SC STATE Retiree Insurance
vs
The Individual Marketplace

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
You should contact SC PEBA to understand your eligibility and situation. However, there are situation where the marketplace is highly competitive and a better option for Medicare Supplemental Insurance options known as "Medigap" as well as Medicare Medicare Advantage (An Alternative to Traditional Medicare) .

THERE IS PLENTY OF PROOF IN THE FOLLOWING QUESTIONS BELOW

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/service with your soon to be former employer. Your employer must be a member of SC PEBA and you must have your eligible be determine for Retiree Insurance. South Carolina Retirement Systems(SCRS) or other state-based system are eligible for SC State Retiree insurance. The retiree insurance option known as the state "Medicare Supplemental Plan" from Bluecross Bluesheild of South Carolina can only be determined by SC PEBA. Let's get some of your general questions answered below.

Funding Status can only be determined by SC PEBA. Contact info above. Or Call Medicare Savings 1-888-608-0654 if you are a Retiree that is "Non-Funded" or "Partially-Funded" status for affordable individual marketplace Medicare Supplement Insurance Plans. SC PEBA 2021 & 2022 Premiums(Active Employees and Retirees)

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. Funding is determined by number of years of service. 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 )

Is it a group supplemental health insurance plan that only eligible members of SC PEBA can purchase. It is secondary coverage/payer after Original Medicare Part A & Part B pays its share. Bluecross Blueshield of South Carolina(BCBS of SC) is the administrator that processes the health care claims for this plan. Express Scripts PBM is the administrator for the outpatient drug coverage for this plan.
You do NOT need to buy a separate marketplace stand-alone Part D drug plan if you enroll into the state "Medicare Supplement Plan".
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 sole 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 increased medical utilization. You can learn more about both the state "Medicare Supplemental Plan" or the carve-out health care insurance with an SC PEBA representative. Next we will learn about the individual marketplace for Medicare.

In 2014 over 216,000 New Medigap Policies were sold in South Carolina alone . Texas, Illinois, Pennsylvania and California are among the STATES with the most New Medigap Policies. "The Sunshine☼🌅 State", Florida is still King when it coming to the number of beneficiaries living out their "Golden Years".

Medicare is the Federal government health program for people typically aged 65 and up or under 65 with certain disabilities like ESRD. However, Each state has laws known as Guaranteed Issue Rights a.k.a. "Medigap Protections" to help protect consumers that shop the individual marketplace for Medicare Supplemental(Medigap) Insurance plans available to all Medicare-Eligible retirees in all 50 states by private health insurance companies.
The companies must abide by these Medigap Protections and the 2010 Medigap Standardization Laws put in place and regulated by each State Dept of Insurance or Finance. Standardization help millions of retirees to choose a Medigap policy that help them pay for the gap in coverage in Original Medicare(A&B). Medigap plans pay for things like the Part A hospital deductible($1,484 in 2021) or 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 risk for seniors and the aging populations. Baby boomers can also shop certain Medigap Plans during Guaranteed Issue situation 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. I will tell you about the FREE service that does this for you within the next few questions.

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.

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.

***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 service that looks at the individual marketplace to help ensure you are not overpaying when possible. Medicare Savings is 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 trusted resource.