South Carolina has a growing Medicare Advantage market with 95 plans available statewide in 2026. About 564,000 of the state's 1.23 million Medicare beneficiaries are enrolled in an MA plan, a 46% penetration rate that closely tracks the national average. Competition from eight or more carriers keeps the average monthly premium around $8, well below the national MA average of $14. Most counties have 40 to 55 plans to choose from, and all 46 counties have at least one MA plan available.
BlueCross BlueShield of South Carolina (marketed as BlueCross MedAdvantage) offers the best-known local brand, with three PPO plans serving 30 counties. Humana leads on plan count with 13 options — confirm your physicians are in the plan's network before enrolling and the lowest average premium ($5/mo). Aetna and HealthSpring (the rebranded Medicare line of HCSC, which acquired Cigna's Medicare business in March 2025) both carry strong Star Ratings in the state. Devoted Health and Clover Health have entered the SC market with $0-premium options. Notably, Kaiser Permanente does not serve South Carolina.
A state-specific development for 2026: South Carolina's Healthy Connections Prime program (the state's Medicare-Medicaid managed care plan) ended as of January 1, 2026. Former Prime members now use Dual Special Needs Plans (D-SNPs) to coordinate their Medicare and Healthy Connections Medicaid benefits. If you qualify for both Medicare and Medicaid, a D-SNP may be your best option. The SC Department of Health and Human Services manages this transition and has aligned D-SNP plans from Humana, WellCare, Aetna, Molina, UnitedHealthcare, and others to fill that role.
2026 Medicare Advantage Market Overview in South Carolina
In 2026, South Carolina has 95 Medicare Advantage plans available, with 564,000 beneficiaries enrolled (46% MA penetration). The average monthly premium is $8 and the statewide average Star Rating is 3.9.
Top Medicare Advantage carriers in South Carolina (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 13 | 3.8 | $5/mo |
| Aetna | 7 | 4.5 | $18/mo |
| WellCare | 5 | 4.0 | $30/mo |
| HealthSpring | 4 | 4.0 | $7/mo |
| BlueCross BlueShield of South Carolina | 3 | 3.5 | $10/mo |
| UnitedHealthcare | 3 | 4.5 | $23/mo |
| Devoted Health | 2 | 4.5 | $0/mo |
| Clover Health | 2 | 3.5 | $0/mo |
Source: CMS Medicare Plan Finder Q4 2025; moneygeek.com 2026 SC MA analysis; healthinsurance.org SC enrollment data (CMS September 2024); medicareadvantage.com SC 2026 plan data
Plan Types in South Carolina: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in South Carolina| Plan Type | Approx Plans | Avg Premium | Best For |
|---|
| PPO | 40 | $18/mo | Flexibility to see out-of-network providers; ideal for retirees who travel |
| HMO / HMO-POS | 29 | $5/mo | Lower premiums; use in-network providers; HMO-POS allows some out-of-network at higher cost |
| Special Needs Plan (SNP) | 26 | $0/mo | Dual-eligible (Healthy Connections Medicaid + Medicare), chronic conditions, institutional care |
PPO plans are more common in SC than the national average, partly because BlueCross BlueShield of SC offers PPO-only options and Devoted Health and UHC also favor PPO structures. SNP count includes D-SNPs, C-SNPs, and I-SNPs.
Source: CMS Medicare Plan Finder Q4 2025; medicare.org SC SNP guide 2026; medicareadvantage.com SC plan breakdown
County-Level Variance in South Carolina
Plan availability across South Carolina's 46 counties is more consistent than in large states, but meaningful differences still exist between metro counties and rural inland counties. Urban counties like Richland (Columbia) and Charleston typically offer 47-54 plans, while rural counties in the Pee Dee and Lowcountry regions may have 30-40 plans. Premium averages also vary by 15-20% across counties.
Plan count and average premium by county in South Carolina| County | Plans Available | Avg Premium |
|---|
| Greenville County | 51 | $16/mo |
| Charleston County | 54 | $35/mo |
| Richland County | 47 | $18/mo |
| Horry County | 48 | $22/mo |
| Allendale County | 48 | $37/mo |
Plan counts and premiums are from CMS Medicare Plan Finder Q4 2025 and medicareadvantage.com county data. Run a ZIP-code search at medicare.gov to see exact plans for your location.
Source: CMS Medicare Plan Finder Q4 2025; medicareadvantage.com county-level plan data
What to Look For in a Medicare Advantage Plan in South Carolina
Picking a Medicare Advantage plan in South Carolina is not just about premium. Here is what matters for shopping in 2026:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital are all in-network before enrolling. PPO plans offer more flexibility to see out-of-network providers at higher cost; HMOs typically require a referral and restrict you to the network.
- Prescription drug coverage (formulary). Most SC Medicare Advantage plans include Part D. Check that your specific medications are on the plan's formulary at the tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans.
- Star Ratings. CMS rates plans 1 to 5 stars annually on quality of care and member experience. Plans with 4 or more stars receive bonus payments that often fund richer benefits. In SC, Aetna, UnitedHealthcare, and Devoted Health hold 4.5-star ratings; WellCare and HealthSpring are at 4.0 stars.
- Supplemental benefits (dental, vision, hearing, OTC, fitness). Most SC plans include some dental and vision coverage; comprehensive benefits like hearing aids, OTC allowances ($50-$150/mo), and fitness programs vary by plan. Compare the Evidence of Coverage for annual limits.
- Maximum out-of-pocket (MOOP). The 2026 federal MA in-network MOOP ceiling is $9,250 (down $100 from $9,350 in 2025). SC plans typically set MOOP at $5,900 to $8,500. Original Medicare has no MOOP, which is a significant financial risk for people with serious illness.
- Prior authorization requirements. MA plans can require prior authorization for certain surgeries, advanced imaging, and specialist referrals. If you have a chronic condition or expect significant care, check the plan's prior authorization policies before enrolling. CMS publishes denial rate data for each plan.
Key Medicare Dates in South Carolina
Medicare and Medicare Advantage have several enrollment windows. Missing them can result in delays or gaps in coverage.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you are already enrolled in an MA plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original Medicare plus Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for Healthy Connections Medicaid (dual eligible), or other life events. Typically a 2-3 month window.
Notable Extras in South Carolina Plans
South Carolina Medicare Advantage plans have several state-specific features worth knowing about for 2026:
- Healthy Connections Prime ended; D-SNPs are now the path for dual eligibles: South Carolina's Healthy Connections Prime program, which coordinated Medicare and Medicaid benefits for dual-eligible members, ended on January 1, 2026. Former Prime members are now expected to use Dual Special Needs Plans (D-SNPs). The SC DHHS has contracted with multiple carriers (Humana, WellCare, Aetna, Molina, UnitedHealthcare) to offer D-SNPs that align with Healthy Connections Medicaid. If you were in Healthy Connections Prime, verify which D-SNP coordinates with your Medicaid plan.
- South Carolina has not expanded Medicaid: South Carolina is one of the remaining states that has not expanded Medicaid under the Affordable Care Act. This means the income threshold for Healthy Connections Medicaid is lower than in expansion states. Medicare beneficiaries who have low incomes may not automatically qualify for Medicaid-based D-SNPs and should check Healthy Connections eligibility carefully.
- HealthSpring rebrand (formerly Cigna Healthcare Medicare): As of January 1, 2026, what was formerly Cigna Healthcare's Medicare line is now called HealthSpring, following HCSC's acquisition of Cigna's Medicare business in March 2025. If you were enrolled in a Cigna Medicare Advantage plan in SC, your plan ID card and plan documents now say HealthSpring. Benefits and networks carry over; contact HealthSpring at 1-800-MEDICARE or HealthSpring.com for questions.
Medicare Advantage vs Original Medicare in South Carolina
Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives you nationwide provider access and no prior authorization for most services. But the monthly premium for Medigap plus Part D in South Carolina typically runs $150 to $350 per month depending on the Medigap plan you choose, your age, and your ZIP code. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into one plan with average premiums of about $8 per month statewide, but require you to use a defined network and may require prior authorization for some services.
If you spend significant time outside South Carolina (snowbirds, frequent travelers), Original Medicare plus Medigap is typically the better fit since coverage works nationwide with any Medicare-accepting provider. If you stay primarily in SC and want lower premiums plus extras like dental, vision, and hearing, Medicare Advantage generally offers better total value for healthy beneficiaries.
Medicare Advantage vs Original Medicare in South Carolina detail| Feature | Medicare Advantage (SC avg) | Original Medicare + Medigap |
|---|
| Monthly premium | ~$8/mo | ~$203 Part B + $150-$350 Medigap + ~$40 Part D |
| Annual MOOP | $5,900 - $9,250 (plan-specific) | None (unlimited exposure) |
| Provider access | In-network (HMO) or in/out-of-network (PPO) | Any Medicare-accepting provider nationwide |
| Extra benefits | Dental, vision, hearing, OTC, fitness (varies by plan) | Not included (buy separate coverage) |
| Prior authorization | Required for some services | Generally not required |
2026 standard Part B premium is $202.90/mo. Part A inpatient deductible is $1,736. Part D annual OOP cap is $2,100.
Source: CMS 2026 Medicare costs fact sheet
How Star Ratings work and what they mean for South Carolina shoppers
CMS publishes Medicare Advantage Star Ratings every October, rating plans 1 to 5 stars on roughly 40 quality measures: management of chronic conditions, customer service, member complaints, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS, which plan sponsors often reinvest as richer benefits the following plan year. The national weighted-average Star Rating dropped to 3.65 for 2026, after several years of inflation in ratings.
In South Carolina for 2026, the highest-rated carriers are Aetna, UnitedHealthcare, and Devoted Health (all at 4.5 stars). WellCare and HealthSpring are at 4.0 stars. Humana holds a 3.8-star average in SC. BlueCross BlueShield of SC and Clover Health are lower at 3.5 stars. No SC plans hold a 5-star rating for 2026, which would trigger a year-round Special Enrollment Period. When comparing plans, prioritize carriers rated 4.0 stars or above -- they typically offer better preventive care, fewer claim denials, and more comprehensive benefits.
Dual eligibility and D-SNPs in South Carolina
If you qualify for both Medicare and South Carolina's Medicaid program (Healthy Connections), you are dual eligible — check whether you also qualify for Extra Help with drug costs and may be able to enroll in a Dual Special Needs Plan (D-SNP). D-SNPs coordinate Medicare and Medicaid benefits in one plan, typically offering $0 premiums, $0 copays for primary care, and greatly reduced prescription drug costs. South Carolina has 26 SNP plans in 2026, with a significant portion being D-SNPs.
South Carolina's Healthy Connections Prime program ended on January 1, 2026. Former Prime enrollees now need to choose a D-SNP. The SC DHHS has set up an aligned enrollment system: if you choose a D-SNP from Humana, WellCare, Aetna, or Molina, you can get a matching Medicaid managed care plan from the same organization (Highly Integrated D-SNP, or HIDE D-SNP), which gives you a single care team for both programs. If you are dual eligible and haven't selected a D-SNP yet, contact SC DHHS at 1-888-549-0820 or visit scdhhs.gov.
Frequently Asked Questions
How many Medicare Advantage plans are available in South Carolina in 2026?
South Carolina has 95 Medicare Advantage plans available statewide in 2026, including 26 Special Needs Plans (SNPs). Standard MA plans (non-SNP) number about 69 to 75 depending on how partial-county plans are counted. The exact number available to you depends on your county and ZIP code. Most SC counties offer 40 to 54 plans. Run a ZIP-code search at medicare.gov to see your exact options.
What is the average Medicare Advantage premium in South Carolina for 2026?
The statewide average monthly premium for Medicare Advantage in South Carolina is about $8 in 2026, well below the national MA average of $14. Many SC HMO and PPO plans charge $0 monthly premium, especially from Devoted Health, Clover Health, HealthSpring, and some Humana plans. Premiums tend to be higher for PPO plans with broader out-of-network access and for plans with richer supplemental benefits.
Who are the top Medicare Advantage carriers in South Carolina?
The leading carriers in South Carolina for 2026 are: Humana (13 plans, most in the state, $5 avg premium), Aetna (7 plans, 4.5 stars), WellCare (5 plans, 4.0 stars), HealthSpring (4 plans, 4.0 stars, formerly Cigna), BlueCross BlueShield of SC (3 plans, PPO-only, strong local brand), UnitedHealthcare (3 plans, 4.5 stars), Devoted Health (2 plans, 4.5 stars, $0 premium), and Clover Health (2 plans, $0 premium). Kaiser Permanente does not serve South Carolina.
When can I sign up for Medicare Advantage in South Carolina?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by moving, losing employer coverage, or qualifying for Healthy Connections Medicaid. Existing MA enrollees can switch plans during the MA Open Enrollment Period (January 1 to March 31, 2026).
What happened to Healthy Connections Prime and how does it affect my Medicare coverage?
South Carolina's Healthy Connections Prime program, which provided coordinated Medicare-Medicaid coverage for dual-eligible beneficiaries, ended on January 1, 2026. If you were enrolled in Healthy Connections Prime, you are now expected to choose a Dual Special Needs Plan (D-SNP) to coordinate your Medicare and Medicaid benefits. The SC DHHS has contracted with multiple carriers including Humana, WellCare, Aetna, Molina, and UnitedHealthcare to offer D-SNPs. Contact SC DHHS at 1-888-549-0820 or visit scdhhs.gov if you need assistance selecting a D-SNP.
What is the difference between HMO and PPO Medicare Advantage plans in South Carolina?
HMO plans (about 29 plans in SC) require you to use in-network providers and typically need a referral to see a specialist. They have lower premiums (average around $5/mo) but restrict your provider choice. PPO plans (about 40 plans) let you see out-of-network providers at a higher cost share and don't require referrals, but charge higher premiums (average around $18/mo). HMO-POS plans are a hybrid -- they are primarily HMO but allow some out-of-network use. If you travel frequently or have specialists in multiple cities, a PPO or Original Medicare plus Medigap may be the better fit.
Does Medicare Advantage cover prescription drugs in South Carolina?
Most South Carolina Medicare Advantage plans include Part D prescription drug coverage (called MA-PD plans). The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans, a cap set by the Inflation Reduction Act (signed August 2022). Insulin costs are capped at $35 per month. Always check the plan's formulary to confirm your specific medications are covered and at which cost-sharing tier.
Are dental, vision, and hearing covered by Medicare Advantage plans in South Carolina?
Yes, most SC Medicare Advantage plans include some level of dental, vision, and hearing benefits -- coverage that Original Medicare does not provide. BlueCross BlueShield of SC includes preventive and comprehensive dental, OTC allowances, hearing, vision, and fitness benefits in all three of its 2026 plans. Coverage varies widely across carriers: some plans cover only exams and cleanings, while others cover crowns, hearing aids up to a dollar limit, and prescription eyewear. Review the Evidence of Coverage for each plan to understand annual limits before enrolling.
