Medicare and Healthy Connections Medicaid: the Medicare Savings Programs and the D-SNPs that replaced Prime

Some South Carolinians qualify for both Medicare and Medicaid — often called being “dual eligible.” When that happens, Medicare pays first, and Healthy Connections Medicaid may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Medicaid works for seniors in South Carolina

South Carolina Medicaid is Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). South Carolina has not expanded Medicaid, so for adults 65 and over eligibility is based on income and resources under the state’s aged, blind and disabled rules, and it is determined by SCDHHS — not by an insurance agency. You apply online at apply.scdhhs.gov or through your county eligibility office, and annual reviews can be completed the same way.

What changed on January 1, 2026: the end of Healthy Connections Prime

For a decade South Carolina ran Healthy Connections Prime, a Medicare-Medicaid plan that combined both programs in one card for people 65 and over. Under federal guidance, Prime ended on December 31, 2025. Members were encouraged to choose a Dual Special Needs Plan (D-SNP) — a Medicare Advantage plan built for people with both Medicare and Medicaid — and some were moved automatically to a D-SNP offered by their Prime plan’s company. SCDHHS now partners with the health plans that offer D-SNPs so that the Medicare and Medicaid sides can be aligned. If you were in Prime and have not looked at your coverage since, this fall’s Annual Election Period is the time.

Programs that can lower your costs

• Medicare Savings Programs (MSPs) — QMB, SLMB and QI — pay the Part B premium ($202.90 in 2026) and, for QMB, Medicare’s deductibles, copays and coinsurance as well. Income limits change each year and are published by SCDHHS; if you do not qualify for QMB, SCDHHS automatically considers you for SLMB, then QI. You apply through SCDHHS, and you do not have to be on full Medicaid to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MSP or Medicaid you get Extra Help automatically; otherwise apply through Social Security.
• Dual Special Needs Plans (D-SNPs) coordinate the two programs, usually at $0 plan premium, and often add extras while keeping your Medicaid benefits intact. Which D-SNPs are sold in your county changes each year; we compare the ones offered where you live.

Free, unbiased state counseling on all of this is available from I-CARE — Insurance Counseling Assistance and Referrals for Elders, South Carolina’s State Health Insurance Assistance Program, run by the Department on Aging through your regional Area Agency on Aging — at 800-868-9095. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how a Medicare Savings Program and Extra Help could reduce your costs, and how to keep your Medicaid benefits working alongside Medicare. Eligibility decisions rest with SCDHHS and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by Healthy Connections Medicaid, the South Carolina Department of Health and Human Services, or the federal Medicare program.