What is Healthy Connections Prime?
Healthy Connections Prime is an enhanced program that combines all of the benefits of Medicare and Healthy Connections Medicaid under a single Medicare-Medicaid Plan to make it easier to get the health services you need. Your Medicare Part D prescription plan is also covered under this plan.
- Better Care: by making it easier to get all of your Medicare, Healthy Connections Medicaid and Medicare Part D services from a single health plan
- Better Value: through a care team and a care manager that works directly with you or your loved one and providers to make sure you or your loved one get needed health services
- Better Health: through flexible benefits that help you stay at home with family as long as possible
Who is eligible for this program?
- You are age 65 or older.
- You have Medicare benefits.
- You have Healthy Connections Medicaid.
- You are not currently residing in a nursing facility.
Note: Some exclusions may apply.
- How can I find out more information? How can I sign up?
- View the Member Frequently Asked Questions (FAQs) section below to learn more details about the program.
- The Member and Advocate Toolkit provides additional information on Healthy Connections Prime.
- Call the SC Thrive Customer Service Center at (800) 726-8774 , Monday - Friday, 8:30 a.m. - 5:00 p.m. TTY users call 711. This call is free.
- Member FAQs
Why Should I join Healthy Connections Prime?
Healthy Connections Prime is an enhanced 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.
- 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
- Services to help you stay at home longer such as Home Delivered Meals and Personal Care (if you qualify)
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 (TTY, TDD: 711), Monday - Friday 8:30 a.m. to 5:00 p.m. This call is free.
What services are covered?
All Medicare and Healthy Connections Medicaid services, including:
- Doctor visits
- Hospital care
- Adult preventive dental
- Prescription and over-the-counter drugs
- Durable Medical Equipment
- Medical transportation
- Long Term Living (Formerly known as Community Long Term Care)
- Behavioral health services
- Nursing facility services
Can I keep my doctors and pharmacies?
Yes. Even if the doctor or pharmacy is not in the 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.
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.
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 - Friday, from 8 a.m. to 6 p.m. TTY users should call 1-877-552-4670.
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.
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.
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.
I received a plan welcome letter. What do I do next?
If you received a welcome letter from your plan saying you are enrolled, review the materials that came with the welcome 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 healthcare needs. Please read through the welcome letter for more information on the plan and next steps. If you misplaced the welcome letter, please call your plan's Member Services number.