Medicare Advantage vs. Medigap in South Carolina: 2027 Comparison

Medicare Advantage replaces Original Medicare with a private plan that usually has a provider network, copays, a low or $0 premium and an annual out-of-pocket limit of no more than $9,850 in-network for 2027. Medigap (Medicare Supplement) works alongside Original Medicare, so you can see any provider in the country that accepts Medicare. You pay a monthly premium for the Medigap policy and buy a separate Part D drug plan. In South Carolina, the biggest practical difference is timing: after your first Medigap enrollment window, insurers can ask health questions, so switching from Medicare Advantage to Medigap later isn't guaranteed.

Most Medicare Advantage plans use a network. With an HMO, you generally need to use in-network providers except in emergencies. A PPO lets you go out of network, usually at a higher cost. Many plans require referrals to see specialists, and many require prior authorization for some services.

That works well if your doctors are in the network and you don't expect that to change. It's harder if you split care between systems, such as a primary care doctor near Irmo and a specialist at MUSC in Charleston. Check every provider against the specific plan for the 2027 plan year. Our guide to Medicare Advantage plans that include Prisma Health and MUSC can help.

Choice also varies by county. In MoneyGeek's analysis of CMS 2027 data, five carriers offer Medicare Advantage plans in Richland and Lexington counties, while all eight South Carolina carriers sell in Charleston County.

With Medigap, there's no network. If a doctor or hospital accepts Medicare, your Medigap policy pays its share. People with complex conditions, or who want access to out-of-state specialists, often choose Medigap for that reason.

Medicare Advantage

Every Medicare Advantage plan must cap your yearly in-network costs for covered medical services. For 2027, the federal limit is $9,850 in-network. For PPOs, the combined in- and out-of-network limit is $14,800. Plans can set lower limits. MoneyGeek found South Carolina Medicare Advantage plans range from $5,900 to $9,850 in-network, with a median of $9,250.

Premiums are low. About 89% of South Carolina's non-special-needs Medicare Advantage plans charge a $0 premium for 2027, per MoneyGeek. You pay as you use care, through copays and coinsurance, up to the MOOP. In a healthy year, total costs can be very low. In a year with surgery or cancer treatment, you could reach the limit. See $0 premium Medicare Advantage plans in South Carolina for more.

Original Medicare with Medigap

Original Medicare on its own has no yearly out-of-pocket limit. Medigap fills that gap. With Plan G, you generally pay only the Part B deductible for covered services after Medicare pays its share. Plan N costs less, but you pay up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission.

There's also a high-deductible version of Plan G. For 2027, its deductible is $3,050, per CMS.

If you first became eligible for Medicare on or after January 1, 2020, you can't buy Plan C or Plan F. Our Medigap Plan G guide covers costs and shopping tips.

Most Medicare Advantage plans include Part D drug coverage. With Medigap, you add a stand-alone Part D plan. Either way, the 2027 Part D rules are the same: the out-of-pocket cap on covered drugs is $2,400 and the maximum standard deductible is $700. See our 2027 Part D changes guide.

• Medigap: You can use any provider in the U.S. that accepts Medicare. Plans C, D, F, G, M and N also cover 80% of emergency care during foreign travel, up to plan limits.
• Medicare Advantage: Emergency care is covered away from home, but routine care outside your area depends on the plan. An HMO may cover little or no non-emergency care outside its network. Some PPOs offer out-of-network or travel benefits. Read the plan's Evidence of Coverage before you assume.

Your Medigap Open Enrollment Period is six months long and starts the month you're 65 or older and enrolled in Part B. During that window, a Medigap insurer must sell you any policy it offers, regardless of your health.

After that window, insurers can generally use medical underwriting. They can ask health questions, charge more or decline you. A few states, such as Connecticut, Maine, Massachusetts and New York, give residents broader rights to buy Medigap later. South Carolina isn't one of them.

Guaranteed-issue rights apply in certain situations, generally within 63 days after you lose other coverage. Examples include:

• Your Medicare Advantage plan leaves your area or stops offering coverage. That applies to members affected by Elevance (Wellpoint) leaving SC Medicare Advantage.
• You lose employer coverage that paid after Medicare.
• You move out of your plan's service area.

Trial rights give you a 12-month do-over. If you joined Medicare Advantage when you first became eligible at 65, or dropped a Medigap policy to try Medicare Advantage for the first time, you can generally return to Medigap without health questions if you leave within the first 12 months.

Under 65 on Medicare due to disability? The South Carolina Department of Insurance notes you may not be able to buy a Medigap policy. Talk with us or I-CARE about your options.

If you think you'll want Medigap, buy it when you're first eligible. Moving from Medicare Advantage to Medigap years later may not be possible if your health has changed. If you're approaching 65, see our turning 65 timeline.

Medicare Advantage often fits people who:

• Want low or $0 monthly premiums
• Have doctors in a local network and stay close to home
• Like extras such as dental, vision and hearing in one plan
• Are comfortable with copays and a yearly cap

Medigap often fits people who:

• Want to see any Medicare provider without referrals
• Travel or split time between states
• Prefer predictable costs and can budget for a higher monthly premium
• Are in their Medigap Open Enrollment Period or have a guaranteed-issue right

We help clients compare both, and our help costs nothing because carriers pay us.