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Answers to Common Questions About Medicare-Medicaid Plans and Medicare

What is a Medicare-Medicaid Plan?

A Medicare-Medicaid Plan combines all the benefits of Medicare and Healthy Connections Medicaid under a single health plan with one ID card.

In South Carolina, a Medicare-Medicaid Plan is also known as a Coordinated and Integrated Care Organization (CICO). This plan includes a network of providers, hospitals, pharmacies, nursing facilities, and home and community-based services providers. As a member, you will also have a care team and Care Coordinator that work directly with you and your providers.

Why should I join First Choice VIP Care Plus (Medicare-Medicaid Plan)?

Better care
You get all of your health care services from a Medicare-Medicaid Plan that will treat you like a VIP.

Better value
You will have a care team that you choose, that works with you and your providers to create a personal care plan. You can choose your providers. They will get to know you and your health history.

Better health
You will have benefits that help you stay at home with your family and in your community as long as possible.

What's different about First Choice VIP Care Plus?

Our Medicare-Medicaid Plan offers you a personal Care Coordinator and a care team. They help you develop a personal care plan that will help you get the services you need. By joining First Choice VIP Care Plus, you will get all the services you need, plus extra benefits. There are no monthly payments and no costs to you for provider visits, hospital care, or drugs.

How will I get health care?

When you join First Choice VIP Care Plus, you can keep seeing your current providers for 6 months even if they are not in our network. You can still get all your services while you and your care team create your personal care plan. Your personal care plan will meet your specific health care needs. If you do not have a doctor, we can help you choose one that best meets your needs.

If you have an emergency, you can go to any hospital or urgent care center.

What about my prescription drugs?

You do not need a separate Part D prescription drug plan: First Choice VIP Care Plus will cover your prescriptions. Our network pharmacies will take care of your health care needs. See our Prescription drug coverage.

What are the basic parts of Medicare?

Medicare is made up of 4 parts: Part A, Part B, Part C, and Part D.

  • Part A is hospital coverage. It helps cover the costs of being in the hospital as an inpatient, as well as long-term hospitalization. Most people who qualify for Medicare automatically get Part A at no monthly cost.
  • Part B is medical coverage. It helps cover your provider visits and outpatient care, as well as some preventive services that help maintain your health. Medicare Part B has a monthly premium. Once you meet a certain amount of spending, known as your deductible, Part B generally covers about 80 percent of your costs for Medicare-approved services.
  • Part C is also known as a Medicare Advantage plan. Part C is provided by plans like First Choice VIP Care Plus that have been approved by Medicare and have contracts with Medicare to cover medical and hospitalization care for their members. They can also offer extra benefits that Original Medicare (also known as Traditional Medicare or Fee-for-Service Medicare) doesn't cover.
  • Part D is prescription drug coverage. Like Part C, it is also provided by private companies like First Choice VIP Care Plus that have contracts with Medicare. It is designed to lower the amount that you pay for your prescription drugs. You can purchase a Part D plan to go with Original Medicare, or prescription drug coverage may be included with a Medicare Advantage plan.

Who is eligible for Medicare?

Turning 65? Medicare is the federal government's health insurance program. It is also known as Original Medicare. Medicare provides medical and health-related services to:

  • People age 65 or older.
  • People of any age who are qualified as disabled.
  • People of any age who have kidney disease that requires dialysis or a transplant.

How do I enroll in Medicare?

You are automatically enrolled in Medicare when you turn 65 if you're receiving Social Security benefits or Railroad Retirement Board (RRB) payments.

  • If you're receiving Social Security benefits or RRB benefits, you'll receive information in the mail 3 months before your 65th birthday explaining your options.
  • If you are not yet receiving Social Security payments, then you will have to contact Social Security to enroll.
  • You can call the Social Security Administration at 1-800-772-1213 (TTY1-800-325-0778), visit them online at www.ssa.gov, or apply at your local Social Security office. It's a good idea to do this well before your 65th birthday so you can start receiving benefits as soon as you are eligible.

When can I enroll in Medicare?

Medicare limits the times when most people can add, change or drop coverage. These times are known as election or enrollment periods. However, recipients who have both Healthy Connections Medicaid and Medicare can add, change, or drop coverage at any time during the year.

NOTE: Effective January 1, 2019, if you’re in a drug management program, you may not be able to change plans.

What is a health maintenance organization (HMO)?

An HMO is a type of health plan that uses a network of health care providers. These providers — doctors, dentists, nurse practitioners, pharmacies, and hospitals — treat members and help prevent them from getting sick.

Ready to enroll?

Call the South Carolina Healthy Connections Choices Customer Service Center at 1-877-552-4642 (TTY/TDD 1-877-552-4670). A counselor can help you Monday to Friday, 8 a.m. to 6 p.m.

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