OneCare (HMO SNP)

Benefits

The OC evidence of coverage has a complete list of benefits.

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Health services

  • “Welcome to Medicare” preventive visit (1 time only)
  • Primary care doctor visits
  • Medical specialist visits
  • Hospital and emergency care
  • Rehabilitation services
  • Immunizations
  • Drugs
  • Laboratory services
  • Hospice
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Behavioral health services

  • Inpatient mental health care
  • Outpatient mental health care
  • Outpatient substance abuse services
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Other services and supplies

  • Hearing aids
  • Oxygen equipment and supplies
  • Home health services
  • Medical supplies
  • Chiropractic services
  • Foot care
  • Wheelchairs, walkers, crutches, etc.
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Vision care

  • Routine eye exams
  • Eyeglasses or contact lenses
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Transportation

  • Ambulance services
  • Non-emergency medical transportation
  • Non-medical transportation to gym
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Long-term services and supports

  • Multipurpose senior services program
  • Community-based adult services
  • Nursing facility care

Dental Care: Preventive and restorative dental services are provided through Denti-Cal. For benefits or to find a dentist, call Denti-Cal at 1-800-322-6384 or visit www.denti-cal.ca.gov.

Download the OC summary of benefits Download PDF Icon This is a summary, please see the OC evidence of coverage for the full benefits list.

Download the OC evidence of coverage Download PDF Icon It lists what is covered, how to get services, your rights as a member, your responsibilities, and much more.

Out-of-network coverage

Most services will be provided by our network providers. If you need a covered service that cannot be provided within our network, OneCare (HMO SNP) will pay for the cost of an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider, when necessary. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for a period of time if he or she agrees to work with OneCare.

Emergency services coverage

If you need emergency care at any time, 24 hours a day, 7 days a week, you don’t need to get approval first. OneCare can provide you with a list of services or procedures that require you to obtain prior authorization before the service is provided.

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To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H5433_WEB020_M Accepted 06/17/19

OneCare (HMO SNP) is a Medicare Advantage organization with a Medicare contract. Enrollment in OneCare depends on contract renewal. Eligible beneficiaries can enroll at any time. Eligible beneficiaries must have Part A and Part B to enroll in the plan. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Other Pharmacies/Physicians/Providers are available in our network. Medicare beneficiaries may also enroll in OneCare (HMO SNP) through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare has neither reviewed nor endorsed this information. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. OneCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available for free in other languages. Please call our customer service number at 1-877-412-2734, 24 hours a day, 7 days a week. TDD/TTY users should call 1-800-735-2929.

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