Medicare is the federal health insurance program for adults 65 and older and certain people with disabilities. If you live in South Carolina and are approaching 65, already on disability, or supporting a family member who may qualify, this guide covers every requirement, cost, and enrollment step for 2026.
Who Qualifies for Medicare in South Carolina
Medicare eligibility rules are set at the federal level and apply uniformly across all states, including South Carolina. You qualify for Medicare if you meet one of the following conditions.
Age-based eligibility: You are 65 or older and either a U.S. citizen or a lawful permanent resident who has lived in the country for at least five continuous years.
Disability-based eligibility: You are under 65 and have received Social Security Disability Insurance (SSDI) benefits for at least 24 months. The 24-month waiting period begins with the first month you receive an SSDI payment.
ALS (Lou Gehrig's Disease): If you are diagnosed with ALS, there is no waiting period. Medicare coverage begins the same month your disability benefits start.
End-Stage Renal Disease (ESRD): If you require regular dialysis or have received a kidney transplant, you can qualify for Medicare at any age. Coverage typically begins the fourth month of dialysis treatments, though it may start sooner in certain cases.
Medicare Parts Explained
Medicare is divided into separate parts, each covering a different type of care.
Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care following a qualifying hospital stay, hospice care, and some home health services.
Part B (Medical Insurance) covers outpatient care, doctor visits, preventive services, durable medical equipment, and medically necessary services.
Part C (Medicare Advantage) is offered by private insurance companies approved by Medicare. These plans bundle Part A and Part B coverage and usually include Part D drug coverage. South Carolina residents in 2026 have access to a range of Medicare Advantage plans through carriers such as Blue Cross Blue Shield of South Carolina, Humana, and UnitedHealthcare.
Part D (Prescription Drug Coverage) helps pay for prescription medications. It is offered through private plans and can be added to Original Medicare (Parts A and B).
2026 Medicare Costs in South Carolina
Medicare is not free for most enrollees. Here are the standard 2026 costs.
Part A Costs
| Cost Type | 2026 Amount |
|---|
| Monthly premium (most people) | $0 (if you or spouse worked 40+ quarters) |
| Monthly premium (30-39 quarters worked) | $311 |
| Monthly premium (fewer than 30 quarters) | $565 |
| Inpatient hospital deductible (per benefit period) | $1,736 |
| Days 1-60 coinsurance | $0 |
| Days 61-90 coinsurance (per day) | $434 |
| Lifetime reserve days coinsurance (per day) | $868 |
Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 40 quarters (10 years) while working.
Part B Costs
| Cost Type | 2026 Amount |
|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of covered services |
Higher-income enrollees pay more through the Income-Related Monthly Adjustment Amount (IRMAA). Your 2026 IRMAA is based on your 2024 tax return income.
Part B IRMAA Surcharges (2026)
| Individual MAGI (2024) | Joint MAGI (2024) | Total Monthly Part B Premium |
|---|
| Up to $109,000 | Up to $218,000 | $202.90 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 |
| $137,001 to $173,000 | $274,001 to $346,000 | $365.40 |
| $173,001 to $207,000 | $346,001 to $414,000 | $446.60 |
| $207,001 to $500,000 | $414,001 to $750,000 | $527.90 |
| Above $500,000 | Above $750,000 | $689.90 |
Medicare Savings Programs in South Carolina
South Carolina administers several Medicare Savings Programs (MSPs) through Healthy Connections Medicaid (the state Medicaid program run by SCDHHS). These programs help low-income Medicare beneficiaries pay for premiums, deductibles, and co-payments.
QMB (Qualified Medicare Beneficiary)
QMB is the most comprehensive MSP. It pays your Medicare Part A and Part B premiums, deductibles, and cost-sharing. Providers who accept Medicare are not allowed to bill QMB beneficiaries for these costs.
| Household Size | Monthly Income Limit |
|---|
| Individual | $1,325 |
| Married couple | $1,783 |
SLMB (Specified Low-Income Medicare Beneficiary)
SLMB pays your Part B premium only. Income limits are slightly higher than QMB.
| Household Size | Monthly Income Limit |
|---|
| Individual | $1,585 |
| Married couple | $2,135 |
QI (Qualifying Individual)
QI also pays your Part B premium. Income limits are slightly above SLMB levels. Slots are limited and awarded on a first-come, first-served basis each year, so applying early matters.
QDWI (Qualified Disabled Working Individual)
QDWI helps certain working people with disabilities pay their Part A premium. This applies to people under 65 who lost free Part A coverage because they returned to work.
Asset Limits for MSPs in South Carolina
South Carolina uses federal asset limits for all MSPs.
| Household Size | Asset Limit |
|---|
| Individual | $9,660 |
| Married couple | $14,470 |
Assets that count include checking and savings accounts, stocks, bonds, and IRAs. Assets that do not count include your primary home, one vehicle, personal property, and burial funds up to $1,500.
Extra Help for Part D Drug Costs
Extra Help (also called the Low-Income Subsidy or LIS) is a federal program that reduces or eliminates Part D prescription drug costs. If you qualify, you pay little to nothing for covered medications.
2026 Extra Help income limits:
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|
| Individual | $2,015 | $23,475 |
| Married couple | $2,725 | $31,725 |
2026 Extra Help asset limits:
| Household Size | Asset Limit |
|---|
| Individual | $16,590 |
| Married couple | $33,100 |
If you are enrolled in a Medicare Savings Program in South Carolina, you are automatically enrolled in Extra Help.
Enrollment Periods
Enrolling at the right time avoids late enrollment penalties that permanently raise your premiums.
Initial Enrollment Period (IEP): This is a 7-month window centered on your 65th birthday. It opens three months before the month you turn 65, includes your birthday month, and closes three months after. Enrolling during the first three months of your IEP means coverage starts the month you turn 65.
Special Enrollment Period (SEP): If you delayed Medicare because you had employer-sponsored coverage through your own or a spouse's active employment, you can enroll within 8 months of losing that coverage without a penalty. Retiree coverage does not qualify as active employer coverage for this purpose.
General Enrollment Period (GEP): If you missed your IEP without a qualifying reason, you can enroll from January 1 through March 31 each year. Coverage starts July 1. A late enrollment penalty applies to Part B: 10% added to the standard premium for each full 12-month period you delayed.
Annual Enrollment Period (AEP): Runs October 15 through December 7 each year. Use this window to join, switch, or drop a Medicare Advantage plan or a Part D plan. Changes take effect January 1 of the following year.
Medicare Advantage Open Enrollment Period: January 1 through March 31. If you are already enrolled in a Medicare Advantage plan, you can switch to a different Advantage plan or return to Original Medicare during this window.
How to Apply for Medicare in South Carolina: Step-by-Step
Step 1: Check your eligibility
Confirm you meet the age or disability requirement. If you are already receiving Social Security or Railroad Retirement Board benefits at least four months before you turn 65, Medicare enrollment is automatic and you will receive your red, white, and blue Medicare card in the mail. If not, you need to apply actively.
Step 2: Apply online, by phone, or in person
- Online: Visit ssa.gov/medicare to apply. The online application takes about 10 minutes and is available 24/7.
- By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m.
- In person: Visit your local South Carolina Social Security office. Use the office locator at ssa.gov/locator to find the nearest location.
Step 3: Choose your coverage type
After enrolling in Part A and Part B (Original Medicare), decide whether you want to add coverage.
- If you stay with Original Medicare, consider a standalone Part D drug plan and a Medigap (Medicare Supplement) policy to cover cost-sharing gaps.
- If you want bundled coverage, compare Medicare Advantage plans available in your South Carolina county at medicare.gov/plan-compare.
Step 4: Apply for a Medicare Savings Program if your income qualifies
Contact Healthy Connections Medicaid at (888) 549-0820 or apply through the South Carolina DHHS website at scdhhs.gov. You can also apply in person at your local county Medicaid office. Applications can be submitted year-round; there is no open enrollment window for MSPs.
Step 5: Apply for Extra Help if needed
Apply directly through the Social Security Administration at ssa.gov/extrahelp or by calling 1-800-772-1213. SCDHHS will also screen you for Extra Help when you apply for a Medicare Savings Program.
Step 6: Get free counseling from SC SHIP
South Carolina's State Health Insurance Assistance Program (SC SHIP) provides free, unbiased Medicare counseling. SHIP counselors can help you compare plans, review your options, and assist with appeals. Reach SC SHIP at 1-800-868-9095 or visit aging.sc.gov.
South Carolina Medicare Advantage Plans in 2026
Medicare Advantage plans in South Carolina vary by county. Urban areas like Charleston, Columbia, Greenville, and Myrtle Beach generally have more plan options than rural counties. As of 2026, major carriers offering Medicare Advantage in South Carolina include:
- Blue Cross Blue Shield of South Carolina (BlueChoice)
- Humana
- UnitedHealthcare
- Aetna
- Wellcare
Use the Medicare Plan Finder at medicare.gov/plan-compare to see every plan available at your specific address, compare costs, and check whether your doctors and prescriptions are covered.
Late Enrollment Penalties
Missing your enrollment window without a qualifying SEP can result in permanent premium increases.
Part B late penalty: 10% added to the standard Part B premium for each full 12-month period you were eligible but not enrolled. The penalty lasts as long as you have Part B.
Part D late penalty: 1% of the national base beneficiary premium multiplied by the number of months you went without creditable drug coverage. In 2026, the national base beneficiary premium is approximately $36.78, meaning each month of delay adds about $0.37 to your monthly Part D premium permanently.
Check Your Full Eligibility
Medicare is one of several programs South Carolina residents may qualify for simultaneously. Use the free Benefits Navigator screener at benefitsusa.org/screener to check eligibility for Medicare, Medicaid, SNAP, LIHEAP, and more in a single step. You can also visit the South Carolina state benefits page at benefitsusa.org/states/south-carolina for a complete list of state-specific assistance programs.
Frequently Asked Questions
What is the age to qualify for Medicare in South Carolina?
The standard age for Medicare eligibility is 65. South Carolina residents under 65 can qualify if they have received SSDI benefits for 24 months, have been diagnosed with ALS, or have End-Stage Renal Disease requiring dialysis or a kidney transplant.
Does South Carolina have a Medicare Savings Program?
Yes. South Carolina offers four Medicare Savings Programs through Healthy Connections Medicaid: QMB, SLMB, QI, and QDWI. These programs pay for Part B premiums and, in the case of QMB, cover additional cost-sharing. Apply through SCDHHS at (888) 549-0820 or at scdhhs.gov.
How much does Medicare Part B cost in South Carolina in 2026?
The standard Part B premium in 2026 is $202.90 per month. If your 2024 income exceeded $109,000 as a single filer (or $218,000 for a joint return), you pay a higher amount through IRMAA surcharges, up to $689.90 per month.
Can I get Medicare if I never worked in the United States?
You may still get Medicare at 65 if you are a U.S. citizen or have been a lawful permanent resident for at least 5 years. However, if you or your spouse did not pay Medicare taxes for at least 40 quarters, you will pay a Part A premium of up to $565 per month in 2026 rather than getting it premium-free.
What is the income limit for Extra Help with Part D in South Carolina in 2026?
For 2026, the income limit for Extra Help is $23,475 per year for an individual (about $2,015 per month) and $31,725 per year for a married couple living together (about $2,725 per month). Asset limits are $16,590 for individuals and $33,100 for couples.
When should I sign up for Medicare if I am still working at 65?
If you have group health coverage through your own active employment or a spouse's active employment, you can delay Part B without penalty and enroll during a Special Enrollment Period within 8 months of losing that coverage. If your employer has fewer than 20 employees, Medicare becomes the primary payer at 65 and you should enroll on time to avoid gaps in coverage.
Is there a Medicare open enrollment period in South Carolina?
The Annual Enrollment Period runs October 15 through December 7 each year. During this window, you can join, switch, or drop a Medicare Advantage or Part D drug plan. Changes take effect January 1. The Medicare Advantage Open Enrollment Period runs January 1 through March 31 and allows Advantage enrollees to make one plan change.
How do I apply for Medicare in South Carolina?
Apply online at ssa.gov/medicare, by phone at 1-800-772-1213, or in person at any South Carolina Social Security office. If you are already receiving Social Security benefits, enrollment in Medicare Parts A and B is automatic and you will receive your card by mail before your 65th birthday.
