OneCare Frequently Asked Questions
What is Medicare Advantage?
Medicare Advantage combines Medicare Part A (hospital), Medicare Part B (medical) and Part D (prescription drugs) into one plan. This is also known as Part C.What is a D-SNP plan?
A dual-eligible special needs plan (D-SNP) is a type of Medicare Advantage plan for people who get both Medicare and Medi-Cal. Medicare Advantage D-SNP plans, such as CalOptima Health’s OneCare options, are made to meet your your unique needs, so that you get your Medi-Cal and Medicare benefits and services in one place.Do I meet the requirements for OneCare?
You could qualify to be a OneCare member if you:
- Live in Orange County
- Have Medicare Parts A and B
- Have full Medi-Cal with no Share of Cost
- Are age 21 or older
How will OneCare help me?
With OneCare, your Medicare, Medi-Cal and Part D benefits are together in one health plan, making it easier for you to understand and use your benefits. You’ll have support from a Personal Care Coordinator (PCC) who can help you get the services you need. You’ll also have access to certain home and community services to help you live safely at home.Can I still see my regular doctor?
Yes, you can see them if they are part of our growing network of more than 7,000 doctors. If your doctor is not in the network, you can keep seeing them for a period of time if they agree to work with OneCare.How much does OneCare cost?
You can enroll in our OneCare options at no cost. You don’t pay plan premiums or deductibles, copays or coinsurance for medical services. However, you might have Standard Part D copays for medicines with OneCare Flex Plus. Call us at 1-877-412-2734 (TTY 711) to learn more.Does OneCare cover transportation?
Yes, you’ll have unlimited trips at no cost to and from your doctor visits. You can also get non-medical transportation, including to the gym and grocery stores, depending on the OneCare option you choose.Will I lose my Medicaid if I get Medicare?
No. Our OneCare options bring your Medi-Cal and Medicare benefits together, so it’s easier for you to get the care you need. With OneCare, you’ll keep getting all the benefits you’re used to, including medical, drug coverage and extra services, such as vision and hearing.Who is eligible for both Medicare and Medicaid?
You could get Medicare if you are age 65 or older, or if you are under age 65 and have a qualifying disability or certain medical conditions. You could get Medicaid (or Medi-Cal, as it is known in California) depending on your income and other factors.Can I still my regular doctor as a OneCare member?
Yes, you can see them if they are part of our growing network of more than 7,000 doctors. If your doctor is not in the network, you can keep seeing them for a period of time if they agree to work with OneCare.What is Medicare Part D?
Medicare Part D coverage is a federal program that helps pay for prescription drugs. Our OneCare options include Medicare Part D prescription drug coverage.Who is eligible for Medicare Part D?
If you qualify for Medicare Part A (hospital) or are enrolled in Medicare Part B (medical), you can sign up for Medicare Part D. If you qualify for both Medicare and Medi-Cal, you might be automatically enrolled in Medicare Part D and could qualify for one of our OneCare options.If I qualify for Medicare Part D, do I also qualify for OneCare?
To be a OneCare member, you must:
- Live in Orange County
- Have Medicare Parts A and B
- Have full Medi-Cal with no Share of Cost
- Are age 21 or older
How Much does Medicare Part D cost?
Medicare Part D costs can vary. With our OneCare options, you could have no or very low copays for your medicines.What does Medicare Part D cover?
Medicare Part D can cover generic and brand-name medicines, such as those for chronic conditions (e.g., diabetes, high blood pressure). With our OneCare options, you’ll have access to formularies for each option which have all the medicines you need.
- OneCare Complete formulary
- OneCare Flex Plus formulary