Carolina Medicare PrimeSM is contracted with Medicare and offers approved HMO Medicare Advantage plans with Part D (MA-PD) benefits and approved Prescription Drug Plans (PDP). The approved HMO MA-PD plans offer Original Medicare benefits-and more. Click on the links below or scroll down this page for more information
Carolina Medicare Prime MA-PD plans
With one of our MA-PD plans, Carolina Medicare Prime can be your complete health plan because we cover all three health care components-hospitalization, physician services, and outpatient prescription drug coverage-all with a zero-premium option. It's Medicare Coverage created with your total health needs in mind.
These plans were designed to make sure you're always taken care of. We've made things simple by committing to work with Medicare for you, reducing your paperwork and hassle. And with Carolina Medicare Prime, you have helpful, knowledgeable customer service representatives standing by.
Carolina Medicare Prime MA-PD plans are a managed care plans with a point of service option-what does that mean?
Managed care is provided by doctors and hospitals focused on prevention and quality. Carolina Medicare Prime MA-PD plans are Medicare-approved HMOs (health maintenance organization) with a point of service option. For Carolina Medicare Prime MA-PD members this means:
- All plans include a point of service option that allows you to choose your physician as long as the practice is in our approved service area.
- Your personal doctor (your "primary care physician or provider" or PCP) works to keep you healthy and treats you when you become ill or injured.
- We cover check-ups and wellness exams that help detect possible health problems or spot any early warning signs.
- You don't need a referral for your first three visits to a specialist.
- Prescription drug coverage. We offer a broad list of formulary generic and name brand medications covered for a copayment. You can even order the prescription drugs we cover through the mail.
What does Carolina Medicare Prime MA-PD Plans offer?
- Choice of four health plans
- Affordable monthly premiums, including a zero-premium option
- Quality assurance
- Wellness programs and health education
- Social community programs
Who can join a Carolina Medicare Prime MA-PD plan?
You can apply if you:
- are a Medicare beneficiary with Medicare Part A (hospital coverage) and Medicare Part B (medical coverage).
- reside in our Medicare-approved service area. Click here to view the service area map
- you do not have end-stage renal (kidney) disease (certain exceptions apply).
What if I only need coverage for a prescription drug plan?
If a Carolina Medicare Prime MA-PD plan isn't right for you, but you need coverage for your prescription medications, consider one of Carolina Medicare Prime's PDP plans. With affordable premiums and low copayments for formulary generic and brand name medications, one of our stand-alone prescription drug plans may be what you're looking for.
Which plan is right for me?
Choice is an important word to understand when making any kind of purchase - especially health care. To find the right plan for all your health care needs, you'll need to understand what features are the most important to you.
The Centers for Medicare and Medicaid Services (CMS) recommends that you evaluate any plan based on the following factors: Cost, benefits, doctor choice, convenience, quality, wellness and health education programs and any additional social programs. Be sure to evaluate your overall financial and health status for today as well as tomorrow. Then determine which plan offers you the best overall value for your health care needs.
Why should I choose a Carolina Medicare Prime MA-PD plan?
Credentialed Network Practitioners. All of our network practitioners are approved through a credentialing process to ensure the quality of practitioners available to members.
Point of Service Option. Freedom to choose any provider in our Medicare approved service area.
No Referrals for Initial Network Specialist Visits. While you do have a Primary Care Physician who oversees all of your care, you can see a specialist from the Carolina Medicare Prime provider network without a referral for your first and two follow-up visits.
Preventive Care Benefits at No Extra Cost to You.
- One annual physical per year
- Bone mass measurement
- Colorectal screening exams
- Immunizations: Flu, Pneumonia, Hepatitis B
- Annual routine mammograms
- Pelvic exams & Pap smears
- Prostate cancer exam
Prescription Drug Coverage. Generic medications and brand-name medications on our formulary are covered for a copayment. And you can even order prescription drugs covered by the plan through our mail service pharmacy.
24/7 Nurseline. Our 1-800 health line provides members with 24/7 access to a Registered Nurse and a library of 400 pre-recorded health topics.
Wellness Programs. Our care management and wellness programs help members manage specific conditions, such as asthma, diabetes, hypertension and cholesterol.
Discounts on Alternative Medicine Services. Save 5% to 30% on many great alternative therapies that complement traditional medicine, such as massage, acupuncture nutritional supplements and more.
Gold's Gym Membership Discount. Receive a discounted monthly rate on new memberships with your Carolina Medicare Prime ID card at participating Gold's Gym locations.
Quarterly Member newsletters. Includes plan news, timely health topics, network provider and prescription drug list updates, and more.
Online Resources. At our web site www.carolinamedicareprime.com, you can find a network provider, check your eligibility and benefits, search the preferred drug list, managing weight and exercise goals, and more!
Carolina Medicare Prime Prescription Drug Plans (PDP)
A prescription drug plan both simple and affordable
Carolina Medicare Prime's PDPs are Medicare contracted and approved prescription drug plans designed to ensure that you get the medicines you need.
With our broad network of pharmacies throughout South Carolina and nationwide, you never have to worry if you're covered. And with low copayments for formulary generic and brand name medications and affordable monthly premiums, you'll know you're saving money.
Carolina Medicare Prime's PDPs takes care of you by reducing your out-of-pocket drug costs and supporting you with helpful, knowledgeable customer service representatives. Things even simpler with mail order service on covered medications so you can get the medicines you needs delivered right to your door.
What are the benefits of Carolina Medicare Prime PDP?
Carolina Medicare Prime offers two stand-alone drug plans that provide:
- Low copayments for formulary generic and brand name medications
- A national network of pharmacies
- Mail order service for covered medications
- Affordable monthly premiums
Where can I purchase my medications?
Carolina Medicare Prime's PDPs have a broad network or pharmacies that span South Carolina and the nation. From your local, corner pharmacy to the major chains, from the Upstate to the Lowcountry, From South Carolina to Hawaii, you'll find one of our network pharmacies.
Who is eligible to join Carolina Medicare Prime PDP?
You can join if you:
- are a Medicare beneficiary with Medicare Part A (hospital coverage) or Medicare Part B (medical coverage) (or both).
How can I find more information on Carolina Medicare Prime plans?
For more information about Carolina Medicare Prime, call toll-free 1-866-624-4790 or 803-750-7413. For accommodations of persons with special needs, call TTY 1-800-735-2905. For medical benefits questions, you may call Customer Relations from 8:00 a.m. - 8:00 p.m. 7 days per week. Customer Relations staff is available Monday through Wednesday and Friday, 8:30 a.m.-5:00 p.m. and Thursday 9:00 a.m.-5:00 p.m. to answer any questions you may have. For questions about prescription drug benefits outside of the business hours listed above, call 1-800-879-9080.
Also, we have included links to the various Carolina Medicare Prime documents for you to review.
How do I join Carolina Medicare Prime?
When you're ready to enroll, you can do so online via the official Medicare website. Use the links below:
Note: clicking the links below will take you from this website to the enrollment area of the official Medicare website.
- Click here to enroll in Carolina Medicare Prime 10.
- Click here to enroll in Carolina Medicare Prime 15.
- Click here to enroll in Carolina Medicare Prime 10 Plus.
- Click here to enroll in Carolina Medicare Prime 15 Plus.
- Click here to enroll in Carolina Medicare Prime (Prescription Drug Only).
- Click here to enroll in Carolina Medicare Prime Plus (Prescription Drug Only).
- Please read, complete, sign and date the Carolina Medicare Prime Election Form. Click here for a MA-PD individual form or the a PDP individual form. Or call the Customer Relations number above to have a form mailed to you.
- Include a photocopy of your Medicare card.
- If you are a guardian/representative, please enclose appropriate documentation.
- If you have further questions, please refer to the back cover of this booklet for the telephone number to call for more information.
After you enroll, we will send you a packet and your Carolina Medicare Prime member identification card. This packet will contain your Evidence of Coverage and other materials which explain how to use your Carolina Medicare Prime coverage. Please read these materials when you get them.