SC STATE Retiree Insurance
vs
The Individual Marketplace

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.

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.

***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.

Rates for "Medicare Supplemental Plan"  have a wide range due to funding status of retiree.

• 2021 SC PEBA Retiree Insurance rates for the retiree ranges from $97.68 - $500.38

• 2021 SC PEBA Retiree insurance rates for the retiree and spouse ranges from $253.36 - $1051.04

• 2021 SC PEBA Retiree Insurance rates for the retiree and children* ranges from $143.86 - $761.92

SC PEBA Monthly Premiums For 2021 & 2022

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.

1. Fully-Funded Retirees are around 79% participation.

2. Partially-Funded assumed participation down to 59%

3. Non-Funded assumed participation down to 20%.

If you compare Non-Funded and Partially-Funded status for State Retiree Health Care Plan these are where we see STATE Retiree participation rates drop significantly.  This is all public information from Governmental Accounting Standards Board(GASB). GRS Consulting conducted a study of the SC Retiree Health Care Plan. Information was disclosed June 30, 2019.

There are a few different situations where SC PEBA "Medicare Supplemental Plan" could cover 'Full-Family', Retiree and Child or provide coverage to survivors. Some of these options could be affordable for these situation. Especially, if no one within your family is eligible for a group health plan.  These situations offer coverage under one premium which could be a good benefit for SC STATE families needing coverage.
According SC PEBA handbook, a family member must be under 26 years of age to be considered a "Child".  The individual health insurance marketplace at Healthcare.gov for major medical health insurance offers higher deductibles for individuals then the SC PEBA Retiree Insurance. Unless others family members 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.

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 for 12 years and worked at Georgetown University for 20 years. He was displease to find out that he and his wife were only eligible for non-funded State Retiree Insurance rates. He and his wife qualified non-funded and both were Medicare-eligible under "retiree/spouse" monthly premium of $1051. However, we found around $900 per month in savings for him and his wife with a marketplace Medicare Supplement(Medigap) Plan with stand alone Part D drug plans. He researched his retiree insurance options extensively with SC PEBA and Medicare Savings, an independent Medicare marketplace brokerage based out of Charleston, SC. 

These beneficiaries were eligible to kept their retiree insurance with the STATE  and enrolled into Original Medicare(A&B). They were both in a very good coverage situation but  wanted to know where their gaps in  coverage might be for them moving  into their  retirement.  Plus the spouse had a Tertiary(3rd Payor) Health Insurance plan to pay all the claims. They mentioned family history of  Cancer. So they wanted more information about Whole Life Lump Sum Products(Cancer Plans).
The neat thing about these policies is they Payout very quickly upon diagnosis and pathology report from your doctor. Beneficiaries are paid within a matter of days in some instances.
Ask about the "Re-Occurance Rider" if you are seeking coverage for Cancer for your and/or your loved ones.
Issue Ages are 18-85. The younger you enroll the more affordable the premium. Whole Life Insurance premiums stay the same over time.

Anyone who is Medicare-Eligible can shop the individual marketplace.  

1. The process for ANY retiree throughout the state of South Carolina is to Learn what Original Medicare(Federal Fee-For-Service) program is 1st.

2. Learn the Medicare Rules & Costly Pitfalls to Avoid future risk and concerns.

3. Then Make an important/informed decision about your Medicare insurance path.

  Typically, retirees would have likely saved up enough to afford to pay future medical expenses. But 63% of retirees Top concern is affording future medical expenses. The benefit of enrolling into Original Medicare(A&B) + a Medicare Supplement + a Part D drug plan is that folks can shop their rates when premiums increase over time. Folks who already have with a Medicare Supplement(Medigap) policy take advantage of 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  your health allows to reduce those Medigap rate increases. Part D drug plan premiums increase over time as well and can be shopped at the end of  the year. Medicare Part B premiums and cost-sharing go up a few dollars each year.  FOR SC STATE Retirees, in my humble opinion, are some pretty BIG DIFFERENCES in premiums with the SC PEBA  "Medicare Supplemental Plan" Premiums. Especially, with the Non-Funded & Partially-Funded premiums compared to the individual marketplace Medicare Supplement(Medigap) Plans. 

We all know the cost of healthcare goes 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 to STATE or Federal health plans. Unfortunately, duration of coverage adversely affects the entire health insurance industry. Medicare marketplace insurance brokerages like Medicare Savings are ready to help retirees safely over-the-phone to compare & shop for market value rates. 

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 and beyond. Note: You may want to contact SC PEBA to ask about rate increases.

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".  

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. 

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. 

Medicare Savings is a home-grown South Carolina service. Founded by Michael C. Fischbach, a former Newberry College Tennis player and a graduate from:

-Pontiac Elementary(Columbia, SC)

-Spring Valley High School(Columbia, SC)
-2003 USC Graduate with a B.S. Sport & Entertainment(Columbia, SC).

We've help retirees enroll into their Original Medicare(A&B) benefits and find the best Medicare Supplement Insurance Plan company for you nationwide. We've been referred by 1-800-MEDICARE agents in the past and Medicare communities.

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 for common keyword search like Medicare or Medigap Quotes to direct you to 1 brand or insurer's consumer-facing website? Think you are getting market value rates? Think again!

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" for beneficiaries. Those are Medicare Advantage Plans disguised at "Medicare Health Plans".

MEDICARE SAVINGS specializes in Original Medicare(A&B) benefits + Medigap Insurance. Original Medicare(A&B) is the benefit you paid into Social Security all of your working life. We aim to help you and your community keep your hard earned retirement benefits and dollars. Learn why Original Medicare is the most robust and comprehensive coverage and payer of medical services and supplies from Billing Buddies who operates in all 50 states to help with medical billing from healthcare providers like PT's, OT's and Physicians on Medicare Forum.  

-Plan F*(Must be 65 or older before Jan 1, 2021 to be eligible) is full coverage and rates range from $108-$407.

-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.

Get your FREE Medigap quote hassle-free by getting filling out our secure Google form.

-Plan F*(Must be 65 or older before Jan 1, 2021 to be eligible) is full coverage and ranges from $100-$360.

-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 $92-$389

-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 $72-$352.

   Medicare Savings is a service started by a former Newberry College Tennis player and 2003 USC Graduate. We help retirees enroll into their Original Medicare(A&B) benefits and find the best Medicare Supplement Insurance Plan company for you. 

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.  

Contact Express Scripts PBM(SC PEBA)  Customer Service if you have questions about their formulary/drug list for your specific Medications. It is Good to KNOW if you or your household has higher than normal out-of-pocket medication expenses when transitioning into Medicare.

 One of the Differences with  Group /Union  Coverage is  Medication  Coverage/Expense for Higher Tier Rx  Drugs

Go to FormularyLookup.com   and Smartphone App can help you look up medications covered by "SC PEBA Express Scripts PBM". This will help you determine if your Medications are covered and the results show you marketplace stand alone Part D plans as well.
Download their android or apple app on your phone to look up High Tier Medications with available plans in your area.

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 that offer internal Medicare insurance options.

 Medicare Savings has proven time and time again that we have saved households their retirement dollars from going out of the door because that are many situations where what you(the retiree) are offered for Medicare insurance is well above market value.

Leave your general inquiries or experiences in the comments so others may benefit from your  retiree experience or insight. I am your humble Medicare insurance broker that doesn't know it all but I will research your situation and concerns so we can all benefit from up-to-date SC STATE retiree information.