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As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how South Carolina’s regulations and policies are likely to affect your bottom line.
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In South Carolina, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
MSP asset limits: The asset limits for QMB, SLMB and QI are $7,860 if single and $11,800 if married.
Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Medicare can also leave its beneficiaries with large cost sharing obligations, and doesn’t cover some medical supply items.
[mro_survey align ="right"]Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for cost sharing and Medicaid services if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
In South Carolina, Medicaid ABD covers an annual cleaning, oral exams, x-rays, extractions and fillings. This dental benefit is limited to $750 each year.
However, Medicaid ABD does not cover routine vision care for adults in South Carolina.
Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.
Asset limits: The asset limit is $7,860 if single and $11,800 if married.
These income and asset limits are the same as for the QMB program, meaning QMB enrollees receive full Medicaid benefits in South Carolina.
Medicare beneficiaries increasingly rely on Long-term Services and Supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
When only one spouse needs Medicaid, the income limit for single applicants is used – and only the applicant’s income is counted.
However, this income limit (of $2,349 a month single applicants) does not mean nursing home enrollees can keep all of their income up to the limit. Nursing home enrollees have to pay nearly their entire income toward their care, other than a small personal needs allowance and money for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If only one spouse has Medicaid, the other spouse can keep a Community Spouse Resource Allowance (CSRA) that is up to $66,480. This is a lower amount that in many other states.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Medicaid long-term care enrollees also can’t have more than $595,000 in home equity.
Every state’s Medicaid program covers certain community-based long-term care services, which are provided at an enrollee’s home, adult day care center, assisted living facility, or another community setting. Medicaid programs offering these services are called Home and Community Based Services (HCBS) waivers. Enrollees can receive these services without entering a nursing home.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
When only one spouse needs Medicaid, the income limit for single applicants is used – and only income from the applying spouse is counted.
Assets limits: The asset limit is $2,000 if single and $4,000 if married (and both spouses are applying). If only one spouse has Medicaid, the other spouse can keep up to $66,480.
Applicants can’t receive HCBS benefits if they have more than $595,000 in home equity.
Applicants with incomes greater than the eligibility limit for nursing home care and HCBS can qualify for those services by depositing income into a Qualified Income Trust or “Miller Trust.”
Even though it is placed in the Miller Trust beforehand, nursing home enrollees must pay nearly all of this income toward their care. However, some states allow HCBS recipients to keep a significant personal needs allowance to pay for certain health and living related expenses.
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. With other Medicaid benefits, the income of both spouses is counted – regardless of who applies.
Spousal impoverishment rules allow the “community spouses” (i.e. the non-applying spouses) of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income, along with resource and housing allowances. These rules apply when one spouse needs Medicaid coverage for LTSS, and the other spouse doesn’t have Medicaid.
In South Carolina in 2020, these “community spouses” are allowed to keep:
Applicants for Medicaid nursing home care and HCBS benefits are not allowed to have significant home equity. In 2020, states can choose a home equity limit based on a federal minimum of $595,000 and maximum of $893,000.
South Carolina uses the most restrictive home equity limit allowed – meaning applicants with more than $595,000 in home equity are not eligible for LTSS programs.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid LTSS. To curb these asset transfers, federal law requires states to institute a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can also have a penalty period for HCBS.
South Carolina has an asset transfer penalty for both nursing home care and HCBS. The state uses a 60-month lookback period during which asset transfers and gifts are prohibited. This penalty is calculated by dividing the value of asset transfers and gifts during the lookback period by the cost of nursing home care (which is about $7,405 a month in 2020).
A state’s Medicaid agency is required to recover what it paid for long-term care related medical expenses while an enrollee was 55 or older. States can choose to also pursue estate recovery for all other Medicaid costs.
South Carolina has chosen to only recover from the estates of enrollees who receive LTSS. If it does pursue estate recovery, the state could also recoup the cost of medical and hospital benefits it covered while the enrollee received long-term care.
When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state contracts to administer Medicaid coverage), the state will attempt to recover what it paid the MCO. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. As a result, the estates of enrollees who used very little care could face large bills.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid may attempt to recover MSP benefits paid through that date. In South Carolina, this could only occur if an enrollee received long-term care.
You can receive free Medicare counseling by contacting the Insurance Counseling Assistance and Referrals for Elders (I-Care) program at 1-800-868-9095. This is the South Carolina State Health Insurance Assistance Program (SHIP).
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. You can also access SHIP services through your Area Agency on Aging (AAA), which you can find by entering your zip code on this website.
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use this search engine from the National Academy of Elder Law Attorneys (NAELA) to find an elder attorney in your area.
South Carolina’s Medicaid program is overseen South Carolina Department of Health and Human Services (SCDHHS). You can apply for Medicaid ABD or an MSP using this website or by visiting a county Medicaid office.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.
