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Answers to frequently asked questions
about One Care

When you join a new health care plan, you always have questions. Here are some of the most frequently asked questions about the Commonwealth Care Alliance One Care. If you have other questions that aren’t answered here, please call Member Services at 866-610-2273 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week.

  • What is the Commonwealth Care Alliance One Care Program?

    One Care is an all-in-one healthcare program for people between the ages of 21 and 64 who have MassHealth Standard or MassHealth CommonHealth and Medicare. With One Care, you get more benefits than with your MassHealth and Medicare coverage at no additional cost. Our One Care Program provides you with a care team of health professionals who will help you stay healthy, independent, and living in your home. Your care team includes a primary care provider, nurses, specialists, and other providers as necessary. You’ll be able to receive care in your providers' offices or in your home.

  • What makes Commonwealth Care Alliance different from other One Care plans?

    For 2017, our One Care program is ranked as the top-rated One Care plan in the United States for member experience, according to the 2016 Medicare national patient survey, Consumer Assessment of Healthcare Providers and Systems. In Massachusetts, 80% of the state’s total One Care membership is enrolled in the Commonwealth Care Alliance plan. In addition, in 2015 CCA’s One Care plan was ranked above the 90th percentile for Medicaid health plans on key performance measures of healthcare quality.

  • Do I receive more benefits with the One Care program than MassHealth?

    Yes. With Commonwealth Care Alliance One Care, you actually get more benefits and services than you now get with your current plans. You keep all the benefits you currently have through Medicare and MassHealth, plus you’ll have new ones. Your new benefits include comprehensive dental care, transportation to medical appointments, medical visits and personal assistance in your home, transitional assistance from a hospital stay, and more.

  • What does One Care cost? Is there a monthly premium?

    You don’t pay anything for the One Care program—all services are provided to you free of charge as part of your MassHealth and Medicare benefits. Important: If you pay a premium to MassHealth for CommonHealth, you must continue to pay the premium to MassHealth to keep your coverage.

  • I lost my ID card. How do I get a new one?

    Please call our Member Services team at 866-610-2273 (TTY 711), and we’ll be happy to send you a replacement ID card.

  • What if I want to change my primary care provider (PCP)?

    You may change your primary care provider (PCP) for any reason, at any time, and choose another doctor from the Commonwealth Care Alliance One Care network. To find a new provider, click below to search our Online Provider Directory or call our Member Services team at 866-610-2273 (TTY 711).
    Search the One Care Online Provider Directory.

  • Do I have to change my primary care provider or specialists when
    joining One Care?

    When you become a member of Commonwealth Care Alliance, you must choose a provider in our network to be your primary care provider. We have a large network of quality primary care providers and specialists, so there’s a good chance your current doctors and providers are in our network and you won’t have to make a change. To see if your doctors and other providers are in the Commonwealth Care Alliance network, search our online provider directory.
    Search the One Care Provider Directory 
    You may also call our Member Services team at 866-610-2273 (TTY 711).

  • I received a bill from a doctor or other medical provider. What do I do with it?

    As a Commonwealth Care Alliance member, you DO NOT have to pay any bills for the services we cover. If you receive a bill from a doctor or medical provider, please send or fax it to: Commonwealth Care Alliance
    Member Services Department
    30 Winter Street, Boston, MA 02108
    Fax: 617-426-1311

    Please note: You must submit any medical bills you receive to us within twelve (12) months of the date you received the service, item, or drug.

  • What dental services are covered under my plan?

    Your plan covers comprehensive dental services at no cost to you. Your dental benefits include:

    • Exams, cleanings, and X-rays
    • Fillings, extractions, and gum disease treatment
    • Crowns, bridges, and root canals
    • Dentures and implants
    • Other services that are medically necessary
  • How do I use my dental benefits?

    Once you receive your CCA member ID card, schedule an appointment with  general dentist in our network. You can find an in-network dentist by using our provider directory or by calling Member Services at 866-610-2273 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week. Your dentist will assess and treat you, and will also refer you as necessary for services that require prior authorization.

  • How do I find a dentist?

    You can find a dentist in the Commonwealth Care Alliance network by using our provider directory or by calling Member Services at 866-610-2273 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week.

  • How do I get transportation approved?

    All non-emergency transportation, whether medical or non-medical, requires prior authorization. During your assessment or thereafter, please communicate with your care partner your need for transportation.

  • Is there prescription drug (Medicare Part D) coverage?

    Yes. As a Commonwealth Care Alliance member, you have no costs for your prescription drug coverage. We’ll cover the drugs listed in our formulary as long as they are medically necessary. Your enrollment entitles you to needed over-the-counter drugs and health care supplies free of charge with a prescription.

  • What is a care team?

    A care team is a group of people that will get to know your needs and work with you to help you create and carry out a personal care plan. Your care team will include a primary care doctor, nurses, specialists, and other providers as necessary. They’ll talk to you about who you’d like to provide care services and when you’d like to get the services. Your care team will work with you to become more independent or to stay independent.

  • How do I get long-term services and supports?

    Long-term services and supports (LTSS) are nonmedical services that help people live independently in the community. Such services may include personal care attendants, rehabilitation specialists, day habilitation, adult day health, adult foster care, peer support, assistive technology and nonmedical transportation. You’ll need to work with your care partner to discuss your care needs and get the right services.

For detailed information on out-of-network coverage rules, see your Evidence of Coverage (Member Handbook): Using the Plan’s Coverage for your Medical and Other Covered services.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, and/or pharmacy network may change on January 1 of each year.

 
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