Frequently Asked Questions
Q. Why should I participate in Healthy Connections Prime?
A. Healthy Connections Prime will provide a new option for older adults in South Carolina with Medicare and Medicaid. Prime will give you access to better care by making it easier for you to get all the Medicare and Medicaid services you need through a single health plan. Added benefits such as having to carry only one card and playing an active role in your health care gives you better value. Finally, you will have a person assigned to you called a care coordinator. He or she will manage your files and be your contact person to make sure you are receiving the right services, resulting in better health.
Q. Who can take part in this program?
A. Anyone age 65 and older who receives both Medicare and Medicaid services and is not currently residing in a nursing facility or enrolled in a PACE (Program of All-Inclusive Care for the Elderly) or Medicare Advantage program can participate.
Q. Who can tell me if I can participate in the program?
A. There will be enrollment counselors trained to answer your questions about how to enroll and tell you whether or not you are eligible.
Enrollment and Services
Q. Do I have to participate?
A. It is your choice to receive your Medicare and Medicaid services through Healthy Connections Prime. You will receive an enrollment packet from Healthy Connections Prime. If you do not want to participate in this program, please call the toll-free number in your packet.
Q. How do I enroll?
A. You can enroll in two ways: 1) Complete and return your enrollment packet, or 2) Contact an enrollment counselor.
Q. If I choose not to enroll, how will I receive my care/services?
A. If you choose not to enroll, you will continue to receive your Medicare and Medicaid services the same as you do today.
Q. How can I find out if my doctor is participating in this program, and what plan they are a part of?
A. You can ask your doctor and other providers which health plans they work with. An enrollment counselor can also help you find out if your providers are a part of this program.
Q. What Medicare-Medicaid Plans are available in South Carolina?
Q. Where do I go to get information about each health plan?
A. There is information about each plan for you and your family on Healthy Connections Prime at the Healthy Connections Prime website. You can also get information at any of the Healthy Connections offices around the state.
Q. What happens if I do not select a plan?
A. If you do not select a health plan, you will be assigned one that works with one of your current doctors. You will have two months to inform Healthy Connections Prime that you want to make changes before your health care coverage begins for Prime.
Q. Can I change my mind at a later date?
A. You may choose to enroll or disenroll at any time if you change your mind. You can also change health plans.
Health Care Services and Coordination
Q. How will my care and services be coordinated?
A. A health plan will be responsible for managing your care and will assign a care coordinator to work with you.
Q. How will I be involved with the planning of my care and services?
A. Healthy Connections Prime wants you to be involved in the planning of your care and services. You will be able to help with your enrollment options, your in-home assessment, and your care plan. If you need home and community-based services, they also have an option for you to help with directing your own care if you decide to do that.
Q. Who is my contact person for the coordination of my care and services?
A. You will have a contact person to help you with any questions you may have about your care and services. Healthy Connections Prime will provide you with a way to get in touch with your care coordinator.
Q. If I enter a nursing facility, will I still be a member of Healthy Connections Prime?
A. Yes. If you are moved to a nursing facility, you will still be a part of Healthy Connections Prime. Your care coordinator will continue to monitor your needs and work with you and/or your family.
Q. If I have a question, how will I know who to call?
A. If you have a question about your care or services, you should contact your care coordinator. Your health plan will also have a special toll-free number for you to contact them.