By Jennifer Mauldin, Licensed Medicare Specialist  |  Mauldin Insurance Group, Lexington, SC  |  Updated April 2026

Most South Carolina seniors enrolled in Medicare would tell you they think they're covered. And honestly? They're probably right — for the routine stuff. Doctor visits, lab work, outpatient care. Medicare handles that reasonably well.

Where things get complicated — and where people get surprised by bills they didn't see coming — is the serious stuff. A major surgery. A cancer diagnosis. A stroke that leads to weeks of rehabilitation. A hip replacement that requires 45 days in a skilled nursing facility.

That's when people find out what their Medicare coverage actually does. And by then, it's too late to make a different choice.

We built a free, 4-minute Medicare self-assessment specifically to help South Carolina seniors — including here in Lexington, Lake Murray, Irmo, and Chapin — understand where their coverage stands before something happens. Not after.

The Problem With "I Think I'm Covered"

Here's what I hear in almost every review I do: "I have Medicare. I think I'm fine." And sometimes that's true. But a lot of the time, when we actually sit down and walk through it, there are gaps — sometimes significant ones — that the person genuinely didn't know about.

The most common one?

Original Medicare has no out-of-pocket maximum. That means there is no ceiling on what you could owe in a single year. If you have a serious illness and you're on Original Medicare with no supplement, you could owe $20,000, $40,000, or more. There is nothing in the program that stops it.

Most people have no idea that's the case. They assume Medicare works like their old employer insurance — copays, deductibles, a cap. It doesn't.

The Three Medicare Situations — and Why Each One Has Different Risks

Not everyone on Medicare is in the same situation. The quiz we built accounts for that by routing you to the path that matches your actual coverage.

Original Medicare Only (Parts A & B — No Supplement)

This is the highest-risk situation. Without a supplement or Advantage plan, you are directly exposed to:

• A $1,632 Part A deductible every time you're admitted to the hospital (2024 figure, resets per benefit period — not per year)
• 20% of all outpatient costs with no cap — including specialist visits, outpatient surgery, chemotherapy, and imaging
• About $200 per day for skilled nursing care from day 21 to day 100
• Zero coverage for long-term care
• No out-of-pocket maximum of any kind

For someone facing a cancer diagnosis or a major cardiac event, those costs can stack up to $50,000 or more in a single year.

Medicare Supplement (Medigap)

If you have a Medigap plan, you're generally well-protected — but there are still things worth checking:

• Do you know which plan letter you have (G, N, F) and exactly what it covers?
• Do you know how your premium is rated — and what that means for your costs as you get older? Attained-age rated plans get significantly more expensive over time.
• Have you compared your current Medigap premium to other carriers recently? Medigap plans with the same letter offer identical benefits regardless of carrier. Many people overpay by $50–$100/month simply because they've never shopped it.
• Do you have a separate Part D drug plan — and is it current?

Medigap clients are usually well-covered for medical costs. The risk is financial — overpaying for coverage or being on the wrong plan letter for your situation.

Medicare Advantage (Part C)

Medicare Advantage plans offer attractive benefits — often $0 premiums, dental, vision, and fitness coverage. But they come with trade-offs that a lot of enrollees don't fully understand:

• Provider networks can change every January 1. A doctor who was in-network last year may not be this year.
• Benefits, copays, and premiums can change annually. What you signed up for may not be what you have now.
• Out-of-pocket maximums range from $3,500 to $8,850 for in-network care in 2024. Out-of-network maximums can be double that. Do you know yours?
• Switching back to Original Medicare with a Medigap supplement after your first year may require medical underwriting in most states. You could be denied coverage based on your health history.

The Advantage path in our quiz focuses specifically on these issues — the things that Advantage enrollees often don't think about until something goes wrong.

What the Quiz Actually Does

This is not a lead generation form dressed up as a quiz. It's a genuine self-assessment that we built because we kept having the same conversations with Midlands seniors who had no idea what their coverage actually looked like until we sat down and walked through it together.

Here's how it works:

• Questions 1–3 are universal — basic Medicare literacy that applies to everyone
• Question 4 identifies your coverage type: Original Medicare, Medigap supplement, Medicare Advantage, or not sure
• Questions 5–12 are specific to your path — different questions for each coverage type
• You get a personalized risk score (0–100) and a plain-language explanation of what it means for your specific situation
• Results include real-dollar cost scenarios tailored to your coverage type

The whole thing takes about 3–4 minutes. There's no email required to start, no obligation to change anything, and no sales pressure. You get your results immediately.

Real-Dollar Examples: What the Gaps Actually Cost

These aren't hypothetical. These are costs South Carolina seniors actually face.

Scenario 1: Five-Day Hospital Stay (Original Medicare Only)

You're admitted to Lexington Medical Center for pneumonia. Five days in the hospital. With Original Medicare and no supplement, you owe the full Part A deductible before Medicare contributes a dollar — $1,632 in 2024. And that resets every benefit period, not just once per year. A second admission within 60 days means another $1,632.

Scenario 2: Hip Replacement and 45 Days of Skilled Nursing

After a hip replacement, you need 45 days in a skilled nursing facility. Medicare covers days 1–20 at 100%. Days 21–45 cost approximately $200 per day — $5,000 out of pocket — with no supplement to absorb it.

Scenario 3: Cancer Treatment Over 12 Months

Surgery, chemotherapy, imaging, follow-up visits. With Original Medicare, you pay 20% of every Medicare-approved outpatient cost — with no annual cap. Twelve months of cancer treatment can easily reach $20,000 to $60,000 or more in out-of-pocket costs.

Scenario 4: Medicare Advantage Out-of-Network (For Advantage Enrollees)

Your specialist drops out of your Advantage plan's network on January 1 and you don't find out until you're already being treated. Out-of-network care under most Advantage plans can trigger a separate, higher out-of-pocket maximum — sometimes $17,000 or more — that you didn't budget for.

Who This Quiz Is For

• SC seniors on Original Medicare who have never added a supplement or Advantage plan
• Medigap enrollees who haven't reviewed their plan letter, premium, or rating method recently
• Medicare Advantage members who aren't sure what changed on January 1 or whether their doctors are still in-network
• Anyone approaching 65 who is trying to understand what Medicare actually covers before they enroll
• Family members helping a parent or spouse navigate Medicare decisions
• Anyone who is simply not sure what type of Medicare coverage they have

After the Quiz: What Happens Next

When you complete the quiz, you'll see your risk score and a personalized explanation based on your coverage type. The explanation is specific — not generic Medicare boilerplate. If you're on Medigap, it talks about premium rating. If you're on Advantage, it addresses your network and out-of-pocket exposure.

After you submit your name and contact info to unlock your full results, you'll hear from Jennifer or Ben — usually within a business day. Not a scripted call. An actual conversation about what you found in the quiz and whether it makes sense to take a closer look at your current coverage.

There is no cost. Ever. As independent Medicare agents, we're compensated by carriers when you enroll in a plan. Your premium is identical whether you work with us or go directly to the carrier. That's just how Medicare works.

Take the Free Quiz

The quiz is available on two of our sites — use whichever is easier to find:

• Midlands Medicare: com/quiz
• SC Medicare Agency: com/quiz

Or call Jennifer directly at 843-509-2462. Most Medicare questions can be answered in a single phone call. There's no reason to wonder what your coverage actually does.

About Jennifer Mauldin

Jennifer Mauldin is a licensed, independent Medicare specialist based in Lexington, SC. She serves clients across the SC Midlands — including Lexington, Lake Murray, Irmo, Chapin, Columbia, and Blythewood — as well as clients throughout South Carolina. As an independent agent, she represents dozens of carriers and compares every plan available in your zip code. Her Medicare consulting is always free.

Phone: 843-509-2462

Email: jennifer@mauldininsurancegroup.com