Eligibility Requirements
If all of the following apply to you, you may be able to sign up for Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan). If they do not, you are not eligible to participate.
Wellcare Prime is available to individuals who:
- Live in our service area; and
- Are age 65 or older at the time of enrollment; and
- Have Medicare Parts A, B and D; and
- Are eligible for full Healthy Connections Medicaid benefits; and
- Are a United States citizen or are lawfully present in the United States.
You are not eligible to participate if you:
- Are part of the Healthy Connections Medicaid spend-down population; or
- Have comprehensive third-party insurance; or
- Live in an Intermediate Care Facility for people with Intellectual Disabilities (ICF/IID) or Nursing Facility at the time of eligibility determination; or
- Are in a hospice program or are getting end-stage renal disease (ESRD) services at the time of eligibility determination; or
- Are participating in a community long-term care waiver program other than the Community Choices Waiver, HIV/AIDS Waiver or Mechanical Ventilation Waiver.
You may choose to either enroll or remain in Wellcare Prime if you:
- Are currently enrolled in a Medicare Advantage plan or in Program of All-inclusive Care for the Elderly (PACE). Enrolling in Healthy Connections Prime will automatically disenroll you from your existing program and any Medicare Part D plan; or
- Transition from a nursing facility or ICF/IID into the community; or
- Are already enrolled in this plan but later enter a nursing facility; or
- Are enrolled in this plan but enter a hospice program or become eligible for ESRD services.
If you have any questions, call South Carolina Healthy Connections Choices Customer Service Center at 1-877-552-4642 (TTY: 1-877-552-4670). Hours are from 8 a.m. to 6 p.m., Monday through Friday, excluding South Carolina state holidays. A member service representative will assist you.
Or you may call Member Services at 1-855-735-4398 (TTY: 711). Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.