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CalOptima Health OneCare Benefits and Services

Whether you’re a senior, living with disabilities or managing chronic conditions, CalOptima Health OneCare (HMO D-SNP) is here to support you.

Your Medi-Cal and Medicare Benefits, Together in One Place

Choose from one of our two OneCare options: OneCare Complete or OneCare Flex Plus. Both options bring your Medicare and Medi-Cal benefits together, so you can focus on your health.

Premiums and Benefits

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CalOptima Health OneCare Complete

Monthly plan premium

You pay $0

Deductible

You pay $0

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CalOptima Health OneCare Flex Plus

Monthly plan premium

You pay $0

Deductible

You pay $0

Supplemental Benefits

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CalOptima Health OneCare Complete

Flex Card: Groceries/Over-the-Counter (OTC) items

You pay $0–$135 per quarter with no rollover of unused funds

Fitness Benefit

You pay $0

Transportation

You pay $0. Unlimited to/from gym and 100 one-way trips to grocery stores within a 10-mile radius

Comprehensive Dental**

You pay $0

Vision Care: Annual exam and $300 hardware every year

You pay $0

Hearing Aid: $1,000 allowance above the Medi-Cal limit of $1,510 per year

You pay $0

Annual Physical Exam: Once per year

You pay $0

In-Home Support Services/Companion Care

You pay $0. Up to 90 hours per year

Erectile Dysfunction Drug

Not covered

Worldwide ER and Urgent Care: $100,000 per year

You pay $0

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CalOptima Health OneCare Flex Plus

Flex Card: Groceries/Over-the-Counter (OTC) items

You pay $0–$135 per quarter with no rollover of unused funds

Fitness Benefit

You pay $0

Transportation

You pay $0. Unlimited to/from gym and 100 one-way trips to grocery stores within a 10-mile radius

**

You pay $0

Vision Care: Annual exam and $300 hardware every year

You pay $0

Hearing Aid: $1,000 allowance above the Medi-Cal limit of $1,510 per year

You pay $0

Annual Physical Exam: Once per year

You pay $0

In-Home Support Services/Companion Care

You pay $0. Up to 90 hours per year

Erectile Dysfunction Drug

Not covered

Worldwide ER and Urgent Care: $100,000 per year

You pay $0

Pharmacy Services

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CalOptima Health OneCare Complete

Pharmacy Services

You pay $0. No copays for generic and brand-name drugs all year

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CalOptima Health OneCare Flex Plus

Pharmacy Services

You pay $0. No copays for generic and brand-name drugs all year

Hospital Services

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CalOptima Health OneCare Complete

Inpatient hospital coverage

You pay $0

Outpatient hospital coverage: Ambulatory surgical center & Outpatient surgery (hospital)

You pay $0

Hospital care and surgeries

You pay $0

Emergency room services

You pay $0

Ambulance services

You pay $0

Skilled nursing facility and home health care

You pay $0

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CalOptima Health OneCare Flex Plus

Inpatient hospital coverage

You pay $0

Outpatient hospital coverage: Ambulatory surgical center & Outpatient surgery (hospital)

You pay $0

Hospital care and surgeries

You pay $0

Emergency room services

You pay $0

Ambulance services

You pay $0

Skilled nursing facility and home health care

You pay $0

General Benefits and Services

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CalOptima Health OneCare Complete

Doctor visits: Primary Care Provider (PCP) & Specialists

You pay $0

Preventive care

You pay $0

Lab tests

You pay $0

X-rays

You pay $0

Durable Medical Equipment (DME)

You pay $0

Flu shots

You pay $0

Screening mammograms

You pay $0

Pap tests and pelvic exams

You pay $0

Prostate cancer screenings exams

You pay $0

Bone mass testing

You pay $0

Diabetic supplies and podiatry services

You pay $0

Mental health services (inpatient and outpatient)

You pay $0

Physical and occupational therapy

You pay $0

Chiropractic and acupuncture services

You pay $0

Medical equipment and supplies

You pay $0

Nurse advice line

You pay $0

Icon of medical symbol
CalOptima Health OneCare Flex Plus

Doctor visits: Primary Care Provider (PCP) & Specialists

You pay $0

Preventive care

You pay $0

Lab tests

You pay $0

X-rays

You pay $0

Durable Medical Equipment (DME)

You pay $0

Flu shots

You pay $0

Screening mammograms

You pay $0

Pap tests and pelvic exams

You pay $0

Prostate cancer screenings exams

You pay $0

Bone mass testing

You pay $0

Diabetic supplies and podiatry services

You pay $0

Mental health services (inpatient and outpatient)

You pay $0

Physical and occupational therapy

You pay $0

Chiropractic and acupuncture services

You pay $0

Medical equipment and supplies

You pay $0

Nurse advice line

You pay $0

Home and Community Services via Medi-Cal

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CalOptima Health OneCare Complete

Orange County In-Home Supportive Services (IHSS)

You pay $0

Community-Based Adult Services (CBAS)

You pay $0

Long-Term Care (LTC)

You pay $0

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CalOptima Health OneCare Flex Plus

Orange County In-Home Supportive Services (IHSS)

You pay $0

Community-Based Adult Services (CBAS)

You pay $0

Long-Term Care (LTC)

You pay $0

*The CalOptima Health OneCare Flex Plus grocery benefit is part of a special supplemental program for the chronically ill. Not all members qualify. To use the grocery benefit, CalOptima Health OneCare Flex Plus members must have one or more comorbid and medically complex chronic conditions that are life threatening or significantly limits the overall health or function of the enrollee. Eligible conditions include but are not limited to cardiovascular disorder, diabetes mellitus, chronic heart failure, chronic lung disease, or end-stage renal disease. Even if the member has a chronic condition, the member will not necessarily receive the grocery benefit. Receiving the grocery benefit depends on the member having a high risk of hospitalization or other adverse health outcomes and a need for intensive care coordination.

Use this form to find out if you qualify to buy groceries with your Flex Card. Print this form and ask your doctor to fill it out.

Flex Card Grocery Benefit form

A dental professional stands next to a patient in a green gown, holding a dental tool against a bright blue background.

Comprehensive Dental

**CalOptima Health OneCare works with Liberty Dental Plan to provide you with comprehensive dental services that add to the services you can get through Medi-Cal Dental. Click below for more information about which dental services CalOptima Health OneCare covers and how they work.

CalOptima Health OneCare Dental Benefits and Medi-Cal Dental Benefits

Liberty Dental Plan Benefits

Liberty Dental Plan Frequently Asked Questions 

For a full list of services covered by Medi-Cal Dental, call 1-800-322-6384 (TTY 1-800-735-2922) or visit Smile, California. These resources can also help you locate a Medi-Cal Dental provider and file a grievance or complaint.

Hundreds of Items Available to You Through Our OTC Network

As a CalOptima Health OneCare member, you can view our catalogue of hundreds of OTC items and choose the ones you need to be mailed to your home.

2025 OTC Catalog and Instructions

Order Your OTC Items in 3 Easy Ways

Senior woman using computer

Online

Visit andmorehealth.com/onecare.*

* By visiting

andmorehealth.com/onecare, you will be leaving the official CalOptima Health website. The policies that apply to our website might not be the same as the terms of use for other websites. We don’t operate or control the linked website and are not responsible for its operation or content.

Man using smartphone app

Mobile App

Download the OTC-Anywhere mobile application.**

** Available for Apple and Android mobile phones. There is no charge to download or use the app. Internet access is required. Data rates may apply.

Woman talking on phone

Phone

Call 1-855-299-5410 (TTY 711).

OneCare Keeps You Covered, No Matter What

Doctor speaking with senior couple

Get Care, Even If It’s Out of Network

Our network providers will provide most of your health care services. If you need a covered service that isn’t in our network, we’ll pay for the cost for you to see an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider when you need to. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for some time if they will work with us.

Senior man speaking with doctor

Stay Covered During Emergencies

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

Doctor speaking with patient

Have Peace of Mind During Disasters and Public Health Emergencies

If a state of disaster or public health emergency is declared in Orange County, you’ll still get the care you need from OneCare. During this time, if you can’t use a network provider, we’ll let you get care from out-of-network providers at no cost to you. If you can’t use a network pharmacy, you’ll also be able to get your medicines at an out-of-network pharmacy.

Help 24 Hours a Day, 7 Days Week From Our Nurse Advice Line

Need health advice? If you can’t get hold of your doctor or health network, you can speak to one of our nurses 24 hours a day, 7 days a week at 1-844-447-8441 (TDD/TTY 1-844-514-3774). It’s like talking to a nurse at your doctor’s office, urgent care or the emergency room — we can help: 

  • Figure out your symptoms and what you can do
  • Give you facts about non-urgent and urgent care
  • Refer you to get help, see your doctor, go to urgent care or visit the hospital
  • Explain your condition or your diagnosis
  • Learn about your medicines
  • Provide interpreter services by phone

Call 911, if you think you have a medical or psychiatric emergency or go to the nearest hospital.

Telephone advice nurse
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