South Carolina Employee Benefit Authority(SC PEBA) is the sole benefits administrator for over 500,000 employees and retirees for the State of South Carolina. Info for SC PEBA Medicare. Ph: 803.737.6800
Retiree insurance from South Carolina Employee Benefit Authority(SC PEBA) is group health insurance that retirees earn their way into based upon eligible years of employment with your soon to be former employer. Your former employer must be a member of SC PEB and you must be a newly-eligible Medicare retiree from South Carolina Retirement Systems(SCRS) or other state-based system to be eligible for SC retiree insurance. You should contact SC PEBA to understand your eligibility and situation. The retiree insurance option known as the state "Medicare Supplemental Plan" from Bluecross Bluesheild of South Carolina eligibility and rates can only be determined by SC PEBA. However, there are situation where the marketplace is highly competitive and a better option for Medicare Supplemental Insurance options known as "Medigap". Let's get some of your general questions answered below.
How do I and/or my spouse or family members qualify for Retiree Insurance with SC PEBA?
SC PEBA determines you or your family members eligibility and funding status. The 3 funding status categories are Fully-Funded, Partially-Funded and Non-Funded. You can quickly determine your funded status here. You can compare the premium rate(s) for the "Medicare Supplemental Plan" for 'Medicare-Eligible' for you and/or your spouse and/or family from SC PEBA in the Medicare-Eligible Member Handbook(2021 SC PEBA Medicare-Eligible Handbook)
Next, What is the retiree "Medicare Supplemental Plan" from SC PEBA?
What is the retiree Carve-Out Plan?
The "Medicare Supplemental Plan" it a group retiree supplemental health insurance plan administered by Bluecross Bluesheild of SC which includes outpatient drug coverage. Employees who are members of SC PEBA can purchase this plan as secondary coverage/payer. Traditional Medicare(Part A & Part B) must pay its share first. Because Medicare(A&B) is the primary, the claims are automatically sent the "Medicare Supplemental Plan" for cross-over claims payment. Bluecross Blueshield of South Carolina(BCBS of SC) is the administrator that processes the health care claims for this health plan. Express Scripts is the administrator for the outpatient drug coverage of this plan. You do NOT need to buy a separate marketplace stand along Part D drug plan if you enroll into the state "Medicare Supplement Plan". The "Medicare Supplemental Plan" is funded by the Retiree Health Insurance Trust Fund. Funding/Financing model is very similar to the national Medicare Hospital Insurance Trust Fund. Bluecross Blueshield of South Carolina processes all the medial claims for SC PEBA retiree insurance. Express Scripts is the Pharmacy Benefit Manager(PBM) for outpatient drugs. The SC PEBA 2021 Medicare Handbook states two different retiree health plans, the "Medicare Supplemental Plan" and the "Carve-out Plan". The "Carve-Out Plan" from SC PEBA is not recommended due to risk of claims processing challenges and risk of higher out-of-pocket cost with increased medical utilization. You can learn more about both the state "Medicare Supplemental Plan" or the carve-out health care insurance with SC PEBA for retirees.
Can I keep my SC State Health Plan PPO?
Some SC STATE AGENCIES have some retirees currently on the "SC State Health Plan(PPO)". However, contact SC PEBA for determination. The trend moving forward from Blue cross Blueshield of SC is to transition retirees to Original Medicare and choose the supplemental or carve-out plans.
What is the individual marketplace for Medicare Supplement(Medigap) Insurance?
In 2021, New Medigap Policies are becoming less popular due to affordability in many markets/states. However, South Carolina, Texas, Illinois, Pennsylvania and California are among the STATES with the most New Medigap Policies within the Individual Medigap Marketplace. "The Sunshine☼🌅 State", Florida is still King when it comes to the number of beneficiaries living out their "Golden Years" with Medigap plans.
The Individual Medicare Supplement(Medigap) Policies were 1st issued by Mutual of Omaha in 1966. These are secondary policies hence the name "Supplement" designed to pay after Original Medicare(A&B) pays its share. The commissioners of each state dept of insurance agreed to implement protections under state laws for Medicare consumers who purchase or own a Medigap plan. These state-based laws are known as Guaranteed Issue Rights a.k.a. "Medigap Protections" to help protect the right for consumers shop and purchase an individual marketplace Medicare Supplemental(Medigap) Insurance plan. Any Medicare-Eligible retiree in all 50 states and territories has specific rights and designation periods to buy a private health insurance company(Aetna, Cigna, UHC, BCBS. . .) that offers Medigap Insurance in their state or territory. The companies must abide by these Medigap Protections and the 2010 Medigap Standardization Laws put in place. Only 3 states standardized Medigap plans defferently. Medigap Insurance is regulated by each State Dept of Insurance or Finance. The 2010 Medigap Standardization help millions of retirees to simplify and choose a Medigap policy that helps them pay for the gaps in coverage in Original Medicare(A&B). Medigap plans pay for things like the Part A hospital deductible($1484 in 2021) and the Part B limitless max out-of-pocket for the 20% coinsurance. It is very common to shop & purchase a Medigap policy when newly-enrolled into Original Medicare(A&B) to protect consumers from higher possible out-of-pocket medical services for seniors and the aging population. Baby boomers can also shop certain Medigap Plans during Guaranteed Issue situations which would trigger a Special Enrollment Period. However, Smart Medicare Consumers tend to shop the marketplace throughout their Medicare journey for lower rates on these standardized Medicare Supplement(Medigap) Insurance Plans. South Carolina has a FREE service that helps you Save while on your Medicare journey(Medicare Savings).
Learn how Medigap Letter Plans(A-N) are standardized(except for MN, MA & WI standardize in a differ way) in the link to the "Guide to Choosing a Medigap Policy" below.
Medigap is secondary coverage/payer to Original Medicare(A&B). Many companies like Aetna, BCBS of SC, AARP United Healthcare, Cigna, Colonial Penn, Humana, Physicians Mutual and the rest of the 71 companies in South Carolina compete for retiree's business. This is where many of the misconceptions & confusion happens surround individual marketplace plans. Medigap Plans are federally regulated to payout the SAME as every company in the state after Original Medicare (A&B) pays its share by law according to the benefits of the Medigap Letter Plan. More info about choosing a Medigap policy published by the Centers for Medicare & Medicaid(CMS) below.
2021 Guide to choosing a Medigap Policy booklet
pg. 11 Medigap Letter Plan Chart
Plans F*,G* & N are the most popular & comprehensive
Medigap Letter Plans
Why compare SC PEBA Retiree Insurance vs The Individual Marketplace?
Simply put you have a decision to make. The main reason we can compare the "Medicare Supplemental Plan" to the individual marketplace for Medicare Supplement(Medigap) Plans is because they both operate as secondary coverage to Original Medicare(Traditional Medicare Part A&B). Medicare Part A and Part B is the primary health insurance coverage for SC PEBA retirees and the individual marketplace for Medicare supplement(Medigap) insurance options. There can be big differences in premium rates based on your funded status offered by SC PEBA. And, there can also be big differences in premium rates based on the market value for Medicare Supplement(Medigap) Insurance offered by private companies.
pg. 11 Medigap Letter Plan Chart
Plans F*,G* & N are the most popular & comprehensive
Medigap Letter Plans
Next, What else do me and/or spouse or family need to consider about Retirement?
***Losing Other Coverage, Out-Of-Pocket Protection & End-Of-Life Planning***
Do you have dental and vision with your employer? You maybe losing other coverage when transitioning onto Medicare. Medicare does NOT cover routine dental, vision or hearing. There are marketplace stand alone Dental, Vision & Hearing(DVH) policies designed to cover what Medicare does not.
Are you losing your employer funded Life insurance policy? Cancer, Heart Disease/Attack & Stroke are the top 3 medical conditions that most beneficiaries do NOT plan ahead for at the beginning of their Medicare journey. The statistics speak for themselves. Do you know someone who died of one of these health conditions? My mother, Carol J. Fischbach, ascended up in July of 2018 from bile duct cancer, kidney failure and other health complications. There can be unexpected financial burden with non-medical expenses like travel, lose of a spouse's income, in-home care and even costly medication with beneficiaries that need considerable medical care. Consider a Cancer, Heart Attack & Stroke Plan if you do not already have them in place for you and your love ones. Learn more about Whole Life Lump Sum Cancer, Heart Attack & Stroke Insurance products designed to payout when you or your family is diagnosed with any of the top 3 health conditions that can alter your Life and medical expenses with your Medicare Savings agent.
Do you have end of life expenses and funeral services taken care of for your family? Many beneficiaries may not want to think or plan ahead burial or final expense but your family won't want to either when the time comes. Help them to be prepared and take the burden off of them to ensure family members can celebrate your life and not worry about burial costs. Learn more about Whole Life Lump Sum Final Expense Insurance products that solve this burden for your family with your agent at Medicare Savings.
Next, How do marketplace insurer price their Medicare Supplement(Medigap) & Ancillary Plans?
There are 3 ways Medicare Supplement Companies can price or rate their Medigap Plans. Community-Rated, Issue-Age Rated and Attained-Age Rated. Typically, AGE is a factor and characteristic that determines your marketplace rates for Medicare Supplement(Medigap) Insurance, Dental, Vision, Hearing, Cancer, Heart Attack, Stroke and other insurance policies. So it's important for retirees to shop in the beginning but have a services that looks at the individual marketplace to help ensure you are not overpaying when possible ----> Medicare Savings based out of Charleston, SC helps South Carolinians and beneficiaries nationwide as a retiree resource and insurance SAVINGS service specifically designed for retirees and baby boomers needing a trust resource.
SC retirees should compare these 'big differences in premium rates' because your decision(s) could save your hard earned retirement dollars when you're first eligible.
It could be much harder to health qualify(Go thru underwriting) later in your "Golden Years" to shop the individual marketplace for a better price on Medigap insurance. There is no difference in benefits from company to company when comparing the SAME Medigap letter plans
How do me and my household know what is the best supplemental health insurance option for us?
Be a smart consumer and identify the BEST deal for you and your household with side-by-side comparison of a similar and/or standardized Medigap plans by coverage and monthly cost. Both the SC PEBA "Medicare Supplemental Plan" and standardized Marketplace Medigap plans are secondary payers of your healthcare after Original Medicare(A&B). So you will already be paying(Or Social Security Deduction) for Part B monthly premium which is $148.50 for 2021 but is on a sliding scale for higher income earners. Check your Medicare Part B cost by going to Medicare.gov here. The major differences you should compare are the monthly premium rates.
**Another consideration is Medications**
If you are trying to decide whether to keep working & stay on your Group Health Plan, remember to account for you or your household's prescribed medication(Rx) expenses. This can be a sticker shock for those with expense drugs(Tier 3, 4, 5 & 6 ) that would be covered by your employer group health plan but not under Part D of Medicare.
-Go to Formularylookup.com
-Enter Username: "mike@medicaresavings.us" and Password "mfischbach"
-Enter your high tier medication 1 at a time. Make sure your Location is correct atop the page.
-Press enter and Click on "Express Scripts PBM" after it shows you ALL the Pharmacy Benefit Mangers(PBM) companies.
-Lastly click on Express Scripts SC PEBA under Plans.
What if my group health plan is the primary insurance?
Primary insurance are those that have the primary responsibility for paying a claim. Once you have determined that your group health plan insurance company is the primary insurance(1st payer of health claims), Medicare Secondary Payer(MSP) can be secondary for employers/companies with 20 or more employees. In this situation, a supplemental insurance policy would be tertiary. Tertiary insurance is the third insurance policy or payer of health claims. It helps to pay out-of-pocket costs like deductibles and co-pays. You'd need to be enrolled into Original Medicare(A&B) to qualify for tertiary insurance.
What situation would NOT be a good deal for me and my spouse with SC PEBA?
According to GRS Consulting an assumed 20% participate in the SC Retiree Health Care Plan from SC PEBA that are Non-Funded. 59% assumed participation for retirees who are Partially-funded and 79% assumed participation for retirees who are Fully-funded. Your retiree insurance premium rate is determined by your funded status and can only be determined by SC PEBA.
Dr. Frank A Treiber, former MUSC employee, chose the individual marketplace for a Medicare Supplement(Medigap) plan instead of the "Medicare Supplemental Plan" from SC PEBA due to a non-funded status.
The Medical University of South Carolina(MUSC) is a member of SC PEBA. Dr. Frank Treiber worked within the Dept of TeleMedicine. He was displease to find out that he was a few years shy from being fully-funded. He and his wife qualified non-funded Medicare-Eligible Member retiree insurance with SC PEBA. However, we found around $900 per month in savings for him and his wife for a marketplace Medicare Supplement(Medigap) Plan. He researched his retiree insurance options extensively with SC PEBA and Medicare Savings, an independent Medicare marketplace brokerage based out of Charleston, SC.
What situation would be a good deal me, my spouse and family members with SC PEBA?
There are situations where SC PEBA "Medicare Supplemental Plan" could cover 'Full-Family' in addition to the retiree and spouse. These situations offer coverage under one premium which could be a good benefit for your family. According their handbook family members must be under 26 years of age. Typically, the individual marketplace for under 65(Healthcare.gov) health insurance can be higher then the SC PEBA. Unless they are employed and covered under another group health insurance plan. Call SC PEBA at 803.737.6800 to determine if you and your family members qualify for Retiree Insurance. The "Medicare Supplemental Plan" from SC State Retiree is a set group/member rate. We will get into how you can save money.
When can I save money for me and my spouse in the individual marketplace?
Anyone who is Medicare-Eligible can shop the individual marketplace. There is a very large and diverse retiree community throughout the state of South Carolina that benefit from lowering down their rates after their enrollment into Original Medicare(A&B) + a Medicare Supplement + a Part D drug plan. Folks who already have with a Medicare Supplement(Medigap) policy take advantage being able to shop 12 months out of the year for a better price on popular individual marketplace Medicare Supplement Plans like Plan F*, Plan G and Plan N. This is especially good when rate increases happen over time. We all know that health plan rates go up over time within the U.S. Healthcare system. This is a known fact from individual ACA plans to small employers to large corporate health plans. Unfortunately, duration of coverage adversely affects health insurance premiums. However, Medicare marketplace insurance brokerages like Medicare Savings help retirees safely(COVID Safe) over-the-phone to shop for market value rates, if folks qualify.
What if I like my "Medicare Supplemental Plan" with SC PEBA?
Beneficiaries are Guaranteed Issued to keep their supplemental policies for life as long as premium payments are made. However, retirees should consider the compounding and long term effects of paying higher than market value rates for your health insurance coverage. Retiree insurance within many retiree systems or an insurance company will never call you to reduce your rate if your situation and health could save you or your spouse money on the same or very similar coverage. Whether it be nominal or significant savings, the individual marketplace for Medicare insurance options are available to every Medicare-Eligible(65+) retiree nationwide that has earned their right into Original Medicare. These companies(300+ nationwide) compete within each state for your business. Medicare Savings is designed to make the individual marketplace easy and simple when shopping for Medicare Supplement(Medigap) Insurance in South Carolina.
What if I live outside of South Carolina but want to shop for a better rate?
Some states like Mississippi, Texas and Virginia offer very affordable rates compared to states like New York, California and Florida. So it does matter which state you live in and enroll into your Medicare Supplement(Medigap) Plan for the individual Medicare marketplace. Note: If you have multiple residents. Social Security advises that you enroll in a Medicare Supplement Plan where you pay income taxes. But, savy beneficiaries can enroll where they live their "Golden Years". If you move that puts you in to a Guaranteed Issue situation where you have the right to shop certain Medicare Supplement(Medigap) plans in your new state of residence. This is known as Guaranteed Issue Rights or "Medigap Protections".
What does it cost for an independent Medicare marketplace insurance broker to help me choose?
Absolutely nothing! There is no-additional cost when enrolling into a Medicare Supplement Plan in the individual marketplace for Medicare Supplement Insurance with a licensed agent/broker. Medicare Savings will help you shop and enroll into a Medicare Supplement(Medigap) Plan. Insurance companies pay a small commission to our brokerage, Medicare Savings. This helps the insurance company with their over-head expense while our agents and brokerage help you for free. The price of the supplement plan is the same whether you enroll direct thru the company or thru our brokerage. You be tickled to know, an independent broker, is able to help you shop the entire marketplace and advocate for you when you need claims research and actively help you with better marketplace Medicare insurance options. Be aware, captive insurance companies(1 company/brand) will guide you through one or maybe a few prices but cannot show you the entire market. Our independent agents and brokerage are able to be accountable to the client and not tied to only insurance company or brand.
How do I get free quotes for individual marketplace Medicare Supplement(Medigap) Insurance Plans?
Simple! Go to www.MedicareSavings.us or Email me mike@medicaresavings.us for free quotes from over 300+ insurers and company trends. Beneficiaries are NOT able to shop for Medigap Insurance on Medicare.gov or your MyMedicare.gov online account. Or If you are New-To-Medicare and want to Learn How To Enrolll into Medicare(A&B) go to www.startmedicare.us.
Please help us to help you! Use our safe Google forms for you to request Medicare help from Medicare Savings. It is an easy and hassle-free to Get Medicare Help from us.
Why Medicare Savings? Original Medicare & Medigap Specialists
-Pontiac Elementary(Columbia, SC)
-Spring Valley High School(Columbia, SC)
-2003 USC Graduate with a B.S. Sport & Entertainment(Columbia, SC).
We help retirees enroll into their Original Medicare(A&B) benefits and find the best Medicare Supplement Insurance Plan company for you.
Some recent stats say that 93% of Medicare beneficiaries DO NOT shop their coverage annually. Over 90% of beneficiaries overpay after a few short years of being on the same Medicare Supplement(Medigap) policy. Easily compare the market value for Medicare Supplement(Medigap) Plan Letter for free.
Did you know Google has targeted ads that key word search Medicare Supplement(Medigap) Insurance or Medigap Quotes to direct you to 1 brand or company on their consumer facing website?
Did you know that Medicare.gov and Medicare.com (by eHealthinsurance) markets and enrolls beneficiaries into the optional alternative known as Medicare Advantage? eHealthinsurance totes that they offer over "4,700 Medicare Plans".
MEDICARE SAVINGS specializes in Original Medicare(A&B) + Medigap Insurance. Original Medicare is the benefit you paid into social security all your working life. We aim to help you and your community keep your hard earned retirement benefits and retirement dollars. Learn why Original Medicare is the most robust and comprehensive coverage and payer of medical services and supplies from Billing Buddies operates in all 50 states to help with medical billing from healthcare providers like PT's, OT's and Physicians at Medicare Forum.
-Plan G*(65 on or after Jan 1, 2021) is similar to Plan F but you take on the Part B Annual deductible($203) along with the monthly premiums. Rates range from $82-$345
-Plan N(Recommended for AGE 65+) is similar to Plan G but you take on $20 doctors visit copays, $50 emergency room(Non-admitted) copays. Along with Part B Annual Deductible($203). If you use a non-participating provider(e.g. OT or PT) they are allowed to charge Part B excess charges. Fortunately, Over 94% of the U.S. healthcare professionals "Accept Assignment" a.k.a full payment from Medicare. So Part B excess charges are non common. But ask any new provider if they accept Medicare Assignment to make sure.
Rates range from $64-$312.
How Much are Medicare Supplement(Medigap) Insurance Plans in South Carolina for a Male AGE 65?
Why does Medicare Advantage offer over 4700 different Medicare health plans?
Medicare Advantage(Part C) are being marketed at "Medicare Health Plans". But in reality they are HMO or PPO network plans that are highly marketed by celebrities, TV commercials and thru online search engines. Especially during the Annual Enrollment Period(AEP) at the end of the year. They don't show you the fine print that these plans are NOT Original Medicare(A&B). Medicare Advantage is the optional alternative for beneficiaries in the individual Medicare marketplace. These insurance options DO NOT have Original Medicare (A&B) as the primary insurance administrator or payer. These private insurance companies become the administrator and primary payer, instead of Medicare. Medicare Advantage(MA) or Medicare Advantage with Part D(MAPD) are offered by private health insurance companies who are paid handsomely by the U.S. government to manage your healthcare cost and administer/pay your health care claims. You can learn the pros and cons of Medicare Advantage on our Medicare Forum here. Many folks are attracted to the $0 or low premiums but when they go to use the plan, they are met with prior-authorization and max out-of-pocket risk of up to $11,500. Although Medicare Advantage plans have around 1/3 participation with seniors nationwide in the marketplace, these plans are typically the ones that receive all the attention from the news media. Huge out-of-network hospital bills, patients concerned about timely authorized care(Prior-Authorization) and doctors concerns about their restrictions recommending healthcare services, medical equipment as well as lower provider payout.
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| Is Part A & B your Primary Coverage? |
Remember, The "Medicare Supplemental Plan" is a standardized group retiree health insurance plan with outpatient drug coverage funded by the Retiree Health Insurance Trust Fund. Note that Bluecross Blueshield of South Carolina is the claims administrator for SC PEBA retiree insurance. Express Scripts is the outpatient drug claims administrator. The SC PEBA 2021 Medicare Handbook states two different retiree health plans, the "Medicare Supplemental Plan" and the "Carve-out Plan". The "Carve-Out Plan" from SC PEBA is not recommended due to risk of claims processing challenges and risk of higher out-of-pocket cost with more use. You can learn more about carve-out health care insurance with SC PEBA. Remember, the main reason we can compare the "Medicare Supplemental Plan" to the individual marketplace Medicare Supplement(Medigap) Plans is because they both operate as secondary coverage to Traditional Medicare(Part A&B). Medicare Part A and Part B is the primary health insurance coverage for SC PEBA retirees and the individual marketplace for Medicare supplement insurance options.
Note: If you decide to return-to-work as a retiree this could affect your insurance coverage. Learn more here
There are a number of retiree systems that operate much like captive insurance companies which does offer benefit to those retirees that can the State "Medicare Supplemental Plan" but smart Medicare consumers know a bad and a good deal when comparing retiree insurance vs the individual marketplace. A captive insurance company can only offer you 1 or possibly a few medicare supplement insurance rates. SC PEBA is strictly tied to Bluecross Blueshield of South Carolina(BCBS of SC) but offer rates according to your eligibility for funding status(Funded, Partially Funded and Non-Funded). Email mike@medicaresavings.us for the side-by-side comparison videos for 'Funded', 'Partially-Funded' and 'Non-Funded Retirees' premiums compared to the individual marketplace for Medicare Supplement(Medigap) Plan rates and coverage. BCBS of SC is a huge insurer for South Carolinians but the individual marketplace for each state has more competitions for affordable rates as stated by Medicare below
Do State retirees like their "Medicare Supplemental Plan"?
Many State retirees are happy with their Medicare Supplemental plan from SC PEBA if they qualify to be 'Fully-Funded'. GASC study shows that retiree participation for SC PEBA 'Retiree Insurance' plans like their Medicare Supplemental Plan deminishes from 79% participation down to 20% for retirees that fall into the 'Non-Funded' eligibility status. However, the individual marketplace for Medicare Supplement(Medigap) insurance options beats out the retiree insurance rates for South Carolinians. Retiree/Retirement systems like South Carolina Retirement Systems(SCRS), Savannah River Site Retiree Association(SRSRA), Dominion Energy Retirees and many other private and public employers direct you to internal options but Medicare Savings has proven time and time again that we have saved households their retirement dollars from going out of the door because it is likely you are offered a plan that is above market value.
Leave your general inquiries or experiences in the comments so others may benefit from your insight. I am your humble Medicare insurance broker that doesn't know it all but I will research your situation, questions or concerns so we can all benefit from the up-to-date retiree information.
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