Benefits

 

Absolute Total Care provides the same benefits as standard Medicaid PLUS MORE!

Adult Benefits
Benefit Absolute Total Care – Adult Standard Medicaid – Adult
Prescribed Drugs (per month) 4 prescription limit; 3 additional if medically necessary / $3.40 copayAsthma, COPD, and Diabetes medications / $0 copay 4 prescription limit / $3.40 copay
Family Planning Services Yes Yes
Lab Work & X-rays Yes Yes
English & Spanish Call Center Yes Yes
Physician Visits (per year) Unlimited / $0 copay 12 visit limit / $3.30 copay
Hospital Stay (per year) $25 copay inpatient $3.40 copay outpatient / $25 copay inpatient
Home Health Care (per year) 50 visit limit / $0 copay 50 visit limit / $3.30 copay
Durable Medical Equipment $0 copay $3.40 copay
Phone Access 24/7 Yes; Registered nurses through NurseWise No
Care Coordinator Yes No
Education programs for chronic illnesses Yes No
Health programs for pregnancy, diabetes, asthma Yes No
CentAccount (Members earn financial rewards for healthy behaviors) Yes No

*Copayments: Absolute Total Care does require member copayments for certain covered and approved medically necessary medical services. The following Medicaid beneficiaries do not have to make copayments: Children under 19 years, pregnant women, individuals receiving family planning services, institutionalized individuals, individuals receiving emergency services and federally recognized Native Americans.


Child Benefits
Benefit Absolute Total Care – Child Standard Medicaid – Child
Physician visits Unlimited / No copay Unlimited / No copay
Prescribed Drugs Unlimited / No copay Unlimited / No copay
Home Health 50 visit limit / No copay 50 visit limit / No copay
Dental Care No. SC Healthy Connections covers all dental benefits. Routine Dental Care through month of 21st birthday
Child Health Screenings (EPSDT) Yes Yes
Family Planning Services Yes Yes
Lab Work and X-ray Yes Yes
Durable Medical Equipment Unlimited / No copay Yes
Vision Care

Ages 20 and younger. 1 pair of glasses every 12 months. 1 replacement set every 12 months.

Check up and one pair of glasses
Hospital Unlimited / No copay Unlimited / No copay
Phone Access 24/7 Yes; Registered nurses through NurseWise No
Care Coordinator Yes No
Education programs for chronic illnesses Yes No
Health programs for pregnancy, diabetes, asthma Yes No
CentAccount (Members earn financial rewards for healthy behaviors) Yes No

*Copayments: Absolute Total Care does require member copayments for certain covered and approved medically necessary medical services. The following Medicaid beneficiaries do not have to make copayments: Children under 19 years, pregnant women, individuals receiving family planning services, institutionalized individuals, individuals receiving emergency services and federally recognized Native Americans.