South Carolina residents who qualify for both Medicare and Healthy Connections Medicaid, the state's Medicaid program, are called dual eligibles. About 190,000 South Carolinians carry this dual status, and what they get depends entirely on which income tier they land in: some receive help with Medicare premiums only, while others receive complete Medicaid benefits stacked on top of Medicare. South Carolina Department of Health and Human Services (SCDHHS) administers both the Medicaid Savings Programs and full Healthy Connections Medicaid using the same 2026 federal poverty level (FPL) figures published by HHS.
This guide breaks down South Carolina's 2026 income limits by household size, the three Medicare Savings Program tiers (QMB, SLMB, QI), what each tier actually pays for, and how the January 2026 shift from Healthy Connections Prime to Dual Special Needs Plans (D-SNPs) changes how dual eligibles get care. Check your eligibility with the screener or review Medicaid income limits by state for other states.
Quick Answer: Are You Dual Eligible in South Carolina?
It depends on your income. South Carolina residents who meet Healthy Connections Medicaid's 100% federal poverty level limit (about $1,350 a month for one person in 2026) qualify as full dual eligibles with complete Medicaid benefits layered on top of Medicare. Residents with income up to 135% FPL still qualify for a Medicare Savings Program that pays Medicare premiums and cost-sharing without adding full Medicaid benefits.
South Carolina Healthy Connections Medicaid Dual-Eligible Income Limits by Household Size (2026)
South Carolina ties dual-eligible Medicaid income limits to the federal poverty level published annually by the U.S. Department of Health and Human Services. Healthy Connections Medicaid's Aged, Blind, and Disabled category, the pathway most Medicare beneficiaries use to become full dual eligibles, sets the income limit at 100% FPL plus a $20 general income disregard. For 2026, that works out to roughly $1,350 a month for a household of one and $1,823 a month for a household of two, with the table above extending the same formula through household size 8.
South Carolina is a 1634 state, which means anyone approved for Supplemental Security Income (SSI) through the Social Security Administration is automatically enrolled in Healthy Connections Medicaid without filing a separate application. Beyond the income limit, full Healthy Connections Medicaid also applies a resource limit of roughly $2,000 for an individual and $3,000 for a couple, separate from the higher resource limit used for the three Medicare Savings Program tiers below. SCDHHS reviews household composition and family size together with income when it assigns you to a row on the table above.
South Carolina Medicare Savings Program income tiers by monthly income (2026)| Program | Individual limit (2026) | Couple limit (2026) | What it pays |
|---|
| QMB (Qualified Medicare Beneficiary) | $1,350/month (100% FPL) | $1,823/month | Medicare Part A and Part B premiums plus all deductibles, coinsurance, and copays |
| SLMB (Specified Low-Income Medicare Beneficiary) | $1,351 to $1,616/month (120% FPL) | $1,824 to $2,184/month | Medicare Part B premium only |
| QI (Qualifying Individual) | $1,617 to $1,816/month (135% FPL) | $2,185 to $2,455/month | Medicare Part B premium only; annual funding is capped and renews each January |
All three South Carolina Medicare Savings Program tiers use a $9,950 individual / $14,910 couple resource limit in 2026 and automatically qualify enrollees for full Extra Help with Medicare Part D drug costs, which is worth roughly $5,300 a year on average.
Source: CMS Medicare Savings Programs Fact Sheet 2026; SCDHHS Program Eligibility and Income Limits
What South Carolina Dual Eligibility Actually Covers
South Carolina dual eligibles at the QMB tier get Medicare Part A and Part B premiums paid, plus every Medicare deductible, coinsurance amount, and copay wiped out, which by itself is worth several thousand dollars a year given the 2026 Medicare Part B deductible of $283 and Part A inpatient deductible of $1,736. SLMB and QI enrollees get help only with the $202.90 monthly Part B premium in 2026 and keep responsibility for Medicare's other cost-sharing.
Full Healthy Connections Medicaid dual eligibles, meaning those who qualify for both Medicare and complete state Medicaid (not just a Medicare Savings Program), also receive benefits Original Medicare does not cover at all: routine dental care, vision exams and eyeglasses, hearing aids, non-emergency medical transportation to appointments, and long-term nursing facility care after Medicare's 100-day skilled nursing benefit runs out.
How to Apply for Healthy Connections Medicaid and Medicare Savings Programs in South Carolina
South Carolina residents apply for dual-eligible benefits through SCDHHS using one combined application that screens for full Healthy Connections Medicaid and all three Medicare Savings Program tiers at once. The fastest channel is apply.scdhhs.gov, which lets you save an in-progress application and return later. Phone applications go through the Healthy Connections Medicaid Member Contact Center at (888) 549-0820, and in-person applications are accepted at every county SCDHHS office.
You must already be enrolled in Medicare Part A and Part B (or in the process of enrolling) before SCDHHS can determine dual-eligible status, because the Medicare Savings Programs pay Medicare premiums and cost-sharing rather than replace Medicare coverage. Applicants who are not yet on Medicare should contact Social Security first at ssa.gov or 1-800-772-1213.
Documents South Carolina Requires for a Dual-Eligible Application
South Carolina asks for proof of identity, income, residency, and assets before approving a Healthy Connections Medicaid or Medicare Savings Program application. Having every document ready before you start the application at apply.scdhhs.gov substantially shortens the 45-to-90-day review window.
- Social Security number and Medicare card for the applicant
- Proof of income: Social Security award letter, pension statement, or pay stubs
- Proof of South Carolina residency: utility bill, lease, or state-issued ID
- Bank statements and documentation of other countable assets
- Proof of age (birth certificate) or a Social Security disability determination
- Information about any other health insurance coverage you carry
Is South Carolina a Medicaid Expansion State?
South Carolina is one of 10 states that has not expanded Medicaid under the ACA, alongside Alabama, Florida, Georgia, Kansas, Mississippi, Tennessee, Texas, Wisconsin, and Wyoming. In the 40 expansion states plus DC, nearly any adult under 138% FPL qualifies for Medicaid regardless of disability or family status; South Carolina instead requires applicants to fit a specific category such as aged, blind, disabled, pregnant, or a low-income parent.
The expansion gap mostly affects South Carolina adults under 65 who have no dependent children and no qualifying disability, since they fall between the state's low parent-income limit and the 100% FPL floor where ACA marketplace subsidies begin. That gap generally does not affect dual-eligible households, because Medicare eligibility (age 65+ or a qualifying disability) already places you in a Medicaid-eligible category if your income and assets fit the household-size table above.
Common Reasons Dual-Eligible Applications Get Denied in South Carolina
South Carolina denies dual-eligible applications for five recurring reasons, most of which are fixable on resubmission. Reviewing the household-size income table and resource limits above before applying catches the two most common issues, income and assets, before SCDHHS does.
- Monthly income above the QMB, SLMB, QI, or full Medicaid threshold for your household size
- Countable resources above $9,950 (individual) or $14,910 (couple) for MSP tiers, or $2,000/$3,000 for full Medicaid
- Missing or incomplete income and asset verification documents
- Not yet enrolled in Medicare Part A and/or Part B
- An incomplete Social Security disability determination for applicants under 65 applying outside the aged category
Appeals and the 2026 Shift from Healthy Connections Prime to D-SNPs
SCDHHS gives applicants 30 calendar days from the date of a denial notice to request a fair hearing, and if the request is filed within 10 days, existing benefits can continue while the appeal is pending. Fair hearings are typically resolved within 90 days, and a further appeal to the South Carolina Administrative Law Court must be filed within 30 days of the hearing officer's decision.
January 1, 2026 brought a major structural change for South Carolina dual eligibles: SCDHHS ended Healthy Connections Prime, the state's long-running Medicare-Medicaid managed care demonstration, and unwound nursing facility services back into Medicaid fee-for-service. Former Prime members are now directed to enroll in a Dual Special Needs Plan (D-SNP), a type of Medicare Advantage plan built specifically to coordinate Medicare and Healthy Connections Medicaid benefits, or in standard Medicare with a coordinating Medicaid managed care organization.
Frequently Asked Questions
What is the 2026 income limit for dual eligibility in South Carolina?
For full Healthy Connections Medicaid dual eligibility (the QMB category), South Carolina's 2026 limit is 100% of the federal poverty level plus a $20 disregard: about $1,350 a month for one person and $1,823 a month for two. SLMB reaches 120% FPL and QI reaches 135% FPL, both with higher income ceilings but narrower benefits. See the household-size table above for sizes 1 through 8.
What counts as income for Healthy Connections Medicaid?
South Carolina counts Social Security retirement and disability benefits, pensions, wages, and most other regular payments as income for the Aged, Blind, and Disabled category, which uses non-MAGI (Modified Adjusted Gross Income) rules rather than the MAGI methodology used for children, pregnant women, and parent categories. A $20 general income disregard applies before comparing your income to the FPL limit.
What documents do I need to apply for dual-eligible benefits in South Carolina?
You need a Social Security number and Medicare card, proof of income such as a Social Security award letter or pay stubs, proof of South Carolina residency, bank statements for the resource test, and proof of age or a Social Security disability determination. Apply at apply.scdhhs.gov with all documents ready to shorten the review.
What happens if my Healthy Connections Medicaid application is denied?
SCDHHS mails a written denial notice explaining the reason. You have 30 calendar days to request a fair hearing, and requesting within 10 days can keep existing benefits active during the appeal. Most fair hearings conclude within 90 days, and you can escalate to the South Carolina Administrative Law Court within 30 days of the hearing decision.
Can I work and still be dual eligible in South Carolina?
Yes, but earned income counts toward the household-size income limits above, and South Carolina applies work-related income disregards (such as the first $65 of earnings plus half the remainder) that reduce your countable income. Many dual eligibles work part-time and stay under the QMB, SLMB, or QI limit; check the household-size table for your exact threshold.
Is South Carolina a Medicaid expansion state?
No. South Carolina is one of 10 states that has not adopted the ACA's Medicaid expansion to 138% FPL for all low-income adults. This mainly affects working-age adults without dependents or a qualifying disability. Dual eligibles qualify through the aged or disabled category instead, so the expansion gap generally does not apply to them.
What is the difference between QMB, SLMB, and QI in South Carolina?
QMB (100% FPL) pays Medicare Part A and B premiums plus all deductibles, coinsurance, and copays. SLMB (120% FPL) and QI (135% FPL) pay only the Medicare Part B premium and leave you responsible for Medicare's other cost-sharing. All three automatically add full Extra Help with Medicare Part D drug costs.
What happened to Healthy Connections Prime in 2026?
Healthy Connections Prime, South Carolina's Medicare-Medicaid managed care demonstration, ended January 1, 2026. Former Prime enrollees are now directed to a Dual Special Needs Plan (D-SNP) or to standard Medicare paired with a coordinating Medicaid managed care organization, and nursing facility services moved back to Medicaid fee-for-service.
