What One Care Means for You
October 1, 2013 § 3 Comments
Starting today, Massachusetts is offering a new healthcare option for our most complex patients with disabilities – those who qualify for Medicare and Medicaid. It’s called One Care: MassHealth plus Medicare. The new plan will help eliminate the confusing and often fragmented access to services that exists for people who receive benefits from both Medicare and Medicaid.
Commonwealth Care Alliance is offering One Care and hopes to educate Massachusetts residents about how this plan can help you or a loved one live healthier, stay active, and be more independent.
What is One Care?
One Care is a new health care option that was developed under the Affordable Care Act for Massachusetts adults with disabilities, whether, physical, developmental, or mental health condition ages 21 to 64 who are eligible for both MassHealth and Medicare coverage. With One Care, each member will have a primary care provider, a Care Coordinator, a Care Team, and a Personal Care Plan to make sure that you receive all the services you need, when and where you need them. The One Care plan will manage all care needs through your Care Team which can include, depending upon your needs, primary care, mental health care, hospital care, specialized care, and long term services and support providers. The Care Coordinator will help manage and coordinate a wide range of services, as you need them, including all medical and community-based services that are currently covered by Medicare and MassHealth, in addition to enhanced services such as dental and other community-based supports.
One Care makes it possible for people with disabilities to have one plan and one card. It’s an easier and new way to live healthier, stay more active, and be more independent, by simply bringing all your care together under one plan.
What is special about One Care?
One Care is new approach to healthcare. It’s the first demonstration program in the country designed to promote member choice and direction in an integrated team-based approach to eliminate the confusing and fragmented access to services that exists when receiving Medicare and Medicaid benefits separately.
With One Care, all of your Medicare and Medicaid services are covered, including Medicare Part D drug benefits. One Care members will have a choice of doctors (or keep their own) and a Care Coordinator to help arrange your physical, behavioral health (including mental health and substance abuse needs), and long-term services and supports. Your team and Care Coordinator will then create a Personalized Care Plan to make sure you are getting the care that best meets your needs.
Depending on personal needs, One Care may be able to provide new ways for you to get additional services, such as peer supports, home care, wellness support, medical equipment repair, and more. Your Personal Care Plan may also include a range of recovery-based community mental health and substance abuse services.
Will I need to change doctors?
If your doctor participates in your One Care plan, you will not need to change your doctor. If not, your plan will work to find you the best provider to address your individual needs.
What plans are available and where?
One Care will be offered by three providers: Commonwealth Care Alliance, Fallon Total Care, and Network Health.
Commonwealth Care Alliance is the only plan offering One Care in every participating county in the state, which includes: Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth (partial), Suffolk, and Worcester Counties. Fallon Total Care is offered in Hampden, Hampshire, and Worcester Counties, while Network Health will offer One Care in Suffolk and Worcester Counties.
When does One Care start?
One Care coverage begins October 1, 2013; eligible participants can enroll at any time after the start date.
How can I sign up?
If you’re eligible for One Care, you should have received information in the mail from MassHealth instructing you how to enroll in One Care. This packet includes a list of One Care plans available in each city or town, information on how to sign up, an Enrollment Decision Form, and phone numbers you can call for help or to get more information.
When researching and choosing the One Care plan that suits you, consider which plans are available in your area and which of your care providers are part of each One Care plan.
Once you’ve made a decision, you can fill out the Enrollment Decision Form and return it to MassHealth, or you can call MassHealth Customer Service at 1-800-841-2900 or TTY: 1-800-497-4648 to enroll.
Those eligible can choose to enroll in One Care and can leave it at any time without losing MassHealth and Medicare benefits.
Where can I find out more information?
You can call the MassHealth Customer Service line at 1:800-841-2900 or TTY: 1-800-497-4648, or visit www.mass.gov/masshealth/onecare.
For more information about Commonwealth Care Alliance’s One Care plan, visit http://www.commonwealthonecare.org/. or call Member Services at 866-610-2273
(TTY 711) seven days a week, 8 am to 8 pm,
*Questions and answers adapted from www.mass.gov/masshealth/onecare