2025 Medicare Annual Enrollment Period (Oct 15 – Dec 7) - Service Area Reductions in South Carolina
As the 2025 Annual Enrollment Period (AEP) approaches, Medicare beneficiaries across South Carolina, and most of the country, will face significant disruptions due to service area reductions (SARs) from major Medicare Advantage insurance companies. In our state, these disruptions affect all 46 counties. Thousands of members will lose access to their current plans.
What Is a Service Area Reduction (SAR) in Medicare Advantage?
A service area reduction occurs when a Medicare Advantage carrier withdraws from certain geographic regions, reducing or eliminating plan options for those areas. This can happen for a variety of reasons, such as changes in healthcare regulations, carrier financial performance, or strategic business decisions. When a service area reduction happens, all members enrolled in the affected plans must find new coverage during the AEP to ensure they have health insurance for the upcoming year.
What is Cross-Walking?
Sometimes, when a plan is discontinued, the insurance carrier may "cross-walk" affected members to another plan that offers similar benefits. This automatic enrollment process helps maintain continuity of care and ensures that beneficiaries do not have a gap in their coverage.
However, in 2025, most of the affected Medicare Advantage beneficiaries in South Carolina will not be cross-walked to another plan. This leaves thousands of beneficiaries without coverage, requiring them to make informed decisions during the AEP.
This lack of cross-walking means that these members will need to explore new options from a variety of carriers and confirm that their prescription drugs are covered and their doctors and hospitals are in network with a new plan.
Why use a local agent when looking at Medicare or Health Insurance Options?
You cannot turn on the tv or open your computer without seeing dozens of celebrities or actors talking about some great benefit that you may be missing with your health coverage. You’re then directed to a call center, and that’s where things can go wrong.
Making decisions about Medicare and Health Insurance requires much thought, planning and research. It’s important to work with someone familiar with the options available in your county and state. If you’re working with a local, licensed agent, they will do the research to make sure your prescription drugs are covered, and your doctors and healthcare facilities are in network with the plan you’re considering.
Local agents can do telephone appointments, or they can meet you in person. Also consider who will be there to answer a question when you have an unexpected medical bill or claim denial. Your local agent is more than an order taker; they are your neighbor, advocate, and regular resource for all your questions.
At Lourie Life& Health, we often see the unfortunate outcome when consumers end up with the wrong health plan. Prescription drug prices can become unaffordable because they may not be covered. An important specialist may not be in network and therefore a client cannot visit the doctor that treated them for years. More preparation and research in the beginning can save people time, money and stress when it comes to their healthcare.
Would you go to an orthopedic doctor for stomach problems? Would you see a divorce lawyer for an automobile accident? Of course not, and the same holds true with insurance. There are agents that specialize in life insurance, annuities, long term care, disability, accident insurance, home insurance, automobile insurance, to name a few. Find an agent that specializes in Medicare and Health Insurance; this field, like the others referenced, has many nuances when it comes to co-pays, deductibles, networks, etc. Work with a local professional experienced in helping you find the health plan that meets your specific needs and budget.