Supplement Shoppers Guide clarifies that if you are under 65 you may buy only from insurers that sell Medigap to under‑65 Medicare beneficiaries in South Carolina.

Where to check and file a complaint if a Medigap application goes sideways: the South Carolina Department of Insurance, 1201 Main St., Suite 1000, Columbia, SC 29201. Consumer Services is available at 803‑737‑6180 or 1‑800‑768‑3467, Monday–Friday, 8:30 a.m.–5:00 p.m. Have the denial letter or agent name handy. If you want help deciding whether your situation qualifies for a guaranteed‑issue event, call I‑CARE at 1‑800‑868‑9095 during the same weekday hours.

If you have limited income or both Medicare and Medicaid: who helps in South Carolina

Many South Carolinians qualify for help with the Part B premium and drug costs. The Medicare Savings Programs and Extra Help are run here by Healthy Connections at SCDHHS. If you think you could qualify, call the Member Contact Center at 1‑888‑549‑0820, open Monday–Friday, 8:00 a.m.–6:00 p.m., and ask about QMB, SLMB, or QI for your household size. If you prefer guided application support over the phone, SC Thrive takes calls at 1‑800‑726‑8774, Monday–Friday, 8:30 a.m.–5:00 p.m.

If you have both Medicare and Medicaid and want one card to manage both, you may see Dual‑Eligible Medicare Advantage plans in your county with $0 monthly premiums. Enrollment counseling for dual plans is available through I‑CARE at 1‑800‑868‑9095 during 8:30 a.m.–5:00 p.m. weekdays.

For people meeting nursing home level of care who want to live at home, South Carolina also operates PACE, the Program of All‑Inclusive Care for the Elderly. If you qualify for Medicaid, your PACE long‑term‑care premium is typically $0. Prisma Health operates two centers you can call directly: Prisma Health SeniorCare PACE – Upstate, 32 Centennial Way, Greenville, SC 29605, phone 864‑522‑1950; and Prisma Health SeniorCare PACE – Laurel, 1308 Laurel St., Columbia, SC 29201, phone 803‑931‑8166. I‑CARE counselors can explain eligibility and whether your county is in a PACE service area.

If you are choosing or changing a Medicaid managed care plan, the state’s enrollment broker, Healthy Connections Choices, is available at 1‑877‑552‑4642, Monday–Friday, 8:00 a.m.–6:00 p.m. They can confirm which plans coordinate with your Medicare coverage in your county.

South Carolina retirees on the State Health Plan: how Medicare fits

If you retired from a South Carolina public agency and have PEBA retiree group coverage, Medicare coordinates differently than it does with a private retiree plan. PEBA states that when a retiree or a covered dependent becomes eligible for Medicare, PEBA will automatically enroll the Medicare‑eligible member in the State Health Plan’s SilverScript Part D program. If you prefer a different PEBA‑sponsored option when you gain Medicare Part A, you must notify PEBA within 31 days. PEBA’s website has the 2026 Insurance Benefits Guide and Medicare handbook, but for a person‑to‑person answer, start with I‑CARE at 1‑800‑868‑9095 during 8:30 a.m.–5:00 p.m. weekdays, or call PEBA using the phone number on your retiree ID card.

If you are still actively working in a benefits‑eligible state job after turning 65, the State Health Plan generally remains primary and Medicare can be secondary. Deferring Part B while you are still actively employed is common in that scenario. When you finally leave active employment, Social Security can open a Special Enrollment Period to start Part B without the lifetime penalty. For SEP timing, call Social Security at 1‑800‑772‑1213, 8:00 a.m.–7:00 p.m. weekdays.

Enrollment windows that apply here, with where to go today

Annual shopping windows

Every fall, the Medicare Open Enrollment Period runs October 15–December 7. That is when you can switch between Medicare Advantage and Original Medicare with Part D, or change Part D plans for a January 1 start. Medicare Advantage has a second window, the January 1–March 31 Open Enrollment Period, which allows one switch between Medicare Advantage plans or a move from Medicare Advantage back to Original Medicare with Part D.

For people new to Part B at 65, your Medigap six‑month window begins the first month you’re 65+ and on Part B. If you miss it, you can still apply later, but South Carolina insurers can use medical underwriting outside of guaranteed‑issue situations.

Local help, with hours

Pick up the phone and you can usually get an answer the same day:

I‑CARE (South Carolina SHIP): 1‑800‑868‑9095, Mon–Fri, 8:30 a.m.–5:00 p.m., 1301 Gervais St., Suite 350, Columbia, SC 29201.
SCDHHS Healthy Connections Member Contact Center: 1‑888‑549‑0820, Mon–Fri, 8:00 a.m.–6:00 p.m..
South Carolina Department of Insurance, Consumer Services: 803‑737‑6180 or 1‑800‑768‑3467, Mon–Fri, 8:30 a.m.–5:00 p.m., 1201 Main St., Suite 1000, Columbia, SC 29201.
SC Thrive Customer Service Center: 1‑800‑726‑8774, Mon–Fri, 8:30 a.m.–5:00 p.m. (application help for Medicaid and other programs).
Social Security (national): 1‑800‑772‑1213, live help Mon–Fri, 8:00 a.m.–7:00 p.m..

Prefer an in‑person discussion? In the Midlands, book I‑CARE counseling at the Central Midlands Area Agency on Aging, 220 Stoneridge Dr., Suite 350, Columbia, SC 29210, 803‑376‑5390. In the Upstate, the Appalachian Council of Governments AAA, 30 Century Circle, Greenville, SC 29607, answers weekdays at 864‑242‑9733.

To quickly narrow your own choice, list your top three doctors and your preferred hospital. If those names are critical, call their offices and ask which Medicare Advantage plan names they accept in 2026. If you want to avoid networks entirely, confirm you can get a Medigap issued at your age and health status. Those two calls decide the path for most people here.

Key things to know before you pick

2026 costs: Part B premium $202.90, Part B deductible $283, Part A hospital deductible $1,736, standard Part D deductible $615, and a Part D out‑of‑pocket cap at $2,100 for the year.
I‑CARE is unbiased and local. Call 1‑800‑868‑9095, Mon–Fri, 8:30 a.m.–5:00 p.m., or visit 1301 Gervais St., Suite 350, Columbia.
Medigap timing matters. Your one six‑month guaranteed window starts the month you’re 65+ and on Part B. Under 65 buyers have fewer insurer options in South Carolina.
$0‑premium Medicare Advantage exists statewide. Still verify your doctors and hospitals are in‑network for the exact plan and county.
Need help paying Part B? Call Healthy Connections at 1‑888‑549‑0820, Mon–Fri, 8:00 a.m.–6:00 p.m., to check Medicare Savings Program eligibility.
PACE can keep you at home. If you meet nursing home level of care, call Prisma Health SeniorCare PACE in Greenville at 864‑522‑1950 or Columbia at 803‑931‑8166. Medicaid‑eligible participants typically pay $0 for the PACE long‑term‑care premium.
State retirees (PEBA): Medicare‑eligible members are automatically enrolled in the State Health Plan’s SilverScript Part D. You have 31 days to request a different PEBA option when you gain Part A.
To file a complaint: South Carolina Department of Insurance Consumer Services, 803‑737‑6180 or 1‑800‑768‑3467, Mon–Fri, 8:30 a.m.–5:00 p.m., 1201 Main St., Suite 1000, Columbia.

Reader Q&A

My doctors are at Prisma Health in Greenville. Can I use a $0‑premium Medicare Advantage plan and still see them?

Possibly. In 2026, $0‑premium Medicare Advantage plans are available statewide, but each plan has its own network. Before enrolling, call your Prisma Health clinic and ask about the exact plan’s network for your county. If you want to avoid networks altogether, Original Medicare with a Medigap policy lets you see any provider that accepts Medicare.

I got Medicare before 65 due to disability. Can I buy a Medigap in South Carolina?

Some insurers in South Carolina sell Medigap to under‑65 beneficiaries, but not all. Prices can be higher and choices fewer. If you are turning 65 soon, a new six‑month no‑underwriting window opens then. I‑CARE at 1‑800‑868‑9095 can tell you which companies currently accept under‑65 applicants.

If I qualify for Medicaid, how much would PACE cost me?

If you have both Medicare and Medicaid and enroll in PACE, the long‑term‑care portion of the PACE premium is typically $0. Prisma Health SeniorCare PACE in Greenville (864‑522‑1950) and Columbia (803‑931‑8166) can confirm county eligibility and enrollment steps.

I’m a South Carolina state retiree. Do I need to shop for a Part D plan?

PEBA automatically enrolls Medicare‑eligible State Health Plan retirees in SilverScript Part D. If you prefer a different PEBA‑sponsored option, you have 31 days from gaining Part A to request it. For questions, call I‑CARE at 1‑800‑868‑9095 or contact PEBA using the number on your retiree card.

Published: September 8, 2026

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