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Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Centene Corporation available for enrollment in 2025 to people living in South Carolina. The overall rating for this plan is not yet available for 2025.
It's important to know that Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
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Drug Coverage
The Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellcare Prime by Absolute Total Care plan offers a wide range of benefits with varying cost structures. You can expect no copay for ambulance services, emergency services, and many primary care services, including occupational therapy, physical therapy, and speech-language pathology. The plan also covers hearing services, including hearing exams and hearing aids up to a certain amount. This plan also includes coverage for dental services, home health services, and medical equipment with no copay. Additionally, there are other services such as over-the-counter items, and home infusion services are covered. However, it's important to note that some services, like inpatient hospital, outpatient, and skilled nursing facilities, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered for Wellcare Prime by Absolute Total Care, but additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered. Prior authorization is required for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, are covered; however, individual and group sessions for outpatient substance abuse are not covered. Prior authorization is required for all outpatient services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Wellcare Prime by Absolute Total Care. All Ambulance Services are covered with no copay and no coinsurance. However, ground ambulance services, air ambulance services, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), with no copay and no coinsurance for Emergency Services and Urgently Needed Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay and no coinsurance, but require authorization. Chiropractic Services do not cover Routine Chiropractic Care, and Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, Health Education, In-Home Safety Assessment, Post discharge In-Home Medication Reconciliation, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, but does not cover Annual Physical Exams, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services are covered, including routine hearing exams and fitting/evaluation for hearing aids, each with one visit per year; prescription hearing aids (all types) are covered up to a plan maximum of $1250 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are partially covered by the Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), with no deductible. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered under the Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), but the plan does not cover Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit, are covered with no copay and no coinsurance, but other sub-services like Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services, including Personal Care Services and Other 1 for Home Health Services such as incontinence supplies, are covered under this plan. There is no copay or coinsurance for these services, but authorization is required and limits apply.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan). Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered and require prior authorization and a doctor referral. The plan covers non-Medicare-covered stays, and you will have to pay a copay and coinsurance, but the specific amounts are not listed.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and additional services such as Behavioral Health Services, Palliative Care, Outpatient Mental Health Services, Infusion Centers, Residential Personal Care Services, Nursing Home Transition Services (1 session per year), Respite Care, Adult Day Health Services & Nursing Services, Environmental Modifications (lifetime max $7500), Telemedicine, Companion Services, Adult Day Health Transportation, Two (2) Additional Prescription Drugs, Personal Emergency Response System, Meal Benefit (2 meals per day), and Oral Nutritional Supplements (Cans) with a limit of 96 per month. Acupuncture, Meal Benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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