Medicare in 2025: The Ultimate National Guide to Coverage, Costs, Enrollment & Plan Choices - Palmetto Mutual

A senior-friendly, Carolina-based guide to understanding Medicare — built for residents of North Carolina and South Carolina, and optimized for phone-based help from Palmetto Mutual.

💡 What is Medicare in 2025 and how does it work?

Medicare in 2025 is a federal health insurance program for people 65 and older, or younger adults with disabilities. It includes four parts:

Part A covers hospital care
Part B covers doctor visits and outpatient care
Part C (Medicare Advantage) bundles coverage through private plans
Part D covers prescription drugs

In places like Charlotte (28277), Greenville County, and Wake County, seniors can choose from local Medicare Advantage plans with dental, vision, and $0 premiums — or nationwide Medigap plans like Plan G for broader coverage.

Table of Contents

🧱 What Is Medicare and How Does It Work?

Blow the Whistle — Let’s Start the Game

Medicare can feel like the start of a game with no playbook. The moment you turn 65 (or qualify due to disability), a whistle blows — and suddenly you’re in the middle of a fast-moving field of plans, parts, costs, and companies.

💬 “Before Palmetto Mutual, Medicare sounded like a foreign language.” — Judy, Myrtle Beach, SC (ZIP 29577)

Let’s decode the rules — clearly, calmly, and one piece at a time.

🧩 Medicare Parts A, B, C, and D Explained

Here’s what each part covers — think of them as different positions on your healthcare team:

Part A: Hospital stays, skilled nursing, hospice
Part B: Doctor visits, outpatient care, lab work, preventive services
Part C (Medicare Advantage): A private plan that bundles A + B + D, often with dental and vision
Part D: Prescription drug coverage

🧠 In areas like Greenville County, SC or Mecklenburg County, NC (Charlotte), many Advantage plans include Part D automatically, while Medigap users need a separate drug plan.

🩺 What Medicare Covers (and What It Doesn’t)

Covered by Medicare:

Hospitalization (Part A)
Outpatient visits (Part B)
Preventive screenings (mammograms, colonoscopies, vaccines)
Medically necessary services

Not Covered:

Dental, vision, and hearing
Long-term care (nursing homes)
Most prescription drugs (unless you add Part D)
Routine foot care, custodial care, and cosmetic surgery

💡 Did You Know?
Even in Wake County and Horry County, many seniors are shocked to find that Medicare does not cover dental — unless you enroll in a Medicare Advantage plan with those benefits included.

🏢 How Private Companies Fit In

Medicare isn’t all run by the government. You can get your coverage in two main ways:

✅ Option 1: Original Medicare (Parts A & B)

Run by the federal government
Add Part D for drug coverage
Add Medigap (like Plan G) to fill coverage gaps
Use any doctor nationwide who takes Medicare

✅ Option 2: Medicare Advantage (Part C)

Offered by private insurance companies
Bundles A, B, and usually D
Often includes extras like dental, vision, hearing, and OTC cards
Must use a local network of doctors and providers

📌 In Myrtle Beach (ZIP 29577), Plan G typically costs $105–$130/month for a 65-year-old — while some Advantage plans offer $0 premiums but may limit your doctor options.

💵 What You Still Pay Out of Pocket

Even after you enroll, Medicare isn’t free.

Here’s what most seniors still pay:

Part B premium: $174.70/month (standard for 2025)
Part D premium (if not built into Advantage): varies by plan
Deductibles and coinsurance for hospital and outpatient care
Copays for prescriptions and specialists
Monthly premiums for Medigap or Advantage (varies by ZIP and plan)

📍 Whether you’re in Charlotte (28215) or Charleston (29407), these out-of-pocket costs can add up — which is why Palmetto Mutual helps every client review their real numbers before enrolling.

📞 Want to Make Medicare Simple?

We’ll walk you through every part, every cost, and every ZIP-specific option — all over the phone, with no pressure and no confusion.

🎯 Get My Free Medicare Review »
Serving all of North Carolina and South Carolina — with local agents who know your ZIP.

🧱 Explore Medicare in Your State

Medicare isn’t the same in every town — or even every ZIP code. In the Carolinas, coverage options can change just by crossing county lines. That’s why we’ve organized every region we serve into easy-to-browse directories.

Whether you’re in a coastal ZIP like 29577 or a rural area in Robeson County, we’ll help you navigate your local options — step by step.

🟦 South Carolina Medicare Directory

📍 See All SC Counties & Cities
From Charleston to Sumter to Florence, Medicare plans and benefits vary widely. Use this page to find your county or city and compare the options available in your area.

🟥 North Carolina Medicare Directory

📍 See All NC Counties & Cities
From Wake to Mecklenburg to rural mountain towns, North Carolina’s Medicare options are shaped by your exact location. Start here to browse every county we serve.

🧱 Section 2: When Do You Sign Up? Your Medicare Timeline

Shift Into Gear Before It’s Too Late

Turning 65 is like shifting into a new life gear. Medicare is part of that transition — but if you miss your shift, you could be stuck paying penalties or waiting months without coverage.

💬 Harold in Moncks Corner (ZIP 29461) thought he had time. But he missed his Initial Enrollment Period and now pays a 10% lifetime penalty on his Part B premium.

Let’s shift into the right gear — at the right time.

🕒 Turning 65: What Triggers Enrollment?

If you’re about to turn 65, this is when Medicare eligibility begins — even if you’re still working or feel healthy.

✅ You’re eligible for Medicare:

The month you turn 65
Or earlier, if you’ve received 24 months of SSDI

But here’s the key: you must take action.
If you don’t have employer coverage and you miss your window, you’ll pay more — for life.

📍 *This is true whether you live in Moncks Corner (29461) or a metro area like Raleigh (27610) or *Rock Hill (29732).

🗓️ The 7-Month Initial Enrollment Period (IEP)

Your IEP is your first chance to enroll in Medicare — and your safest.

📅 Here’s how the timeline works:

Timeline Phase	What It Means
✅ 3 Months Before	Best time to enroll — coverage starts on time
📍 Birthday Month	You can still enroll — but your start may be delayed
⚠️ 3 Months After	Late enrollment could mean delayed coverage or penalties

💡 Did You Know?
In places like New Hanover County and York County, missing this 7-month window means paying 10% more on your Part B premium for every 12 months delayed — permanently.

👷‍♂️ What If You’re Still Working?

If you or your spouse are still working and have health insurance through an employer, you might be able to delay enrollment — but it must meet certain rules.

✅ You can delay if:

Your employer has 20+ employees
Your plan is considered creditable coverage

⚠️ You shouldn’t delay if:

You’re covered by COBRA, VA, or a retiree plan
Your employer plan will drop you at 65
You’re unsure whether your coverage counts as creditable

📌 In Columbia (ZIP 29210) and Durham (ZIP 27703), we see many retirees mistakenly delay Part B — then face lifetime penalties.

🧾 Employer Coverage and Delay Options

Here’s a quick gear guide:

Situation	Recommendation
✅ Still working, creditable coverage	Delay Part B & Part D safely
⚠️ On COBRA or small-group coverage	Enroll in Medicare on time
❌ Unsure if coverage qualifies	Get a free review with Palmetto

🧠 Palmetto Mutual helps you call your HR or benefits office to confirm whether your plan qualifies — at no charge.

🧓 Harold’s Missed Shift in Moncks Corner

Harold thought Medicare would notify him when it was time. But nobody did.
By the time he realized, his 7-month window had closed.
Now, in 29461, he pays 10% more on Part B premiums every single month — for life.

Don’t let that be your story.

📞 Want to Know If It’s Time to Enroll?

Let a local Palmetto Mutual agent walk you through your personal Medicare timeline — based on your ZIP, job status, and coverage.

🎯 Check My Medicare Enrollment Window »
Serving seniors by phone across every NC and SC county — from Wake to Dorchester.

🧱 Section 3: Medicare Advantage vs. Medicare Supplement

Choose Your Track Before You Ride

When it comes to Medicare, you’re standing at a railroad switch. One track leads to Medicare Advantage, the other to a Medicare Supplement (Medigap). Both can get you where you’re going — but the ride is different.

💬 Budget Betty in Conway (ZIP 29526) picked Plan G to keep her costs predictable. Travel Tom in Charleston (ZIP 29407) chose Advantage for the extra benefits — and because he rarely travels far.

Let’s compare tracks — side by side.

🚂 This or That? | Advantage vs. Supplement at a Glance

Feature	Medicare Supplement (e.g., Plan G)	Medicare Advantage (Part C)
Doctors & Hospitals	✅ Any provider nationwide that accepts Medicare	⚠️ Must use local HMO/PPO network
Drug Coverage	❌ Separate Part D plan needed	✅ Often included
Monthly Cost	💵 ~$110/month (Conway, ZIP 29526)	💵 $0–$29/month (Charleston, ZIP 29407)
Dental, Vision, Hearing	❌ Not included	✅ Often included
Travel Flexibility	✅ Nationwide	❌ Limited to local region
Referrals Needed?	❌ No	⚠️ Sometimes (HMO plans)
Copays for Doctor Visits	❌ Usually none	✅ Yes — varies by plan

🧩 Coverage Differences

Plan G: Pays almost everything Original Medicare doesn’t, except the Part B deductible
Advantage Plans: Combine your hospital, medical, and often drug coverage into one private plan — with added perks

🧠 *In counties like Horry and Charleston, some Advantage plans now include:

$2,000+ dental
$100 OTC cards
Vision and hearing aids*

But… only if you stay in network.

📍 Network Rules

Plan Type	Doctors in Network	Flexibility
Plan G (Supplement)	Any Medicare provider	Travel freely across the U.S.
Medicare Advantage	Local network only	May require referrals, limited out-of-area care

📌 In Charleston (29407), Tom’s plan only works at Roper St. Francis and affiliated clinics. When he visited family in Asheville, he had to pay full price for an urgent care visit.

💰 Out-of-Pocket Costs

Type	Supplement (Plan G)	Advantage Plan
Monthly Premium	~$110/month	$0–$29/month
Deductibles	~$240/year	$0–$1,000+/year (varies)
Doctor Copays	$0	$15–$50 (average)
Annual Max Spending Limit	Not capped, but rare expenses	Capped at ~$4,500–$7,500/year

📍 In Conway, Betty’s Plan G covers nearly every service after she pays the Part B deductible. No surprise bills.

🧭 Which Is More Flexible?

Question	Best Option
Want to see any doctor anywhere?	✅ Supplement (Plan G)
Need dental and vision bundled in?	✅ Advantage
Prefer to avoid referrals and copays?	✅ Supplement
Want a lower monthly premium?	✅ Advantage
Travel often or live in multiple states?	✅ Supplement

💡 Did You Know?
Seniors in Greenville County and Mecklenburg County (Charlotte) often start on Advantage plans for the savings, then switch to Medigap at age 65 for broader protection — while they’re still in their guaranteed enrollment window.

📞 Not Sure Which Track to Take?

Let Palmetto Mutual help you compare both options based on your doctors, ZIP code, and medications — not a cookie-cutter checklist.

🎯 Compare Advantage vs. Supplement »
We serve all of North Carolina and South Carolina — from Cumberland County to Charleston County.

🧱 Section 4: What Does Medicare Part A Cover?

Your Hospital Umbrella — But It Doesn’t Cover Everything

Think of Medicare Part A like an umbrella over your hospital care. It covers a lot — but not every drop. And many seniors are surprised by the gaps they’re still responsible for.

💬 Chat Transcript:
Agent: “Do you know your hospital stay isn’t always 100% covered?”
Client (Florence, SC – ZIP 29501): “Wait, what? I thought Medicare covered everything.”

Let’s walk through what’s truly under the umbrella — and what’s not.

🏥 Q: Does Medicare Part A Cover Hospital Stays?

A: Yes — but only under specific conditions.

✅ Covered:

Semi-private room
Meals, nursing, medications, and inpatient treatment
Surgery and recovery
Blood transfusions (after the first 3 pints)

⚠️ Not Covered:

Private room (unless medically necessary)
Personal care items (TV, phone, toiletries)
Doctor services during the stay (that’s Part B)

📌 In Florence County, many patients at McLeod Regional Medical Center are surprised to learn that Part A has a $1,632 deductible per benefit period (2025).

🛏️ Q: What About Skilled Nursing Facility (SNF) Care?

A: Medicare Part A helps — but only after a qualifying hospital stay.

✅ To qualify:

You must have a 3-day hospital admission (not observation status)
Your SNF stay must be related to that condition

⏳ Coverage Breakdown:

Days in SNF	What You Pay (2025)
Days 1–20	$0 (covered fully)
Days 21–100	$204/day
Day 101+	❌ Not covered — 100% your responsibility

💡 In cities like Greenville, SC (29607) and Durham, NC (27703), many rehab stays exceed 20 days — which means patients without a supplement are often billed over $4,000.

🕊️ Q: Does Part A Cover Hospice and Home Health?

A: Yes — with strong coverage.

🏥 Hospice:

Covered when your doctor certifies a terminal illness (6 months or less expected lifespan)
Includes pain management, palliative care, counseling, and home nursing
Delivered at home, hospice center, or facility

🏡 Home Health Care:

Covered if your doctor certifies medical necessity
Includes intermittent skilled nursing, PT, OT, and speech therapy
Must be provided by a Medicare-certified agency

⚠️ Long-term, non-medical caregiving (bathing, dressing, meals) is not covered under Part A.

💰 What Triggers Part A Charges?

Situation	What You Pay in 2025
Hospital deductible	$1,632 per benefit period
Days 1–60 (hospital)	$0 per day (after deductible)
Days 61–90	$408/day
Days 91–150 (lifetime reserve)	$816/day
SNF Days 21–100	$204/day
Hospice care	$0 for most services

📌 Florence residents with only Original Medicare often pay hundreds per day for extended hospital or SNF stays — which is why many choose a Medigap plan like Plan G to fill the gaps.

📞 Need Help Understanding What Part A Really Covers?

Palmetto Mutual will walk you through what’s protected — and what still falls outside the umbrella.

🎯 Get a Free Part A Coverage Review »
Serving seniors in Florence County, Richland County, Durham County, and across the Carolinas.

What Does Medicare Part B Cover?

Measure Twice — Budget Once

If Part A is your hospital umbrella, Part B is your measuring tape — covering doctors, outpatient care, and the tests that help you stay well. But like any tape measure, you need to understand where the numbers stop.

💬 “My doctor bills shocked me until I learned about the 20% coinsurance.” — Robert, Fayetteville, NC (ZIP 28306)

Let’s break down what Part B really covers — and what’s still on your side of the line.

🩺 Doctor Visits

Part B covers:

Primary care visits
Specialist care (cardiology, oncology, dermatology, etc.)
Mental health therapy
Preventive services (wellness visits, cancer screenings, vaccines)

📌 In places like Fayetteville (28306) and Lexington County, SC, seniors often rely on Part B for routine care — but don’t realize they’ll still owe 20% of the bill unless they have a Medigap plan or Advantage plan with set copays.

🏥 Outpatient Procedures

Covered services include:

X-rays, MRIs, CT scans
Surgeries that don’t require overnight stays
Chemotherapy or radiation
Emergency room visits (unless admitted — then Part A applies)

📊 Coverage Meter Example:

Procedure	Medicare Pays (80%)	You Pay (20%)
Colonoscopy	$640	$160
Cataract surgery	$2,000	$400
Knee injection (series)	$300	$60

🧠 In Charleston County, we’ve helped clients avoid surprise surgery bills by pairing Part B with the right supplemental coverage.

🦽 Durable Medical Equipment (DME)

Medicare Part B covers:

Walkers, wheelchairs, oxygen tanks
CPAP machines and diabetic supplies
Blood sugar monitors and testing strips

✅ You must:

Have a doctor’s prescription
Use a Medicare-approved supplier

💡 In Durham (27707) and Greenville, SC (29609), some Advantage plans now waive the 20% coinsurance on certain DME — while Original Medicare-only users pay out of pocket.

❌ What Part B Doesn’t Include

Even though Part B covers a lot, it’s not full coverage. Here’s what it leaves out:

Prescription drugs (you need Part D or an Advantage plan with drug coverage)
Long-term care or custodial services
Dental, vision, or hearing
Routine foot care
Eyeglasses and hearing aids (unless related to a covered condition)

🧠 This is where most seniors get caught off guard — thinking Medicare is “full coverage,” when it’s really just the foundation.

📞 Not Sure How Much You’ll Owe?

We help you measure every detail — your doctors, your prescriptions, your budget — before you enroll in a plan.

🎯 Get a Free Medicare Part B Cost Review »
Palmetto Mutual serves all of Cumberland County, Durham County, and every ZIP across NC and SC.

Part D Prescription Drug Plans

Balancing Your Grocery Budget — But for Meds

Choosing a Medicare drug plan is like managing your grocery budget. Some meds are cheap, like canned soup. Others — like insulin — are more like steak. The plan you pick determines how far your Medicare dollars stretch.

💬 In Surfside Beach (ZIP 29575), Susan switched to a new Part D plan and saved $432/year on her insulin. All it took was a five-minute phone review with Palmetto Mutual.

Let’s unpack what’s really in your drug cart.

💊 Drug Tiers & Formularies

Most Part D plans (and Advantage plans with drug coverage) divide medications into tiers — and each tier has a different cost.

📦 Common Tier Layout:

Tier	Type of Drug	Typical Cost with Coverage
Tier 1	Preferred generics	$0–$5
Tier 2	Non-preferred generics	$5–$10
Tier 3	Preferred brand-name	$30–$50
Tier 4	Non-preferred brand	$75+
Tier 5	Specialty drugs	25% coinsurance

📌 In counties like Horry, Wake, and Charleston, some enhanced drug plans now cover Tier 3 insulin for just $0–$15/month — depending on your ZIP and pharmacy.

🏪 Pharmacies That Matter

Not all pharmacies are equal under your plan.

Pharmacy Type	What It Means
Preferred Pharmacy	Lowest copays (e.g., $0 generics, $15 brands)
Standard Pharmacy	Higher copays (can be $10–$25 more per fill)

📍 In Surfside Beach (ZIP 29575), Susan’s original plan charged her $40/month at CVS. After switching to a plan where CVS was preferred, her copay dropped to $4.

💡 Did You Know?
In places like Greensboro (27407) and Columbia (29210), some plans favor Walmart or mail-order, while others prefer Walgreens or Rite Aid. Always check.

🧾 How the Donut Hole Works in 2025

Spoiler: It Doesn’t. It’s Gone.

Medicare Part D no longer has a “coverage gap” in 2025. Instead, it’s replaced with a simple $2,000 out-of-pocket cap.

🛒 Here’s the 2025 breakdown:

Phase	What You Pay
Deductible Phase	Pay up to first $590 (varies by plan)
Initial Coverage Phase	Pay ~25% coinsurance or copays
After $2,000 Out of Pocket	Pay $0 for rest of year

🎯 If you take insulin, brand-name inhalers, or arthritis meds in places like Durham (27703) or Mount Pleasant (29464) — hitting $2,000 could happen fast. After that? You pay nothing.

🛍️ How to Shop Smart for Prescriptions

✅ Here’s what to bring to your Part D review:

A list of all prescriptions
Your preferred pharmacy
Any mail-order preferences
Your ZIP code

📞 Palmetto Mutual agents compare every available plan in your ZIP, using your actual medication list — not just a guess.

📌 In counties like York, New Hanover, and Greenville, we’ve helped clients save $300–$800/year just by matching their drugs to the right plan.

📞 Ready to Save on Your Prescriptions?

Let us do the work. We’ll compare drug plans across every major carrier, every ZIP, and every pharmacy in your area — all over the phone.

🎯 Get My Free Part D Comparison »
Serving all of North and South Carolina — from Chapel Hill to Charleston.

How Medicare Advantage Plans Work

Let Medicare Be Your GPS — But Know the Route

Medicare Advantage Plans are like a GPS system — they’ll get you where you’re going, but only if you stay on the mapped route. Every ZIP code has different plans, different benefits, and different doctor networks.

💬 “Palmetto Mutual mapped everything for me. I didn’t realize my ZIP limited my doctor choices.” — James, Sumter, SC (ZIP 29150)

Let’s break down how these bundled plans work — and how to avoid the detours.

🧭 HMO vs. PPO Advantage Plans

Most Advantage plans come in two types: HMO and PPO. Both are run by private insurance companies — and both are required to cover everything Original Medicare does (and more). But how they route your care is very different.

Plan Type	What It Means	Example from NC/SC
🏠 HMO	Must use in-network providers. Referrals often required.	$0–$35 plans in Sumter (29150), Charlotte (28277)
🛣️ PPO	More flexibility. Can go out-of-network (at a cost).	Popular in Charleston (29407) and Greensboro (27407)

📌 In Sumter, James was locked into a plan where only a handful of local doctors were available. He switched to a PPO and regained access to his preferred cardiologist in Columbia.

🦷 Built-In Drug, Dental & Vision

One of the biggest perks of Advantage plans is what’s bundled in:

✅ Prescription Drug Coverage (Part D)
✅ Dental – cleanings, fillings, even dentures
✅ Vision – exams, eyeglasses, allowances
✅ Hearing – tests and hearing aids
✅ Extras – OTC cards, fitness memberships, meal delivery

💡 In counties like Richland, York, and Mecklenburg, many Advantage plans now include $2,000–$3,000 in dental, $100+ OTC cards, and free rides to doctor visits.

🧑‍⚕️ Local Networks Matter

Here’s where most people get tripped up:

Even if two ZIPs are in the same city, plan networks may be totally different.

Scenario	What Happens Without Checking
Your doctor isn’t in-network	You pay the full bill 💸
Your hospital is out-of-network	You may not be covered ❌
You move ZIP codes	You may lose your plan 🚨

📍 In Sumter (ZIP 29150), James’s HMO plan didn’t include the Sumter Heart Center — which meant he couldn’t see his regular cardiologist until he switched plans.

📏 Pros and Cons of Local Advantage Options

Advantage Plan Benefit	Pros ✅	Cons ⚠️
Low or $0 premium	Affordable upfront	Watch for hidden copays
Drug, dental, and vision included	One-stop coverage	Not all doctors are in-network
Out-of-pocket maximum	Financial protection	Can still reach $4,500–$7,500/year
Extra benefits (meals, fitness)	Adds real value	Not standardized across ZIPs

🧠 In places like Durham, Lexington, and New Hanover counties, seniors often choose Advantage plans for the perks — but only after checking their provider list with Palmetto Mutual.

📞 Want to See Which Advantage Plans Work in Your ZIP?

Every county and ZIP has different plans, networks, and perks. Let us guide you like a Medicare GPS — from Sumter to Spartanburg and beyond.

🎯 Get My Medicare Advantage Plan Comparison »
Free help. Real local agents. All by phone.

Medicare Supplement (Medigap) Plans Explained

Plan G: The Life Raft That Keeps You Afloat

Medicare Supplement Plans (also called Medigap) are like life rafts. When Original Medicare starts taking on water — from deductibles, coinsurance, or hospital bills — the right Medigap plan can keep you financially afloat.

💬 Meet Ellen in Conway (ZIP 29526). After a 4-day hospital stay, she was shocked to learn her bill would’ve been over $6,000 without a supplement. Her Plan G covered everything except a small deductible — and saved her from sinking into debt.

🔍 Myth vs. Fact: Understanding Medigap Plans

❌ Myth	✅ Fact
“Medicare covers everything.”	Medicare only covers 80% — the rest is your responsibility
“Medigap is too expensive.”	Plan G in Conway ranges $115–$140/month for age 65 (2025)
“I can switch Medigap plans any time.”	After age 65, underwriting rules apply in most cases
“Medigap includes dental, vision, and prescriptions.”	Medigap only fills medical gaps — not extras like Advantage plans

📌 In counties like Horry, Lexington, and Wake, we’ve seen thousands of seniors mistakenly assume Medicare covers more than it does — until bills start arriving.

🧾 Plan F, Plan G, Plan N: Key Differences

Plan	Who It’s For	What It Covers	Not Covered
Plan F	Only for those eligible before 2020	Everything, including Part B deductible	Not available to new enrollees
Plan G	Most popular in SC and NC	Covers 100% after $240 Part B deductible	No dental, vision, hearing
Plan N	Lower premiums, some copays	Similar to Plan G, but copays for doctor/ER visits	Doesn’t cover Part B excess charges

📍 In Conway (29526) and Cabarrus County, NC, Plan G offers the best blend of cost and protection for new Medicare enrollees.

💸 What You Still Pay With Medigap

Even with Medigap, there are a few fixed costs:

Monthly premium (varies by ZIP, age, company)
Part B deductible ($240 in 2025 for Plan G)
Standalone Part D plan (for prescriptions)

✅ Once the deductible is met, Plan G typically pays 100% of remaining hospital and outpatient charges.

💡 That means in places like Rock Hill (29732) or Greenville, NC (27834) — you’ll never see surprise copays after a surgery or hospital visit.

📋 How Underwriting Works After 65

Most people don’t realize this:
⏰ You only have 6 months after enrolling in Medicare Part B to join a Medigap plan without health questions.

After that, you may have to answer:

Medical history
Recent hospitalizations
Pre-existing conditions

📌 In counties like Mecklenburg and Charleston, we’ve helped clients appeal denied Medigap applications — but it’s much easier to enroll during your guaranteed issue window.

⭐ Why Plan G Is the Popular Choice in the Carolinas

✅ Strongest coverage for new Medicare members
✅ Predictable costs and no hidden copays
✅ Accepted by every Medicare doctor nationwide
✅ Works great for those who travel or split time between states

💬 “I live in Conway but spend every summer in the NC mountains. My Plan G goes wherever I go — no referrals, no surprises.” — Ellen, 29526

📞 Want a Medigap Plan That Actually Covers You?

Let us compare Medigap rates across every carrier in your ZIP — and help you enroll while you’re still protected by guaranteed issue.

🎯 See My Local Medigap Options »
Serving every Carolina county, from Horry to Mecklenburg to Richland.

Dental, Vision & Hearing Coverage Options

One Missing Battery Can Break the Whole System

Original Medicare doesn’t cover dental, vision, or hearing — and that’s like running a hearing aid without a battery. You’ve got the shell, but not the function. These services are essential to aging well, but they’re not built into the core plan.

💬 Chat Transcript:
Agent: “Did you know Medicare doesn’t include hearing aids?”
Mr. Alston (Florence, SC – ZIP 29505): “So that’s why it cost me $2,000 out of pocket!”

Let’s stack up your options — and help you power your plan the right way.

🧱 Layer 1: Why Medicare Leaves These Out

When Medicare was created in 1965, dental fillings and hearing aids weren’t seen as essential care. But today, we know better.

❌ Original Medicare does not cover:

Dental exams, cleanings, fillings, crowns, dentures
Vision exams, eyeglasses, or contacts
Hearing exams or hearing aids

📌 In counties like Florence, Wake, and Greenville, many seniors learn this only after the bill arrives.

🧱 Layer 2: DVH Standalone vs. Advantage Add-Ons

There are two main ways to get dental, vision, and hearing coverage:

Option	Description	Available in Florence (29505)?
🏥 Advantage Add-On	Included in many Medicare Advantage plans	✅ Yes
📦 Standalone DVH Plan	Separate policy just for dental, vision, and hearing	✅ Yes

💡 In Florence, DVH standalone plans typically cost $15–$55/month depending on coverage level.

🧱 Layer 3: Senior-Focused Plan Examples

Here’s how common options compare:

Benefit	Advantage Plan (HMO)	Standalone DVH Plan
Routine dental cleanings	✅ Often included	✅ Always included
Dentures or extractions	⚠️ Sometimes covered	✅ Covered (80–100%)
Eyeglasses or contacts	✅ Vision allowance ($100–250)	✅ More flexibility
Hearing aids	✅ $500–$1,000 allowance	✅ Higher-tier plans cover more
Choose any dentist?	❌ Network only	✅ Usually allowed

📍 In places like Columbia (29203) and Greensboro (27407), we’ve helped clients combine an Advantage plan with a high-end DVH to cover both local networks and full dental reconstruction.

🧾 Bundled vs. Separate DVH Plans

You Want…	Best Option
One card for everything	✅ Advantage Plan
Major dental work, crowns, or dentures	✅ Standalone DVH
Hearing aid flexibility	✅ Standalone DVH
Maximum coverage for cleanings + glasses	✅ Both combined
Any dentist or specialist	✅ Standalone DVH

🧠 Not sure what’s best for you? We walk through both options and show you what your ZIP qualifies for — not just what the ads promise.

📞 Don’t Let DVH Gaps Catch You Off Guard

Whether you’re in Florence, Durham, Charleston, or anywhere across the Carolinas, we help seniors protect their teeth, eyes, and ears — without overpaying.

🎯 Compare DVH Options in My ZIP »
Speak with a local Palmetto Mutual agent who knows the plans and the providers near you.

Medicare Special Needs Plans (SNPs)

When Health Issues Spark a Fire, This Plan Puts It Out

A Special Needs Plan (SNP) is like a fire extinguisher for your health and budget. If you qualify due to a chronic illness or dual eligibility (Medicare + Medicaid), an SNP can fully extinguish costly premiums, doctor copays, and drug bills — but most people don’t know they qualify.

💬 Maria in Fayetteville (ZIP 28304) didn’t realize her diabetes qualified her for a special plan. After calling Palmetto Mutual, she enrolled in a $0 SNP plan with dental, prescriptions, and a $125 monthly grocery card — all at no cost to her.

🚨 Emergency SNP Checklist: Do You Qualify?

Question	If Yes…
Are you on both Medicare and Medicaid?	✅ You may qualify for a Dual SNP (D-SNP)
Do you have a chronic condition like diabetes, CHF, COPD?	✅ You may qualify for a Chronic SNP (C-SNP)
Have you been in a nursing home or facility?	✅ You may qualify for an Institutional SNP (I-SNP)

📌 SNP plans are available across Cumberland County, Richland County, New Hanover County, and more.

👥 Dual-Eligible (Medicaid + Medicare)

If you have both Medicare and Medicaid, you may be eligible for a D-SNP — a powerful $0 plan that includes:

Full hospital and doctor coverage
Dental, vision, and hearing
Prescription drugs
Grocery/OTC cards ($100–$150/month)
$0 copays on most services
Free transportation to doctors

📍 In Fayetteville (ZIP 28304), some D-SNPs also include home health support, case managers, and money toward utility bills.

❤️ Chronic Condition SNPs (C-SNPs)

If you have one or more of these conditions, you may qualify:

Diabetes
Congestive Heart Failure (CHF)
COPD or other lung diseases
ESRD (End-Stage Renal Disease)
Dementia or mental health disorders

✅ These plans are designed with condition-specific benefits, such as:

Access to specialists in your condition
Extra medication coverage
Lower insulin and device costs
Telehealth and nurse case management

💡 In places like Charleston (29414) and Durham (27703), C-SNPs offer free diabetic supplies and nutrition coaching.

📅 Enrollment Windows for SNPs

You don’t have to wait for AEP (October–December). You may qualify for a Special Enrollment Period at any time if:

Life Event	Enrollment Trigger?
You were diagnosed with a chronic illness	✅ Yes
You just became eligible for Medicaid	✅ Yes
You moved to a new ZIP code	✅ Yes
Your current SNP plan dropped coverage	✅ Yes

🧠 Most seniors don’t know they can change outside of AEP — Palmetto Mutual checks this for free.

📞 Could You Qualify for a $0 Special Needs Plan?

One quick call with our team could unlock a plan designed specifically for your condition and financial situation.

🎯 See If I Qualify for an SNP »
We help seniors in every Carolina county, from Fayetteville to Florence to Fort Mill.

How to Avoid Medicare Late Enrollment Penalties

Follow the Medicare Speed Limit — Or Pay for Life

When it comes to Medicare deadlines, the rules are strict — like speed limit signs on a winding road. If you miss your turn or go too slow, you won’t get a ticket — you’ll get a monthly penalty that lasts forever.

💬 “I delayed because I didn’t think I needed Part D. Now I pay a penalty every month.” — Thomas, Lumberton, NC (ZIP 28358)

Let’s help you avoid the fines — before the clock runs out.

🛑 Red Light / Green Light: Medicare Timing Rules

Action	Light	What to Know
Enroll in Part B during your IEP	🟢 Green	No penalties. You’re right on time.
Skip Part B with no employer coverage	🔴 Red	10% penalty per year delayed — for life
Delay Part D because you’re healthy	🔴 Red	1% per month penalty — forever
Keep employer/union/VA coverage (creditable)	🟢 Green	You’re safe. No penalty if it meets Medicare standards
Go 63+ days without drug coverage	🔴 Red	Triggers permanent Part D penalty

📌 In Lumberton (ZIP 28358), Thomas delayed enrolling in a drug plan. Now he pays an extra $5.60/month — every month — on top of his plan premium.

💸 Part B Late Penalties

If you delay Part B and don’t have creditable employer coverage, Medicare adds a penalty to your monthly premium:

10% for every 12-month period you delay
Applied for the rest of your life

🧠 If the standard Part B premium is $174.70 (2025), a 2-year delay = 20% penalty = $34.94/month extra, permanently.

💊 Part D Penalties Explained

Even if you don’t take medications now, you’re expected to have Part D or equivalent coverage.

Delay Duration	Added Penalty
10 months without coverage	10% of $34.70 ≈ $3.47/month extra
24 months (2 years)	24% of base ≈ $8.33/month

💡 Part D penalties are cumulative and permanent — even if you later join a great plan.

✅ What Counts as Creditable Coverage?

To avoid penalties, you must have coverage as good as Medicare’s.

Coverage Type	Creditable? ✅❌
Large employer group plan	✅ Yes
VA or TRICARE drug coverage	✅ Yes
COBRA or retiree plan	❌ Usually not
Marketplace/ACA plan	❌ Not creditable
Discount drug card	❌ Not coverage

📌 In counties like Robeson, York, and Guilford, many seniors are caught off guard after retiring and going on COBRA — only to discover it didn’t count toward Medicare’s clock.

⏳ Special Enrollment Periods That Save You

You can still enroll without penalty if you qualify for an SEP (Special Enrollment Period):

Qualifying Event	SEP Granted? ✅
Lost employer or union coverage	✅ Yes
Moved to a new ZIP code	✅ Yes
Gained or lost Medicaid	✅ Yes
Released from jail or institution	✅ Yes
Missed IEP due to misinformation	✅ In some cases

🧠 Palmetto Mutual will help you file SEP paperwork — or appeal a penalty — if you were given incorrect info.

📞 Don’t Let a Mistake Cost You for Life

Avoiding Medicare penalties starts with knowing your window — and having someone local to guide you through it.

🎯 Check My Enrollment Timing »
We serve all of NC and SC, from Lumberton to Lexington, and everywhere in between.

What If You’re Still Working at 65?

Contractor or DIY — Your Health Coverage Needs a Plan

Turning 65 doesn’t mean you have to retire — but it does mean you have to decide whether to stay on your employer’s health insurance or switch to Medicare. It’s a lot like deciding whether to hire a contractor or do a home project yourself.

💬 Mike in Charleston (ZIP 29414) stayed on his employer plan — because it covered his wife, too. Gloria in Hartsville (ZIP 29550) switched to full Medicare. Her COBRA would’ve cost $650/month — Medicare was just $175.

Both made smart moves. The key? They reviewed their options with Palmetto Mutual first.

🧑‍🔧 Employer Group Health Plans vs. Medicare

Situation	Best Route
Still working at a large company	✅ Staying may make sense
Retiring or COBRA coverage only	✅ Medicare is often better
Coverage is limited or expensive	✅ Medicare is likely cheaper

📌 In Charleston (29414), Mike’s employer plan cost $200/month and covered his family. Medicare wouldn’t have covered his spouse — so he delayed enrolling in Part B and avoided penalties.

📍 In Hartsville (29550), Gloria’s COBRA offer was $650/month. She chose Medicare Part A and B, added a $0 Advantage plan with prescriptions and dental — and saved over $5,000/year.

⏳ What Happens If You Delay Enrollment?

If you delay Part B (doctor/outpatient coverage), make sure your employer coverage is creditable — otherwise:

❌ You may owe:

A 10% late enrollment penalty for every full year delayed
Higher out-of-pocket costs later
A wait until the next General Enrollment Period

✅ You can delay safely if:

Your employer has 20+ employees
You’re actively working and insured (not retired or on COBRA)

📞 Palmetto Mutual helps you contact your HR team to confirm — at no charge.

💰 Comparing Costs and Networks

Feature	Employer Plan	Medicare (Parts A & B + Advantage)
Monthly Premium	$300–$1,200/month (COBRA)	~$175–$250 (Medicare + drug/dental)
Doctor Flexibility	Limited to network	Wider options with Supplement
Family Coverage	✅ Often included	❌ Medicare is individual only
Drug Coverage	Included (varies)	Add Part D or get through Advantage
Out-of-Pocket Costs	Can be unpredictable	$0–$7,500 max (Advantage)

📌 In counties like Charleston, Darlington, and Wake, employer plans can cost 4–6x more than Medicare once subsidies end.

🚧 How to Avoid Overlapping Coverage

Don’t Do This…	Do This Instead…
Enroll in Medicare and keep employer plan	✅ Compare side-by-side first
Assume your coverage is “creditable”	✅ Confirm with your HR department
Sign up for COBRA without a Medicare plan	✅ Check your Medicare window
Let your Medicare clock run silently	✅ Use your Special Enrollment Period

🧠 We help you avoid penalties, double premiums, and coverage gaps with one free review.

📞 Still Working? Let’s Compare Your Options

We’ll show you if it makes more sense to keep your plan or shift to Medicare — using real numbers from your ZIP code and employer type.

🎯 Get a Free Medicare vs. Employer Plan Comparison »
Serving working seniors from Charleston to Charlotte and Hartsville to Hendersonville.

Medicare for Veterans (VA + TRICARE)

The Right Tool for Every Health Job

If you’re a veteran, you’ve already got a few tools on your belt — like VA coverage or TRICARE. But when you turn 65, Medicare adds another tool that may fill important gaps. The trick is knowing how the pieces work together.

💬 “TRICARE and Medicare worked together — but no one explained how until I called Palmetto Mutual.” — Gerald, Carolina Forest, SC (ZIP 29579)

Let’s load up your toolbelt the right way.

🔧 Using Medicare and VA Together

Veterans enrolled in VA health benefits can also enroll in Medicare for more flexibility and protection.

✅ What You Get:

Care at any Medicare-participating hospital or doctor
Coverage when the VA facility is too far or unavailable
A backup plan if you need urgent or emergency care outside the VA

❗ Important: VA coverage is not considered creditable coverage for delaying Part B — so you may face penalties if you don’t enroll in Medicare on time.

📍 Veterans in ZIP 29579 and across Horry and Richland counties often combine Medicare with VA to increase access to civilian specialists.

💊 Should You Get Part B or D?

Coverage Type	Do You Need It If You Have VA?
Part B (Doctors/Outpatient)	✅ Yes — or face a penalty later
Part D (Prescriptions)	🟡 Maybe — depends on your access to VA pharmacies

✅ Many veterans enroll in Part B to use civilian doctors, outpatient surgery centers, or travel coverage.

⚠️ Part D is optional if you’re comfortable using only VA pharmacies — but if you want the option of CVS, Walgreens, or Walmart, it’s smart to enroll in a low-cost plan.

🪖 TRICARE for Life Overview

If you’re a military retiree with TRICARE, your benefits get an upgrade when Medicare starts.

✅ How it works:

You must enroll in Parts A & B
Medicare becomes your primary payer
TRICARE for Life pays the secondary share — often leaving you with $0 out-of-pocket

📌 In areas like Carolina Forest (ZIP 29579), veterans with TRICARE for Life can see any Medicare-approved provider nationwide — no referrals, no copays.

⚙️ When Medicare Is Primary vs. Secondary

Where You Receive Care	Primary Payer	Secondary Payer
Civilian doctor or hospital	✅ Medicare	🪖 TRICARE for Life
VA facility	🟤 VA only	Medicare not billed
Pharmacy (non-VA)	⚠️ Only covered if you have Part D or TFL prescription benefit

🧠 Knowing which plan pays first helps avoid denials, delays, or unexpected bills.

📞 Veteran? Let Us Help You Coordinate Coverage

You served us — now let us serve you. We’ll help you build the perfect Medicare + VA + TRICARE toolbelt, with zero pressure and full clarity.

🎯 Get My Medicare & Veteran Coverage Review »
Trusted by veterans across Horry, Cumberland, and York counties.

Medicare and Medicaid – Dual Eligibility

The Emergency Blanket That Covers Everything

For seniors with limited income or chronic health conditions, having both Medicare and Medicaid is like wrapping up in an emergency blanket — warm, protective, and life-saving when everything else fails.

💬 Rosa in Marion, SC (ZIP 29571), didn’t know Medicaid could help with her Medicare bills. But after a free call with Palmetto Mutual, she qualified for a $0 Dual Advantage Plan with dental, rides, prescriptions, and more — all without paying a penny.

👩‍⚕️ Persona Contrast: Rosa vs. Gloria

Name	Location	Situation
Rosa	Marion (29571)	Lives on $1,150/month Social Security; diabetic; takes 4 meds
Gloria	Durham (27707)	Owns her home, has savings, not Medicaid-eligible

✅ Rosa qualified for a Dual Special Needs Plan (D-SNP) — $0 premium, $0 copays, and $125/month grocery/OTC card.
⚠️ Gloria has standard Medicare and pays copays and premiums out-of-pocket.

📌 Thousands of seniors in Marion County, Durham County, and Richland County qualify but don’t know it.

✅ Who Qualifies for Both Medicare and Medicaid?

You may be dually eligible if:

You’re 65+ (or on SSDI)
Your monthly income is below:
- ~$1,700 for singles
- ~$2,300 for married couples
Your assets are limited (rules vary by state)

📞 We help you verify eligibility over the phone in minutes.

🧾 QMB, SLMB, and Other Medicaid Programs

Program	What It Stands For	What It Covers
QMB	Qualified Medicare Beneficiary	Part A & B premiums, deductibles, coinsurance
SLMB	Specified Low-Income Medicare Beneficiary	Part B premium only
QI	Qualifying Individual	Limited assistance with Part B premium

💡 If you qualify for QMB, you should not be charged for any Medicare-covered services — zero out-of-pocket.

💊 How Dual Advantage Plans Work

Dual Special Needs Plans (D-SNPs) are designed specifically for seniors on both Medicare and Medicaid.

Benefit Type	What’s Included in Most D-SNPs
Premiums	$0 per month
Copays	$0 for doctor visits, hospital, and prescriptions
Dental & Vision	Cleanings, fillings, glasses, and hearing aids
OTC & Grocery Cards	$100–$175/month for food and household items
Transportation	Free rides to medical appointments
Nurse Case Manager	Yes — personalized help navigating your care

📌 In places like Marion (29571), Columbia (29210), and Charlotte (28208), seniors are getting thousands in annual benefits — all at no cost.

🧺 Medicaid Waivers and Flex Cards

If you qualify for Medicaid, you may also be eligible for state-level support programs, including:

Flex Cards: $200–$500/year for dental, glasses, or hearing aids
Home & Community-Based Waivers: Support for seniors aging in place
Extra support: Utility bills, personal care items, meal delivery

🧠 Palmetto Mutual helps you apply — or tells you if you already qualify and just aren’t using your benefits.

📞 Not Sure If You Qualify? We’ll Check For You

You may already be eligible for a $0 Dual Advantage Plan and not know it.
We’ll walk you through eligibility, plan options, and added benefits based on your ZIP code.

🎯 Check My Dual Eligibility Now »
Proudly helping seniors in Marion, Durham, Charleston, and every Carolina county.

Understanding IRMAA (Income-Related Monthly Adjustment Amount)

When Your Income Turns Up the Heat

IRMAA is like a thermostat on your Medicare premiums. Even a small income increase can cause the dial to rise — and most seniors don’t realize how fast it climbs until they get the bill.

💬 “One raise pushed my premiums up by $68. I had no idea income mattered!” — Lisa, Myrtle Beach, SC (ZIP 29588)

Let’s walk through the heat settings — and how to turn them back down if you qualify.

❓ IRMAA Quiz: Can You Answer These?

Q1: Do all Medicare beneficiaries pay the same for Part B and D?
🅧 No. If your income is higher, Medicare charges more — that’s IRMAA.

Q2: Is IRMAA based on this year’s income?
🅧 No. It’s based on your tax return from two years ago. For 2025, that means your 2023 income.

Q3: Can you appeal an IRMAA charge?
✅ Yes! If your income has dropped due to retirement or other life events, you can request a reduction.

📌 In Myrtle Beach (ZIP 29588), Lisa’s income spiked temporarily in 2023 — which raised her 2025 Part B premium to $244.60/month. She filed an appeal and lowered her cost.

💵 What Is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount — a surcharge added to your Part B and/or Part D premiums if your income exceeds a certain threshold.

It affects:

Part B (doctor/outpatient services)
Part D (prescription drug coverage)

📍 This mostly applies to retirees with pensions, rental income, asset withdrawals, or Social Security + IRA combos — common in areas like Horry County, Wake County, and Greenville County.

📊 Income Tiers and Premium Surcharges (2025)

Filing Status	2023 MAGI (Modified Adjusted Gross Income)	Part B Premium (2025)	IRMAA on Part D
<$103,000	Standard premium only	$174.70/month	$0
$103k–$129k	IRMAA Tier 2	$244.60/month	~$12.90/month
$129k–$161k	Tier 3	$349.40/month	~$33.30/month
$161k–$193k	Tier 4	$454.20/month	~$53.80/month
$193k+	Tier 5	$559.00+/month	~$74.20+/month

💡 Even a one-time income bump from a house sale or Roth conversion can place you in a higher IRMAA tier.

✍️ How to Appeal IRMAA

You can file Form SSA-44 with Social Security to request a lower IRMAA tier if your income has changed due to:

Retirement
Marriage or divorce
Death of a spouse
Loss of income-producing property
Work stoppage or reduction

📞 Palmetto Mutual walks you through the appeal form — and helps you gather the right documentation.

🔁 Life Events That Trigger Relief

Life Event	Can You Appeal IRMAA? ✅
Retired or stopped working	✅ Yes
Spouse passed away	✅ Yes
Sold rental property	❌ Only if income drops
Inherited IRA	❌ Usually no
Switched from full-time to part-time	✅ Yes

🧠 You must act quickly — appeals should be filed as soon as the IRMAA notice arrives.

📞 Not Sure Why Your Premium Went Up?

One quick call could reveal whether you’re paying more than necessary — and if we can help reduce it with a simple SSA form.

🎯 Appeal My IRMAA Surcharge »
Serving Medicare clients across Myrtle Beach, Raleigh, Columbia, and all of the Carolinas.

How to Compare Medicare Plans by ZIP Code

One Mailbox Flag Up, the Other Still Down

Medicare plan options can vary dramatically between ZIP codes — even if they’re just down the street from each other. Think of it like two side-by-side mailboxes: one has new plan offers waiting inside, the other’s still empty. You’ll never know the difference unless you check.

💬 Chat Transcript:
Agent: “Did you know plans in 29577 and 29588 are different?”
Client: “I thought they were the same — they’re 10 minutes apart!”

They’re not — and here’s why.

📬 Why ZIPs Change Plan Availability

Medicare Advantage and Medigap plan availability is set at the county and ZIP level, not the state level. Each ZIP can have:

Different carrier contracts
Varying hospital network partnerships
Unique plan pricing and benefits

📌 In the Myrtle Beach area:

29577 (central Myrtle Beach): Plan N = ~$90/month
29588 (south side): Plan N = ~$110/month, different dental options, and separate Advantage networks

💡 The same applies across the Carolinas — ZIP-level changes are common in places like Charlotte (28277 vs. 28215) or Columbia (29203 vs. 29210).

🏙️ Urban vs. Rural Differences

Factor	Urban ZIP (e.g., 28277, 29577)	Rural ZIP (e.g., 28455, 29168)
Plan Variety	✅ More Advantage and Medigap options	⚠️ Fewer total plans
Premiums	Often lower due to competition	Can be $10–$40/month higher
Network Size	Larger — includes specialists/hospitals	Smaller — limited facility options
Extra Benefits	Better OTC, grocery cards, gym perks	More limited or not included

📍 ZIPs in Wake County, Charleston County, and Greenville County tend to offer the broadest Advantage and Supplement options.

💰 Which ZIPs Have the Best Value?

There’s no “best” plan — only what’s best for your ZIP, your doctors, and your prescriptions.

ZIP Code	Type	Sample Plan	Monthly Cost	Notable Feature
29577	Medigap N	Plan N	$90/month	Lower premium, strong access
29588	Medigap N	Plan N	$110/month	Higher cost, but dental add-on
29210	Advantage	PPO Plan	$0/month	$3,000 dental + $100 OTC card
27703	Advantage	HMO Plan	$19/month	Extra ride benefit + vision

📌 We track these costs and changes daily — so you don’t have to.

👨‍⚕️ How to Find Plans That Match Your Doctors

The right plan isn’t just about the price — it’s about access.

✅ Before enrolling, make sure your plan:

Covers your primary care physician (PCP)
Includes your specialists and hospital of choice
Works with your pharmacy
Doesn’t drop your doctors next year

🧠 Palmetto Mutual checks this for you — by ZIP, by plan, and by provider name.

📞 Want to Know Which Plans Work Best in Your ZIP?

We compare plans across every ZIP code in the Carolinas — from 29577 to 27513, and everywhere in between.
No guesswork. No ads. Just real options.

🎯 Start My ZIP-Based Medicare Comparison »
Available by phone — and personalized to your local provider list.

Medicare & Prescription Drug Costs in 2025

Your Pharmacy Bill = A Grocery Budget You Can Control

Think of your prescription costs like a grocery budget. Every drug you take adds an item to the receipt — and for many seniors, those line items stack up fast.

💬 “Last year I spent over $1,200 just on my prescriptions — I had no idea there were better options.” — Brenda, Fayetteville, NC (ZIP 28306)

Let’s break down what’s changed — and how to shrink your bill in 2025.

💊 National Drug Price Caps (2025)

Thanks to the Inflation Reduction Act, Medicare Part D has new nationwide protections in place starting this year:

Medication Type	2025 Maximum Cost with Coverage
Insulin	$35/month cap
Vaccines (like shingles)	$0 — fully covered
Out-of-pocket limit	$2,000/year cap (NEW)

📌 In Fayetteville (ZIP 28306) and across Cumberland and York counties, insulin users now save hundreds annually — especially when paired with enhanced Part D plans.

🍩 The 2025 Donut Hole Rules (Gone!)

Forget everything you knew about the “Donut Hole.” In 2025, the coverage gap is completely replaced by a clear out-of-pocket spending cap.

🛒 Here’s how drug costs work now:

Coverage Phase	What You Pay
Deductible Phase	Up to first $590 (varies by plan)
Initial Coverage	~25% or flat copays per drug
After $2,000 OOP	You pay $0 for all drugs

💡 If you reach $2,000 in out-of-pocket spending — whether from high-tier meds, insulin, or specialty drugs — you pay nothing else for the rest of the year.

💊 Enhanced vs. Basic Part D Plans

Feature	Basic Part D Plan	Enhanced Part D Plan
Monthly Premium	$0–$30	$30–$70
Preferred Drug Tiers	Often limited	Wider coverage, more generics
Preferred Pharmacies	Fewer	More flexibility + lower copays
Copay for Tier 3 Brand Rx	$40–$50	As low as $10–$25
Support for insulin/diabetes	Basic	Enhanced management + coaching

📍 In Cumberland County and Horry County, many seniors find the best value by pairing an enhanced drug plan with an Advantage or Supplement plan — reducing annual Rx costs by $500–$800.

🧾 Where You Can Still Save Big

✅ Here’s where smart comparisons matter most:

Switching pharmacies: Some plans offer $0 generics at Walmart, but charge $15 at Walgreens
Choosing the right tier structure: Not all plans classify your drug the same way
Using mail-order: 90-day supplies = better pricing and fewer trips
Annual plan review: Formularies change every year — so should your plan

📞 Palmetto Mutual compares every available plan in your ZIP — with your exact drug list.

📞 Ready to Lower Your Drug Costs?

If you’re paying more than $2,000/year in prescriptions, there’s a better way.
We’ll find the most affordable drug plan in your ZIP — and explain exactly how the new cap works.

🎯 Get My 2025 Drug Plan Review »
Serving seniors across Fayetteville, Greenville, Charleston, and all of the Carolinas.

Extra Benefits — Dental, OTC, Flex Cards, Meals & More

Your Porch Light to Hidden Medicare Value

Medicare Advantage plans can feel like a porch at night — the core is there, but until you flip the light on, you don’t see the extras waiting for you. Many seniors are surprised to find they qualify for over $2,000/year in added benefits — at no extra cost.

💬 Frank in Goose Creek, SC (ZIP 29445), enrolled in a $0 Advantage plan and got:

✅ $75/month grocery card
✅ $2,500 in dental benefits
✅ Free rides to his doctor
All with $0 premium and $0 copays.

🛒 Grocery Cards & Utility Support

🛍️ Benefit	What It Does
Grocery Cards	$50–$175/month for healthy food
OTC Allowances	Buy aspirin, vitamins, wound care, etc.
Utility Support	Help paying for gas, electric, water bills
Home Meal Delivery	Hot meals after hospital stay or chronic issue

📍 In ZIPs like 29445 (Goose Creek), 27610 (Raleigh), and 29203 (Columbia), these benefits are commonly built into local $0 plans.

😁 Dental, Vision & Hearing Add-Ons

🦷 Service	Typical Advantage Plan Coverage
Dental	Cleanings, fillings, crowns, dentures — up to $3,000/year
Vision	Exams + glasses or contacts — up to $250/year
Hearing	Tests and hearing aids — often with low or $0 copay

✅ These are not included with Original Medicare, and must be added through Advantage or DVH (Dental-Vision-Hearing) plans.

💡 In counties like Berkeley, Wake, and Guilford, Advantage plans now offer dual cleanings, full X-rays, and oral surgery allowances — with $0 copays in many ZIPs.

💳 Flex Cards and Transportation

🪪 Flex Benefit	What It Covers
Flex Cards	$200–$500/year — for dental, eyewear, hearing aids, or wellness gear
Transportation	20–36 free round-trip rides/year for appointments
Partner Networks	Many plans partner with Uber, Lyft, and ride services

📌 Frank uses his card for over-the-counter meds and dental copays. The rides help him get to appointments on time, without worrying about gas.

❓ Are These Benefits Worth It?

Question	If Yes… Choose:
Need help with food or medications?	✅ Advantage plan
Paying out of pocket for dental work?	✅ Advantage or DVH add-on
Need rides to appointments?	✅ Advantage plan
Want one card that does it all?	✅ Advantage plan

🧠 We break down which plans in your ZIP offer these perks — and which ones are just fluff.

📞 Want to Unlock These Benefits in Your ZIP?

If you’re not using your grocery card, flex funds, or dental allowance, you’re leaving value on the table.
Let us help you flip on the porch light — and find out what your plan can really do.

🎯 Get My Local Benefits Breakdown »
Palmetto Mutual serves all of Goose Creek, Greensboro, Durham, and your ZIP too.

The Annual Enrollment Period (AEP)

Your Medicare Route Planner — Don’t Miss the Turn

Medicare has just one major route adjustment window each year — the Annual Enrollment Period (AEP). If you miss it, you may be stuck with your current plan for another 12 months. Think of it like a route planner: this is the moment to reroute, recalculate, and save money.

💬 “I didn’t even know I could change my plan — and I missed the window.” — Edna, Wilmington, NC (ZIP 28401)

The good news? AEP happens every year. Here’s how to prepare — and make the most of it.

🗓️ When AEP Happens: October 15 – December 7

Every fall, Medicare opens its biggest planning window. During these 54 days, every Medicare beneficiary can review and change their coverage.

Date Range	What Happens
October 15	✅ AEP begins — changes can be made
December 7	🛑 Last day to enroll/change plans
January 1	🚀 New plan starts

📍 In ZIP 28401 (Wilmington), Edna used her AEP window to switch to a new Advantage plan with better drug coverage — and saved $38/month.

🔄 What You Can Change During AEP

Change Type	Allowed During AEP? ✅
Switch from one Advantage plan to another	✅ Yes
Drop Advantage and go back to Original Medicare	✅ Yes
Enroll in a new Part D drug plan	✅ Yes
Change from one drug plan to another	✅ Yes
Apply for extra benefits (dental, vision)	✅ Yes — if bundled

⚠️ What you can’t do:

Apply for a Medigap plan without underwriting if your 6-month window has passed
Enroll in Medicare for the first time — that’s done during your Initial Enrollment Period (IEP)

⚠️ Common Mistakes to Avoid

Mistake	Why It Matters
Assuming your plan hasn’t changed	Drug formularies and premiums shift yearly
Waiting until December 7 to review	Agents and systems are overloaded
Choosing a plan for the extras only	May not cover your doctors or prescriptions
Ignoring your ZIP-specific options	Plans vary between ZIPs — sometimes even across town

💡 In areas like New Hanover County, Wake County, and Charleston County, dozens of new Advantage plans launch every year — with new networks and updated benefits.

✅ How to Prepare Before It Starts

Your Medicare route review should feel like a GPS check — not a guessing game.
Here’s what to gather before October:

📃 Your current plan card(s)
💊 Updated list of prescriptions (name, dosage, pharmacy)
👨‍⚕️ List of current doctors and specialists
📍 Your home ZIP code (plans are ZIP-specific!)
📝 Any recent plan frustrations: costs, copays, billing surprises

📞 Palmetto Mutual builds a custom comparison report before AEP even begins — so you’re first in line when the gates open on October 15.

📞 Want to Plan Your AEP Route the Smart Way?

One free review now can save you hundreds next year — and give you more benefits, more choices, and more peace of mind.

🎯 Schedule My Medicare AEP Review »
Serving all of Wilmington, Charleston, Cary, and every ZIP in the Carolinas.

Special Enrollment Periods (SEPs)

When Life Changes, You Need a Medicare Filter

Medicare is like a water system — and when life changes unexpectedly, a Special Enrollment Period (SEP) acts like a filter that keeps things flowing. Whether you moved ZIP codes, lost employer coverage, or became eligible for Medicaid, SEPs let you adjust your plan without waiting for AEP.

💬 Chat Transcript:
Agent: “Did you just move ZIP codes?”
Mrs. White: “Yes — I left Bennettsville for Conway!”
Agent: “Perfect. You qualify for an SEP. Let’s find a better plan now.”

🚨 SEP Emergency Checklist: Do You Qualify?

Life Event	SEP Triggered? ✅
You moved to a new ZIP or county	✅ Yes
You lost employer or union health coverage	✅ Yes
You were released from a facility or jail	✅ Yes
You became eligible or lost Medicaid	✅ Yes
Your current Medicare plan ended or changed	✅ Yes

📌 When Mrs. White moved from Bennettsville (ZIP 29512) to Conway (ZIP 29526), she unlocked new Advantage plans not available in her old ZIP — and saved $45/month.

🗺️ Moving to a New County or ZIP Code

Even a short-distance move can change your Medicare eligibility.

✅ You may qualify for an SEP if:

You move out of your plan’s service area
You relocate into a new network
Your new county or ZIP code offers different Advantage or drug plans

📍 This happens often in areas like:

Conway (29526)
Greensboro (27407)
Rock Hill (29732)

💡 We help you review all new options as soon as your address changes.

🧑‍💼 Losing Employer Coverage

If you leave your job or your spouse retires, you may lose health benefits — but you don’t have to wait until AEP.

✅ SEP lets you:

Enroll in Medicare Advantage or Part D
Drop your employer plan
Avoid late enrollment penalties

⚠️ You have just 2 months after losing coverage to use this SEP — don’t delay.

💡 How to Use Your SEP Wisely

Don’t Do This…	Do This Instead…
Assume you have to wait for October	✅ Call us now to check your SEP status
Enroll in a random plan on TV	✅ Review your doctors, drugs, and ZIP
Miss your SEP deadline	✅ Let us track it for you — free

📞 Palmetto Mutual walks you through your SEP start and end dates — and helps you avoid permanent penalties.

📞 Think You Missed the Window? You Might Still Qualify

If you moved, lost coverage, or had any major life event, let’s check for a Special Enrollment Period. We’ll guide you every step of the way — no waiting, no pressure.

🎯 Check My SEP Eligibility Now »
Helping clients across Conway, Bennettsville, Raleigh, and every Carolina ZIP.

Medicare Marketing Scams to Avoid in 2025

When the Smoke Starts Rising — Grab the Right Fire Extinguisher

Medicare marketing has become a wildfire of confusion. Call centers, TV ads, and fake “benefits departments” are flooding the airwaves — and if you’re not careful, you can get burned. The solution? A trusted guide with the right fire extinguisher.

💬 Tammy in Burgaw, NC (ZIP 28425) signed up through a call center after seeing a flashy TV ad. What they didn’t tell her? Her new plan didn’t cover her specialists. Now she’s paying $385/month out of pocket — and stuck until AEP.

🔥 Myth vs. Fact: What’s Real and What’s a Sales Trap?

❌ Medicare Myth	✅ Palmetto Mutual Fact
“You’ve been pre-approved for a better plan!”	Medicare does not pre-approve plans. That’s a bait tactic.
“This plan is totally free and covers everything!”	All plans have limits, networks, and copays — even the $0 ones.
“We’re with Medicare — just verify your ID.”	Real Medicare will never call or text you out of the blue.
“Switch now and get $148 back every month!”	The “giveback” only applies to certain ZIPs — and often cuts other benefits.

📍 This misinformation is especially common in Pender County, York County, and Durham County, where new Advantage plans launch annually and scammers piggyback on confusion.

📞 Robocalls & Fake Agencies

🚫 Red Flags:

Out-of-the-blue calls claiming to be from “Medicare Benefits”
Offers to enroll you “right now” without reviewing doctors or drugs
Asking for your Medicare number over the phone or by text

✅ Palmetto Mutual does not cold-call. You call us when you’re ready — and we never enroll you without a complete review.

📺 Deceptive TV Commercials

We’ve all seen them:
“$0 premiums! Free dental! Vision! Get money back now!”

🎭 The catch?

The plan may not be available in your ZIP
Your doctors may not accept it
The fine print buries critical limitations

📌 In Burgaw (28425), Tammy’s TV-promoted plan looked great — until she realized her neurologist in Wilmington wasn’t in-network. That mistake cost her nearly $400/month.

💬 “Too Good to Be True” Offers

🚨 Watch for:

“One card covers it all!” ads
Guaranteed approval “with no review”
Promises of free dental/vision without checking your county

✅ Real help asks about your needs: doctors, prescriptions, budget, ZIP. That’s what Palmetto Mutual does — every single time.

🧯 What Real Help Looks Like

Feature	Palmetto Mutual	Call Center/TV Ad
Local, licensed agents	✅ Yes — in the Carolinas	❌ Usually out-of-state
Verifies doctors, prescriptions	✅ Every single time	❌ Almost never
Explains every benefit & drawback	✅ Transparent and easy to follow	❌ Pushes only the sale
Helps with enrollment AND appeals	✅ Yes	❌ No post-enrollment help

💡 We believe in clarity over flash, and people over profits.

📞 Think You May Have Been Tricked? We Can Help.

If you enrolled through a national ad, call center, or mailer and something doesn’t feel right — we’ll review your plan, check for errors, and help you change if you still qualify.

🎯 Request a Scam-Free Medicare Review »
We’ve helped seniors in Burgaw, Charleston, Cary, and beyond fix enrollment mistakes — without judgment.

Medicare’s Future — What’s Changing in 2025?

Your Medicare Route Is Under Construction — Detours Ahead

Every year, Medicare gets a few new potholes… and a few new lanes. For 2025, Congress has repaved some major parts of the program — from drug pricing to mental health. Think of it like a construction zone on your healthcare highway: delays if you ignore it, smoother roads if you plan ahead.

💬 “Every year something changes. It’s exhausting.” — Geraldine, Georgetown, SC (ZIP 29440)

We’ll break it down — and show you how to avoid the traffic.

🏛️ Legislative Updates That Matter in 2025

✅ Key changes to Medicare in 2025:

No more Donut Hole: Prescription out-of-pocket costs capped at $2,000/year
Expanded insulin savings: Still capped at $35/month
New mental health access: Licensed counselors and marriage therapists now covered under Part B
Enhanced telehealth: Rural ZIPs (like 29440) now qualify for year-round virtual care
Stronger protections from robocall scams: New federal rules targeting deceptive marketing

📌 These updates especially help seniors in counties like Georgetown, Cumberland, New Hanover, and York, where rural networks and drug costs have been ongoing concerns.

🌟 New Benefits Coming to Advantage Plans

Many 2025 Medicare Advantage plans across the Carolinas are rolling out:

💳 Higher Flex Card limits ($250–$500/year)
🛒 Grocery & OTC cards with fewer restrictions
🦷 Expanded dental allowances — $2,500+ on major work
💬 More behavioral health benefits, including remote therapy
🏠 In-home support services for eligible seniors

💡 *These changes are ZIP-specific — so what’s available in Georgetown (29440) may differ from Raleigh (27610) or *Rock Hill (29732).

📊 Cost Trends to Watch

Category	2025 Trend
Part B Premium	Slight increase expected (est. $174.70)
Part D Out-of-Pocket Max	New $2,000 limit — huge savings for many
Medigap Plan G Pricing	Stable in most Carolina ZIPs
Advantage Plan Benefits	More plans offering bundled extras
Marketing Enforcement	Stronger penalties for deceptive ads

📌 We monitor these trends ZIP by ZIP — and will flag any plan that removes benefits, adds copays, or loses network access in your area.

✅ What You Should Do Today

Step	Why It Matters
Review your plan benefits	See what’s being added or taken away
Check if your doctor’s still covered	Networks change annually
Look at your pharmacy list	Formularies update every year
Run a fresh ZIP comparison	New Advantage and Medigap plans launch annually

🧠 Palmetto Mutual runs this entire checklist for you — for free, by phone.

📞 Want to Stay Ahead of Medicare Changes in Your ZIP?

Don’t wait until the road is closed. We’ll help you plan your 2025 Medicare route now — with the latest plan options in your area.

🎯 See What’s Changing in My ZIP »
Helping seniors in Georgetown, Wilmington, Columbia, and every Carolina county navigate Medicare with confidence.

Common Medicare Mistakes (and How to Avoid Them)

Choose the Right Track Before It’s Too Late

Enrolling in Medicare is like standing at a railroad switch. One track leads to the coverage you need, while the other can send you off course — and cost you. Once you switch, it’s not always easy to get back on track.

💬 “I picked a plan for the gym benefit — then couldn’t see my cancer doctor.” — Lester, Darlington, SC (ZIP 29532)

Let’s break down the most common Medicare missteps — and how to stay on the right track from day one.

❌ Mistake #1: Choosing Based on Extras Only

Many Advantage plans promote:

🏋️ SilverSneakers gym memberships
🛒 Grocery cards
🦷 Dental and vision

✅ These are great, but if your specialist isn’t covered or your hospital is out-of-network, it won’t matter how nice the perks are.

📌 In Darlington (ZIP 29532), Lester chose a $0 Advantage plan for its extras — only to find out his cancer doctor at McLeod wasn’t covered. The out-of-network bill? Over $500.

🧠 We always prioritize doctors and prescriptions first — then help you find a plan with perks.

❌ Mistake #2: Ignoring Prescription Coverage

Skipping drug coverage (Part D) — or assuming all plans cover your meds — is a fast track to surprise bills.

What Goes Wrong	What You Pay
Brand drug moved to higher tier	$30–$60 more per refill
Plan removed drug entirely	You pay full retail price 💸
Pharmacy network changed	Up to $15–$25 extra per refill

📍 In counties like Darlington, York, and Wake, drug plans change every year — even if the company name stays the same.

✅ Palmetto Mutual runs an annual drug list comparison by ZIP, pharmacy, and plan tier — so you’re never caught off guard.

❌ Mistake #3: Not Checking Doctor Networks

Many seniors enroll in plans without checking if:

Their primary care physician is in-network
Their specialists or surgeon are covered
Their hospital of choice participates in the plan

📌 Even neighboring ZIPs can have different networks. A plan in Darlington (29532) might not cover the same doctors as a plan in Florence (29501).

✅ We confirm every doctor and hospital before you enroll — not after.

✅ Simple Review Can Prevent Regret

Quick Fix	Why It Works
Review your ZIP + doctors	Ensures local network match
Compare your drug list	Avoids surprise copays
Check extra benefits second	Aligns perks with core coverage
Schedule an annual review	Keeps you current on plan changes

🧠 Most mistakes happen when people enroll in a plan based on a mailer or TV ad. One 15-minute review can prevent a year of frustration.

📞 Want to Stay on the Right Medicare Track?

We’ll help you switch before it’s too late — or confirm you’re already on the best route for your ZIP, doctors, and prescriptions.

🎯 Get My Medicare Plan Checkup »
Trusted by seniors across Darlington, Columbia, Raleigh, and all of the Carolinas.

How to Help Your Parents or Spouse with Medicare

Build the Chart Before You Treat the Patient

Helping a parent or spouse with Medicare is like opening a medical chart. You need all the right information — prescriptions, doctors, ID numbers — or you risk prescribing the wrong plan.

💬 Alan in Bladen County (Elizabethtown, NC – ZIP 28337) tried helping his mom after AEP ended. Her $0 Advantage plan came with a $6,200 out-of-pocket limit — and no coverage for her preferred hospital. He never made that mistake again.

Here’s how to manage a loved one’s Medicare like a pro — even if you’ve never done it before.

🏥 Scenario Simulation: Alan’s Medicare Wake-Up Call

📍 Setting: Alan’s mom lives in Elizabethtown. She’s 74, diabetic, and recently had a hospital stay.
❌ Mistake: Alan assumed she was on a good plan — but it wasn’t until January that he checked the paperwork. By then, she was stuck for the year.
✅ Resolution: He called Palmetto Mutual, created a Medicare chart with her details, and switched her to a better plan during the next AEP.

🧾 Legal Permissions (HIPAA, POA, CMS Rep Form)

To speak on your parent’s or spouse’s behalf, you may need:

Form Type	What It Allows
HIPAA Release	View medical and claims information
Power of Attorney	Make healthcare and financial decisions
CMS Authorized Rep	Speak directly to Medicare about their coverage

📌 Palmetto Mutual helps caregivers complete these forms correctly — so you’re not blocked when it matters most.

📋 What to Bring to Plan Reviews

Here’s what to collect before any Medicare enrollment or comparison:

📄 Medicare card (red, white & blue)
💊 List of medications (names, dosages, pharmacy)
👩‍⚕️ List of doctors and specialists
🏥 Preferred hospital or facility
📝 Current plan info (if applicable)
📍 ZIP code of residence (plans are ZIP-specific)

📌 In areas like Bladen County, Cumberland County, and Charleston County, the right plan depends heavily on ZIP — even across town.

⏳ When to Reevaluate Coverage

Medicare should be reviewed annually — just like a physical.

✅ Times to recheck:

After a hospital stay
When new prescriptions are added
If a doctor retires or leaves the network
When moving ZIP codes or counties
Before every AEP (October 15–December 7)

📞 We help caregivers run a full chart review before plan changes — and explain every option in plain English.

📆 The Annual Checkup Strategy

Annual Medicare Review Checklist	Why It Matters
Check plan’s drug list	Medications move tiers every year
Verify doctor networks	Providers drop in and out of plans
Review copays and max out-of-pocket	May rise without notice
Explore new Advantage plan perks	Benefits vary by ZIP each year

💡 One 20-minute review could prevent 12 months of frustration — or $6,000+ in surprise bills, like Alan’s mom faced.

📞 Helping a Loved One? We’ll Be Your Guide

Whether it’s your parent, spouse, or neighbor — we’ll walk you through what to gather, what to check, and what to expect in their ZIP code.

🎯 Schedule a Medicare Review for My Loved One »
Proudly helping caregivers in Elizabethtown, Columbia, Winston-Salem, and every Carolina county.

What Makes Palmetto Mutual Different?

Your Medicare Toolbelt — Not a One-Size-Fits-All Wrench

When it comes to Medicare, most people are handed a generic toolbox — and told to figure it out. At Palmetto Mutual, we build you a custom toolbelt — fitted with the exact plan, doctor list, pharmacy, and extras you need in your ZIP code.

💬 Jan in Dillon (ZIP 29536) tried Medicare.gov but got overwhelmed. Brenda called Palmetto Mutual — and within 30 minutes, she had a personalized plan with $0 premium, $1,000 dental, and all her doctors in-network.

Let’s break down why thousands across the Carolinas trust us to build their plan.

🛠️ Local Agents vs. Call Centers

Feature	Palmetto Mutual	National Call Centers or Medicare.gov
Knows your local ZIP code	✅ Yes — down to the block	❌ Generalized info only
Verifies doctors and prescriptions	✅ Every time	❌ You’re on your own
Matches you to the right network	✅ Based on your real providers	❌ May enroll you without checking
Available for follow-up questions	✅ Always — we stick with you	❌ No support after enrollment
Serves the Carolinas exclusively	✅ Yes — licensed local experts	❌ National scripts, no personalization

📌 In Dillon, SC (29536), Advantage plans range from $0–$29/month, but vary by network — only a local agent will know which one fits.

🧾 Real Reviews vs. Sales Gimmicks

We’re not here to “close the deal.” We’re here to:

✅ Compare every option
✅ Review your doctors
✅ Show you what’s covered — and what’s not
✅ Explain your copays, deductibles, and extras
✅ Guide you through enrollment and beyond

💬 Brenda in Dillon said, “This felt like someone helping me with a life decision — not a transaction.”

❌ Call centers are focused on speed.
✅ We’re focused on accuracy, trust, and results.

🤝 Free Consults, Real People

What You Get with Palmetto Mutual	How It Helps You
One-on-one phone consultation	Personalized to your doctors and ZIP
Full plan comparison (Advantage, Medigap)	We find the right fit — not the flashy one
Drug list and pharmacy review	Avoids nasty refill surprises
Zip-level network analysis	Ensures your hospital and doctors are covered
Help with forms and follow-up	We don’t leave you hanging after you enroll

📞 Whether you’re in Dillon (29536) or Charlotte (28215), we’ll build your plan like a custom toolbelt — not a generic starter kit.

⭐ Why Thousands in the Carolinas Choose Us

✅ Local agents who live where you do
✅ Coverage across every NC and SC county
✅ Plans from every major carrier — no bias
✅ 100% free Medicare reviews — no pressure
✅ We stay with you year after year

💡 Most people only shop for Medicare once. Make sure you get it right — with someone who knows the system inside and out.

📞 Want Help You Can Actually Trust?

Skip the robocalls, confusing websites, and “fast enroll” gimmicks.
Talk to someone who knows your ZIP, your doctors, and your options.

🎯 Get My Free Medicare Comparison »
Serving seniors across Dillon, Greenville, Raleigh, Rock Hill, and beyond.

How to Enroll in Medicare Step-by-Step

Let Us Set the GPS — You Just Follow the Route

Enrolling in Medicare can feel like driving through a city without GPS. You know your destination — but you’re not sure when to turn, where to stop, or how to avoid detours. That’s where Palmetto Mutual comes in: we plug in the route for you.

💬 Chat Transcript:
Agent: “Do you want us to enroll for you?”
Client (Columbia, 29203): “Can you really do that?”
Agent: “Absolutely — we’ll check your doctors, prescriptions, and find the best plan based on your ZIP.”

In less than an hour, this client was enrolled in a $0 HMO plan with $2,000 in dental coverage — all without touching Medicare.gov.

🧭 Medicare.gov vs. Agent Help

Feature	Medicare.gov	Palmetto Mutual
Compare local plan networks	❌ No	✅ Yes — ZIP-specific
Check doctors + prescriptions	❌ Self-service only	✅ Verified for you
Explain copays and extras	❌ Not clearly	✅ Full breakdown in plain English
Handles the enrollment form	❌ You fill it out	✅ We complete it for you — step by step
Available after enrollment	❌ No support	✅ We stay with you year after year

📌 In places like Columbia (29203), seniors are often overwhelmed by the Medicare.gov system — we simplify every step.

📝 Step-by-Step: Signing Up for Original Medicare (Parts A & B)

This is the first step — and it’s handled through the Social Security Administration.

✅ If you’re turning 65 and not receiving Social Security yet:

Go to www.ssa.gov/medicare
Click “Apply for Medicare Only”
Fill out the online form (takes ~10 minutes)
Receive your red, white, and blue card in the mail
Effective date will be based on your birthday month

📞 Need help with the SSA site? We’ll walk you through it live, line by line.

💊 Step-by-Step: Enrolling in Part D or Advantage Plans

Once you have Medicare Parts A & B, the next step is to:

✅ Add Part D (if you want standalone drug coverage)
✅ OR enroll in a Medicare Advantage plan (Part C) that includes:

Drug coverage
Dental, vision, hearing
OTC cards, gym, transportation

How It Works:

We collect your ZIP, doctor list, and prescriptions
Compare every plan available in your county
Find the one that fits your needs and budget
Submit the application securely and compliantly
Confirm enrollment, coverage start date, and benefits

📍 In Richland County, many clients are surprised to find $0 Advantage plans with built-in dental and insulin coverage — they just never knew where to look.

🧭 How Palmetto Mutual Can Do It for You

Here’s how we help, from start to finish:

✅ Help you apply for Medicare A & B (SSA)
✅ Compare Advantage vs. Supplement plans by ZIP
✅ Check your doctors and drug list
✅ Submit your enrollment electronically — same day
✅ Track your card arrival, effective date, and benefits
✅ Provide support if your doctor, pharmacy, or plan changes

💡 Most of our clients never visit Medicare.gov. We do it all by phone — clearly, and with no pressure.

📞 Want to Get Enrolled Without the Headache?

No confusion. No call centers. Just a clear route from “turning 65” to “coverage confirmed.”

🎯 Let Palmetto Mutual Enroll Me in Medicare »
We serve seniors in Columbia, Florence, Raleigh, Charleston, and every Carolina ZIP.

What to Bring to a Medicare Review Appointment

Pack Your Medicare Toolbelt — We’ll Handle the Rest

You don’t need to know everything about Medicare. But when you show up with the right tools in your belt, the job gets done faster — and with fewer mistakes. Whether it’s your first Medicare review or your fifth, here’s what to bring to make it count.

💬 “I brought nothing to my first appointment. Nate had everything covered.” — Sheila, Whiteville, NC (ZIP 28472)
She switched from a $75/month plan to a $0 plan with better prescription coverage — just by showing up.

🧰 Must-Have Tools for Your Medicare Review

🧪 Item	Why It Matters
💊 Prescription list	Names, dosages, and how often you take each — ensures your drugs are covered affordably
👨‍⚕️ Doctor list	Includes primary care + specialists — helps us check network access
🆔 Medicare card	Red, white, and blue card for Parts A & B enrollment status
💳 Medicaid or LIS info	If applicable — unlocks additional $0 plan options and extra help
🏥 Preferred hospital or clinic	Helps ensure coverage if you’re ever admitted or need surgery

📌 In Whiteville (ZIP 28472), Sheila’s plan didn’t cover her preferred pharmacy — we switched her to a $0 plan that saved her over $900/year on copays alone.

🗂️ Optional Items That Help Speed Things Up

📄 Last year’s plan ID card or EOB (Explanation of Benefits)
📋 A written list of any new or changing prescriptions
📝 Notes about coverage issues (billing problems, surprise copays, etc.)
📍 Your ZIP code history (if you’ve recently moved — it may trigger a Special Enrollment Period)
👪 A family member or caregiver, if you want a second set of ears

💡 We can run your entire review with just your ZIP, prescriptions, and doctor list — but a few extra items help us move even faster.

🧠 Think of It Like a Toolbox

Just like a contractor brings their hammer, tape measure, and drill — you’ll want your Medicare essentials:

📄 Your coverage details
🩺 Your care team
💊 Your meds and routine
🧾 Any issues or goals you want to fix this year

✅ Palmetto Mutual assembles everything else — including verifying networks, comparing plans, and submitting enrollment if needed.

📞 Ready for a Medicare Review That Actually Makes a Difference?

Grab your essentials — and we’ll take care of the rest.
One checklist = lower copays, better doctors, and the confidence of knowing you’re covered.

🎯 Book My Free Medicare Review Appointment »
Serving all of Whiteville, Wilmington, Rock Hill, and every ZIP in the Carolinas.

What If You Made the Wrong Choice?

Medicare Gave You the Wrong Boat? Grab the Life Raft

Even with the best intentions, some seniors end up in a Medicare plan that just doesn’t fit. Maybe your doctor’s not covered. Maybe your prescriptions skyrocketed. The good news? There are life rafts built into Medicare — you just need to know where they are.

💬 Cheryl in Sumter (ZIP 29150) picked a plan without checking her eye doctor. After being told her provider was out of network, she called Palmetto Mutual. We helped her switch plans during the OEP, and she now pays $0 for her eye exams.

❓ When Can You Change Plans?

There are three main windows where you can switch your Medicare coverage:

Annual Enrollment Period (AEP): Oct 15 – Dec 7
Open Enrollment Period (OEP): Jan 1 – Mar 31
Special Enrollment Period (SEP): Triggered by life events

✅ Palmetto Mutual helps you figure out which window you’re in — and which plans are available in your ZIP.

❓ What Is the OEP (Jan–Mar)?

The Open Enrollment Period (OEP) is your second chance — if you’re already in a Medicare Advantage plan.

Action	Allowed During OEP? ✅
Switch from one Advantage plan to another	✅ Yes
Drop Advantage and go back to Original Medicare	✅ Yes
Switch drug plans (Part D only)	❌ No
Enroll in Advantage for the first time	❌ No

📌 In Sumter (29150), Cheryl used OEP to find a plan that included her local vision provider — and still had a $0 premium.

❓ Can You Appeal?

Yes — in some situations, you may be able to file a Medicare enrollment appeal:

✅ If you were:

Given incorrect information
Enrolled by mistake (e.g., robocall or TV ad misrepresentation)
Dropped from your plan without notice

📞 Palmetto Mutual can guide you through the appeals process and help submit your request with the right documentation.

✅ Steps to Take Today

Task	Why It Matters
Call to check your plan details	We’ll verify your doctor and pharmacy list
Find out if you’re in OEP or SEP	Determines if you can switch today
Review your prescriptions again	Formularies change — even midyear
Get help submitting a plan change	We’ll walk you through it by phone

💡 One wrong plan can cost you hundreds — but one smart call can reverse it.

📞 Made a Medicare Mistake? Let’s Fix It.

Whether it’s the wrong doctors, wrong pharmacy, or just the wrong fit — we can help you switch to the right plan if you still qualify.

🎯 Fix My Medicare Plan »
Serving all of Sumter, Columbia, Fayetteville, and every ZIP in the Carolinas.

Medicare Help for People Under 65 with Disabilities

Medicare Is the Umbrella — Even Before You Turn 65

If you’re on disability, Medicare might already be your right — even if you haven’t hit retirement age. But most people aren’t told when they qualify. And fewer know what their plan options really are. That’s where Palmetto Mutual steps in — to hold the umbrella until you’re ready to take it.

💬 “No one told me that SSDI makes me eligible after 24 months.” — Randy, Conway, SC (ZIP 29526)

Let’s break down how Medicare works for those under 65 — and how to protect your health and finances now.

⏱️ SSDI and Medicare Timeline

Step	What Happens
Approved for SSDI	Clock starts
24 months of SSDI payments	You become eligible for Medicare
Month 25	Medicare Parts A & B begin automatically

✅ You don’t need to wait for age 65.
📌 If you’re receiving SSDI in Conway (29526) or Winston-Salem (27103), you may already be eligible.

💡 What Plans Are Available

Once you’re eligible for Medicare under 65, you have access to:

Type	What You Get
Original Medicare	Hospital and doctor coverage through Parts A & B
Part D Plan	Optional drug plan (standalone or built-in)
Medicare Advantage	Often includes drugs, dental, and low/no premiums
Medigap (Plan N)	Monthly premium, but low out-of-pocket costs

📍 In ZIP 29526, Plan N for disabled adults runs between $130–$180/month, depending on age, ZIP, and tobacco status.

⚖️ Advantage vs. Supplement (for Under 65)

Feature	Medicare Advantage	Medigap (e.g., Plan N)
Monthly Premium	$0–$35/month	$130–$180/month
Drug Coverage	Usually included	Requires separate Part D plan
Doctor Flexibility	Limited network (HMO/PPO)	See any Medicare-accepting doctor
Travel Coverage	Regional only	Nationwide
Out-of-Pocket Max	$4,000–$7,000/year	Usually <$300 after deductible

✅ Many disabled adults start with Advantage for affordability, then switch to Medigap at age 65 during their second guaranteed enrollment window.

🧭 How to Get Help Choosing

Palmetto Mutual helps people under 65:

Verify their SSDI-based eligibility
Compare Advantage vs. Supplement plans
Check doctor networks and drug coverage
File applications quickly and correctly
Plan ahead for their 65+ transition window

📞 Randy in Conway thought he had to wait. We showed him he was already eligible — and helped him enroll in a $0 Advantage plan with insulin coverage and dental.

📞 On SSDI? You May Already Be Covered — or Just a Step Away

One phone call can tell you:

✅ Whether you’re eligible
✅ What plans work in your ZIP
✅ What your monthly cost would be
✅ How to avoid penalties or gaps

🎯 Check My Medicare Disability Eligibility »
Helping SSDI recipients in Conway, Greensboro, Columbia, and every Carolina ZIP.

Final Checklist & Free Medicare Review

Your Medicare GPS — Know Where You’re Headed Before You Enroll

Most people treat Medicare like a maze. We treat it like a GPS — input your ZIP, your doctors, and your prescriptions… and we’ll guide you to the right plan with no wrong turns.

💬 “This wasn’t a sales call — it was a roadmap for the next 20 years of my life.” — Helen, Myrtle Beach, SC (ZIP 29577)

She saved $45/month — and gained peace of mind. You can too.

🚨 Emergency Medicare Readiness Checklist

Whether you’re enrolling for the first time or reviewing a current plan, here’s what to double-check before making a move:

✅ Review Your Doctors

Are all your primary care providers in the plan’s network?
Are your specialists (cardiology, oncology, orthopedics) covered?
Is your preferred hospital or medical group included?

📍 In Horry County, Wake County, and York County, network mismatches are one of the most common and expensive Medicare mistakes.

✅ Check Your Rx List

Is each medication covered on your plan’s formulary?
What tier is it listed under — and what’s the copay?
Is your pharmacy preferred or will you pay more?

💡 Many clients in ZIP 29577 don’t realize their plan moved a key med to Tier 3 — until they see the bill.

✅ Compare Advantage vs. Medigap

Feature	Advantage Plan	Medigap (Plan G/N)
Monthly Premium	$0–$35/month	$105–$140/month
Doctors & Network	Local network (HMO/PPO)	Any Medicare provider
Drug Coverage	Often included	Requires separate Part D plan
Extras (Dental, OTC, etc.)	Usually included	Not included
Out-of-Pocket Cap	$4,000–$7,500/year	Often <$300 total

📞 Palmetto Mutual compares both options in your ZIP — and explains the tradeoffs clearly.

🧭 One Free Call Could Save You Thousands

✅ Our review includes:

Doctor network check
Prescription drug comparison
Medigap vs. Advantage walkthrough
Plan availability in your ZIP
Copay and max-out-of-pocket breakdown
Special benefits eligibility (grocery cards, dental, rides, etc.)

🎯 No pressure. No obligation. Just the truth — tailored to your life.

📞 Ready to Let Us Map Out Your Medicare?

It’s time to stop guessing and start planning. We’ll build your custom Medicare roadmap — in just one free phone call.

🎯 Schedule My Medicare Review Now »
Helping seniors in Myrtle Beach, Carolina Forest, Durham, and every corner of the Carolinas.

❓ Medicare FAQ: Your 2025 Questions Answered

🔍 Coverage & Plan Options

Q: What’s the difference between Medicare Advantage and Medicare Supplement (Medigap)?
A: Advantage plans are all-in-one, often with $0 premiums, but come with local networks and copays. Medigap plans like Plan G cost more each month but offer broader coverage with nationwide access to Medicare-approved doctors.
📍 In Charlotte (28277), Plan G averages ~$125/month, while many Advantage plans are $0–$25/month with bundled extras.

Q: Are there Medicare Advantage plans with dental and vision in Guilford County?
A: Yes. In Greensboro (27407) and surrounding ZIPs, many Advantage plans include dental, vision, hearing aids, OTC cards, and even grocery benefits — often with $0 premiums.

Q: Can I use any doctor with Medicare?
A:

Medigap: ✅ Yes — any doctor who accepts Medicare nationwide
Advantage: ⚠️ Usually network-restricted
📌 Access can vary between ZIPs like Cary (27513) and Durham (27703), even within the same metro area.

🧾 Costs & Budget

Q: How much does Plan G cost in North or South Carolina?
A: Most seniors pay $105–$145/month depending on ZIP, age, and insurer.
📍 In Columbia (29210), Plan G often costs around $120/month for a 65-year-old non-smoker.

Q: Why did my Medicare premiums go up in 2025?
A: You may be subject to IRMAA (Income-Related Monthly Adjustment Amount) if your income increased.
📍 In Raleigh (27610), high-income seniors may pay $244.60/month for Part B — compared to the standard $174.70.

Q: Are there truly $0 Medicare plans?
A: Yes — but they’re not “free.”
📍 In Rock Hill (29732) and New Bern (28562), $0 Advantage plans are common, but they still have copays, coinsurance, and yearly out-of-pocket limits.

🗓️ Enrollment & Deadlines

Q: What is the Medicare Annual Enrollment Period (AEP)?
A: October 15 – December 7 each year. During AEP, you can:

Switch Medicare Advantage plans
Change or enroll in a Part D drug plan
Return to Original Medicare

Q: Can I still get Medicare if I missed my IEP?
A: Maybe. You may qualify for a Special Enrollment Period (SEP) — especially if:

You lost employer coverage
You moved ZIP codes (e.g., from Wilmington (28401) to Greenville (29607))
You gained Medicaid

Q: What is the Medicare OEP?
A: The Open Enrollment Period (Jan 1 – Mar 31) lets you:

Switch Advantage plans
Go back to Original Medicare
It’s a one-time do-over if your AEP choice didn’t work out.

💊 Prescriptions

Q: How do I find a Part D plan that covers my prescriptions?
A: A local Palmetto Mutual agent can run a ZIP-based drug comparison using your medication list and pharmacy preferences.
📍 Example: In Greenville, SC (29607), plans vary dramatically based on pharmacy choice — CVS vs. Walmart can mean a $200 difference per year.

Q: Does CVS in Cary (27513) accept Medicare Part D?
A: Yes — but it depends on your plan. Some plans favor CVS, others prefer Walgreens or Walmart.
✅ Always compare pharmacy networks before enrolling.

Q: What’s the Part D “Donut Hole” in 2025?
A: There’s no more traditional “Donut Hole.” In 2025:

Your total drug spending is capped at $2,000/year
Once you reach that amount, you pay $0 for the rest of the year
✅ *Huge relief for insulin users in places like Winston-Salem (27103) and *Mount Pleasant (29464).

🧓 Special Situations

Q: Does Medicare cover people under 65 on disability?
A: Yes — after 24 months of SSDI.
📍 In Conway (29526) and Durham (27707), many disabled beneficiaries qualify for Plan N or Special Needs Advantage plans.

Q: Can I have Medicare and Medicaid?
A: Yes — this is called dual eligibility.
📍 In counties like Robeson (28358) and York (29745), you may qualify for $0 D-SNP plans with grocery cards, dental, and rides.

Q: Can my adult children help me enroll in Medicare?
A: Absolutely. With a permission form or power of attorney, your child or spouse can:

Speak with Palmetto Mutual on your behalf
Compare plans
Submit your enrollment
📍 We help caregivers across the Carolinas — including Asheville, Columbia, and Wilmington.

🧰 Support & Help

Q: How do I get local Medicare help in Greensboro (27407)?
A: Palmetto Mutual offers free reviews by phone — no robocalls, no pressure, and no confusion. We’re licensed in every NC and SC county.

Q: Is Medicare.gov the best place to enroll?
A: It’s an option — but many people find it confusing. Palmetto Mutual compares all plans in your ZIP and handles the paperwork for you — usually in one call.

Q: What if I need to change plans after enrolling?
A: You may qualify for a Special Enrollment Period (SEP) or use OEP (Jan–Mar) to make a switch.
📞 If you’re unsure, call us — we’ll review your ZIP, plan, and eligibility in minutes.