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Frequently Asked Questions

Please click on any question to quickly jump to the answer.
  1. Why should I join Healthy Connections Prime?
  2. Who is eligible?
  3. What services are covered?
  4. Can I keep my doctors and pharmacies?
  5. Do I have to join?
  6. After joining a plan, can a member switch plans?
  7. Can I choose my health plan?
  8. How does this program support caregivers?
  9. How do I sign up?
  10. What do I do if I received a letter saying I am enrolled?

1. Why should I join Healthy Connections Prime?

Healthy Connections Prime is an ehanced program that gives access to better care and provides benefits and support needed to help you stay healthy and live at home as long as possible.

Benefits include:

  • One plan to manage all Medicare (Parts A and B), Medicare Part D and Healthy Connections Medicaid medical and prescription drug benefits
  • No insurance premiums
  • No costs for doctor visits and hospital stays
  • No drug copays
  • One card for all health needs
  • One number to call when help is needed
  • A personal care coordinator
  • A member-approved care team

Click on the image below to compare this new program to Medicare and Medicaid!

  

2. Who is eligible?

Healthy Connections Prime is available to seniors age 65 or older who have both Medicare and Healthy Connections Medicaid and are living at home.  Some exclusions may apply.  To learn more, call SC Thrive at 1-800-726-8774, Monday-Friday 8:30 a.m. to 5:00 p.m.  This call is free.

3. What services are covered?

All Medicare and Medicaid services, including:

  • Doctor visits
  • Hospital care
  • Adult preventive dental
  • Prescription and over-the-counter drugs
  • Durable Medical Equipment
  • Medical transportation
  • Community Long Term Care (CLTC)
  • Behavioral health services
  • Nursing facility services

Click on the image below for a full list of covered services. 

4. Can I keep my doctors and pharmacies?

Yes. Even if the doctor or pharmacy is not in network, they can continue to be seen for 6 months while the plan reaches out to build a connection with them or help you transition to a doctor or pharmacy that is satisfactory. Ask the provider if they participate in Healthy Connections Prime.  An enrollment counselor can also help you find out if a provider is a part of this program.

5. Do I have to join?

You do not have to join. If you receive a letter regarding your enrollment in a specific plan and you do not want to join, please contact South Carolina Healthy Connections Choices at 1-877- 552-4642, Monday through Friday, from 8 a.m. to 6 p.m. TTY users should call 1-877-552-4670.

6. Can I switch plans?

It is your choice to stay enrolled in a Healthy Connections Prime Medicare-Medicaid Plan, switch to another plan, or leave Healthy Connections Prime altogether. To make a change, just call South Carolina Healthy Connections Choices at 1-877- 552-4642, Monday through Friday, from 8 a.m. to 6 p.m. TTY users should call 1-877-552-4670.

7. Can I choose my health plan?

Yes, you or your loved one can choose a plan as long as it is available in the county.  We currently offer the following three plans and the enrollment counselor will help answer questions and help with plan selection.

8. How does this program support caregivers?

The program helps simplify how members get health care services as everything will be handled by one plan, with one card, and one number to call for questions.

In some cases, caregivers can receive some short term relief for the care of the member (also known as respite care). You or your loved one may also get other long-term services and supports (LTSS) such as environmental modification (minor changes to the home), in-home personal care, and home delivered meals. LTSS helps people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine.

9. How do I sign up?

Call the SC Thrive Customer Service Center at (800) 726-8774 to speak with an enrollment counselor. Monday-Friday, 8:30 a.m. – 5:00 p.m. TTY users call 711. This call is free.

10. I received a plan welcome letter.  What do I do next?

If a letter is received saying you are enrolled, review the materials that came with the letter. Someone from your health plan will call and welcome you within 30 days and answer any questions. The plan will also schedule a time to meet with you to discuss your health care need. Please read through the welcome letter for more information on the plan and next steps.  If you misplaced the welcome letter, please go call your plan's Member Services number (numbers can be found here ).

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