One Care members never have to pay any co-pays or fees to get care, but sometimes providers may send bills by mistake. In rare circumstances, a member may get a bill if One Care doesn’t cover the service they received, if Medicare was billed rather than your plan, or if the care required approval before getting it. You might also get a bill if the care was from an out-of-network provider (though there may be exceptions to this). If you receive a bill, contact your One Care plan right away to find out why and what you can do.

To help avoid these situations, it is a good idea to check with your plan before you get a service to make sure it will be covered. If you need help with a billing issue, contact your One Care plan or feel free to reach out to My Ombudsman for guidance.

There are no (co-pays) for prescriptions if you join One Care. Learn more about One Care’s prescription coverage here.

Each One Care plan has their own list of covered medications (click here to learn more ) that includes all drugs covered by MassHealth and Medicare Part D and may also include over-the-counter medications like vitamins, allergy pills, and nicotine patches (with a prescription). To know whether your One Care plan covers a specific medication you need, you can look at your plan’s list or call your plan.

One Care offers many services to help members live independently at home and in the community. These are called long-term services and supports, or LTSS. LTSS includes things like healthcare you get at home, medical equipment (like wheelchairs, hospital beds, or oxygen), day programs, and more. One Care members have the right to add a Long-Term Supports (LTS) Coordinator to their care team to help them understand the options and arrange for LTSS. LTS Coordinators work for organizations in the community. They are independent form the One Care plan). Click here to learn more.

If you think you may need PCA services, let your PCP or care team know that you would like an assessment for Personal Assistance Services (PAS) to see if your needs meet the criteria for a PCA. You will also be asked about any needs for Long Term Services and Supports (LTSS), including any need for personal assistance services, during your comprehensive assessment. In general, to qualify for PCA services, you need to have a chronic or permanent disability that stops you from doing your own personal care, and you have to need (hands-on) help with 2 to 7 Activities of Daily Living (ADLs). This includes bathing, dressing, taking medications, cooking, eating, toileting, and laundry. If you need cueing and monitoring to complete some ADLs, you may be able to get PCA services as well. PCA support with cueing and monitoring is only available through One Care. Your care team and Long-Term Supports (LTS) Coordinator (if you choose to get one) will help guide you through the process of getting a PAS evaluation and PCA services as you may need.

If you do not qualify for PCA services, your care team can help you think through other support services that may be available to meet your needs. All One Care members also have the option to have a Long-Term Supports (LTS) Coordinator who may be able to give more education and support around your options. If you need more help understanding PCA services, contact My Ombudsman.

Yes. One Care offers both medical and non-medical rides through a variety of companies. You can get rides to medical appointments and to places like the grocery store or the pharmacy. There are some limits on what kinds of non-medical rides are available and how many non-medical rides you can get each month. To learn more about what transportation services are covered and how to request rides, you can call your One Care plan or ask your Care Partner, Care Manager, or Care Coordinator.

One Care members can get all the dental services MassHealth covers. (check here for a list). To receive services, you will need to go to a dental provider in your One Care plan’s network. Your One Care plan may also need to approve the service ahead of time (meaning they require prior authorization). Contact your Care Partner, Care Manager, or Care Coordinator for more information about dental benefits and how to find a provider. Or, reach out to us at My Ombudsman if you need more help.

In the first 90 days after you join One Care, you will get a comprehensive assessment so that you and your care team can talk about your needs. After the assessment, you will work with your Care Team to make your individualized care plan (ICP). Every year, your Care Team will work with you to update your ICP in case there is a change in the health services you need and want. Your ICP can also be updated as your goals or needs change throughout the year.

An ICP identifies the health-related goals that you want to address, such as getting services for your physical and mental health care and getting long-term services and supports. They can also help coordinate: the providers you see, the medications you take, and can help you with any health-related social needs like getting housing and food supports. You will be able to record your health, independent living, and recovery goals. You will be at the center of this process to create your ICP.

Your Care Team will work with you to update your ICP any time your needs change or you want to add new needs or goals. Your Care Partner, Care Manager, or Care Coordinator will review and update your ICP with you at least once every year. Reach out to them if your goals or needs have changed, or if you have any questions about your ICP. Feel free to contact My Ombudsman if you need more help.

When you join One Care, your One Care plan will tell you who your Care Partner, Care Manager, or Care Coordinator is. This person is a key member of your care team, so it’s important to know who they are and how to reach them. If you don’t know their name (or forgot it), you can call your One Care plan to ask who they are and how to contact them. Feel free to contact My Ombudsman if you need more help.

Care coordination means that all behavioral health, medical, and community service providers work closely with each other, your primary care provider (PCP) and with you to help you get the care you need.

Care coordination includes:

Managing your care with your provider and other health care and social services agencies working to improve your health.

Helping you with transitions between different care settings such as from the hospital back to home or to a nursing facility

Every One Care member gets a care coordinator (that may be called a Care Coordinator, Care Partner or Care Manager depending on your plan,) to help coordinate your care, and a member’s care is provided through a care team. One Care’s approach to care coordination puts the member at the center of their own care team. The care team also includes someone who may be called your Care Coordinator, Care Partner or Care Manager; providers; and other supports you may want. In One Care, the care team helps with coordinating services according to your individualized care plan.

If you want, you can also choose to have a Long-term Supports (LTS) coordinator to help you find resources and benefits available to you in your community.

Care coordination means that all behavioral health, medical, and community service providers work closely with each other, your primary care provider (PCP) and with you to help you get the care you need.

Care coordination includes:

• Managing your care with your provider and other health care and social services agencies working to improve your health.

• Helping you with transitions between different care settings such as from the hospital back to home or to a nursing facility

Every One Care member gets a care coordinator (that may be called a Care Coordinator, Care Partner or Care Manager depending on your plan,) to help coordinate your care, and a member’s care is provided through a care team. One Care’s approach to care coordination puts the member at the center of their own care team. The care team also includes someone who may be called your Care Coordinator, Care Partner or Care Manager; providers; and other supports you may want. In One Care, the care team helps with coordinating services according to your individualized care plan.

If you want, you can also choose to have a Long-term Supports (LTS) coordinator to help you find resources and benefits available to you in your community.

If your provider is part of your One Care plan, you do not need to change. Ask your provider’s office if they accept your One Care plan (Commonwealth Care Alliance, Tufts Health Unify, or UnitedHealthcare Connected). If they don’t normally accept your One Care plan, you can keep seeing them up to 90 days after you join the plan (or until your individualized care plan (ICP) is completed), at no cost to you. This period is also known as the Continuity of Care period. During that time, your One Care plan will reach out to your provider to see if they would like to join their network. If the provider declines, after those 90 days pass, you will be required to see providers in the One Care network, with some exceptions. Reach out to your One Care plan for more information. If you need further assistance, feel free to contact My Ombudsman.

No, there are no co-pays for any of the benefits, including medications. If you pay a premium to MassHealth or Medicare, you must continue to pay the premiums to keep your coverage.

No, being a One Care member is optional. You can change your mind and leave at any time, but the enrollment lasts through the end of the month. If you decide to leave One Care, you will go back to getting the same healthcare benefits and services you used to get from MassHealth and Medicare separately. If you want to join One Care again later, you can do that too.

No. My Ombudsman can’t help people enroll (sign up) in MassHealth health plans, including One Care plans. To enroll in One Care, you need to call MassHealth Customer Service at (800) 841-2900, or fill out the One Care online enrollment form found here. You can learn more about how to enroll in One Care here. 

My Ombudsman can’t recommend one plan over another or tell you which one to pick, but we can give you the information you need to make the best decision for yourself.

If you need more help, other options include talking to a SHINE Counselor, your doctor, a social worker, a trusted friend, or the MassHealth Customer Service Center.

The One Care program is available in all of Massachusetts except for Dukes and Nantucket counties. In some counties, Commonwealth Care Alliance, Tufts Health Unify and UnitedHealthcare Connected are available. In other counties, only one plan is available. If you want to know which plans are available in your area, visit this page.

There are currently two One Care plans, Commonwealth Care Alliance and Tufts Health Unify. 

To learn more about each plan, you can:

• Call Commonwealth Care Alliance Member Services at (866) 610-2273.

• Visit the Commonwealth Care Alliance website.

• Call Tufts Health Unify Member Services at (855) 393-3154.

• Visit the Tufts Health Unify website.

• Call UnitedHealthcare Connected Member Services at (866) 633-4454.

• Visit the UnitedHealthcare Connected website.

You can join One Care If you are an adult who is:

• Living in an area in Massachusetts covered by One Care

• A person with a disability

• Between the ages of 21 and 64

• Enrolled in MassHealth Standard or CommonHealth as well as Medicare Parts A, B, and qualify for Part D

• Not enrolled in private insurance

• Not getting services from a Home and Community-Based Services waiver

To learn more about One Care enrollment, click here.

One Care combines all the benefits you get now from MassHealth and Medicare and offers extra benefits to help you manage your health conditions. As a member of One Care, you belong to one health plan and have one health insurance card to use for all your providers, including at the doctor’s office, hospital, pharmacy, or dentist.

Starting in 2013 Massachusetts created a new health coverage program called One Care. This program is for people aged 21-64 at the time of enrollment who have both Medicare and MassHealth (Medicaid). The goal is to offer more personalized and accessible care to people with complex health needs. The three One Care health plans now available in Massachusetts are called Commonwealth Care Alliance (CCA), Tufts Health Unify (THU) and UnitedHealthcare Connected.

These plans combine all the benefits of MassHealth and Medicare, along with some additional benefits. All One Care members work with an individual care coordinator (sometimes called a Care Partner, Care Manager or Care Coordinator) who helps them manage their care. One Care members use a single insurance card at the doctor’s office, hospital, or pharmacy, because their health plan coordinates all their healthcare services from both MassHealth and Medicare.

For general information on One Care, visit this website.