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
CalOptima Health OneCare Complete
Monthly plan premium
You pay $0
Deductible
You pay $0
CalOptima Health OneCare Flex Plus
Monthly plan premium
You pay $0
Deductible
You pay $0
Supplemental Benefits
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
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
CalOptima Health OneCare Complete
Pharmacy Services
You pay $0. No copays for generic and brand-name drugs all year
CalOptima Health OneCare Flex Plus
Pharmacy Services
You pay $0. No copays for generic and brand-name drugs all year
Hospital Services
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
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
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
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
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
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.
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.
Order Your OTC Items in 3 Easy Ways
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.
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.
Phone
Call 1-855-299-5410 (TTY 711).
OneCare Keeps You Covered, No Matter What
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.
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.
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.