Alyssa Lane
CalOptima is a health insurance company that offers Medicare Advantage plans called OneCare. OneCare combines Medicare Part A (hospital), Medicare Part B (medical), and Part D (prescription drugs) into one plan, providing benefits for seniors and people with disabilities. It is designed for those who are eligible for both Medicare and Medi-Cal, which is California's Medicaid program serving low-income individuals and families. OneCare includes supplemental services, such as the OneCare Flex Plus grocery benefit for the chronically ill, to make accessing care more convenient.
| Characteristics | Values |
|---|---|
| What is Cal Optima? | The single largest health insurance company in Orange County, California |
| What does it offer? | Medicare Advantage Plan called OneCare |
| Who is it for? | For people who qualify for both Medi-Cal and Medicare, including low-income seniors and people with disabilities |
| What is Medi-Cal? | California's Medicaid program, a public health insurance program for certain individuals and families with low income |
| What does Medicare Advantage Plan offer? | Combines Medicare Part A (hospital), Medicare Part B (medical) and Part D (prescription drugs) into one plan |
| What is OneCare? | OneCare Complete and OneCare Flex Plus are the two options that bring together Medicare and Medi-Cal benefits |
| What is unique about OneCare Flex Plus? | It offers a grocery benefit as part of a special supplemental program for the chronically ill |
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What You'll Learn
- CalOptima Health OneCare is a Medicare Advantage Plan
- OneCare Complete and OneCare Flex Plus are CalOptima's Medicare Advantage plans
- Medicare Advantage combines Medicare Part A, B, and D
- CalOptima's OneCare plans offer supplemental services
- Medicare Advantage is for those eligible for both Medicare and Medi-Cal
CalOptima Health OneCare is a Medicare Advantage Plan
CalOptima Health is the largest health insurance company in Orange County, California. It manages Medi-Cal, California's Medicaid program, which provides comprehensive medical services for low-income individuals, including families with children, seniors, people with disabilities, pregnant women, and those with specific diseases.
OneCare offers two options: OneCare Complete and OneCare Flex Plus. Both plans aim to simplify the process of receiving care by consolidating Medicare and Medi-Cal benefits. The Flex Plus plan provides additional flexibility with more customizable benefits. It also includes a grocery benefit as part of a special supplemental program for the chronically ill, although not all members qualify for this specific program.
One advantage of enrolling in OneCare is that it allows members to continue seeing their current Medi-Cal or Medicare provider, even if that provider is out of network. This flexibility ensures that members can maintain their preferred healthcare providers while still enjoying the benefits of the OneCare plan.
In summary, CalOptima Health OneCare is a Medicare Advantage Plan that streamlines access to healthcare services for eligible individuals in Orange County, California. By combining Medicare and Medi-Cal benefits, OneCare simplifies the healthcare process and provides comprehensive coverage for its members.
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OneCare Complete and OneCare Flex Plus are CalOptima's Medicare Advantage plans
CalOptima is a Medicare Advantage plan. It combines Medicare Part A (hospital), Medicare Part B (medical) and Part D (prescription drugs) into one plan. It is a dual-eligible special needs plan (D-SNP) that combines Medicare and Medi-Cal benefits.
CalOptima Health OneCare is CalOptima's Medicare Advantage Special Needs Plan. It combines Medicare and Medi-Cal benefits, and is designed to meet the unique needs of its members. OneCare supports seniors and people with disabilities who are enrolled in both Medicare and Medi-Cal. Members have access to a Personal Care Coordinator (PCC) who can help them get the services they need, as well as certain home and community services.
OneCare has two options: OneCare Complete and OneCare Flex Plus. Both options bring your Medicare and Medi-Cal benefits together. The OneCare Complete plan offers support for your unique needs, while the OneCare Flex Plus plan offers more flexible benefits.
OneCare Complete offers benefits such as unlimited trips at no cost to and from doctor visits, and no copays for generic and brand-name drugs all year. OneCare Flex Plus also offers these benefits, but with standard Part D copays for medicines. OneCare Flex Plus also has a grocery benefit for members with comorbid and medically complex chronic conditions that are life-threatening or significantly limit the overall health or function of the enrollee.
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Medicare Advantage combines Medicare Part A, B, and D
CalOptima Health's OneCare options are Medicare Advantage plans. Medicare Advantage combines Medicare Part A (hospital coverage), Medicare Part B (medical coverage), and usually Part D (prescription drug coverage) into one plan. This is also known as Part C or an MA plan.
Medicare Advantage is an alternative to Original Medicare (Parts A and B) offered by private companies that must follow rules set by Medicare. These "bundled" plans are approved by Medicare and are designed to meet your unique needs. They bring your Medicare and Medi-Cal benefits together, so it's easier for you to get the care you need.
Medi-Cal is California's Medicaid program, a public health insurance program for certain individuals and families with low incomes. A dual-eligible special needs plan (D-SNP) is a type of Medicare Advantage plan for people who qualify for both Medicare and Medi-Cal.
You can get Medicare if you are age 65 or older, or if you are under 65 and have a qualifying disability or certain medical conditions. Medicare Advantage plans may have different out-of-pocket costs than Original Medicare or supplemental coverage, and they may offer some extra benefits that Original Medicare doesn't.
It's important to note that insurance companies can decide to join or leave Medicare annually, and a Medicare Advantage Plan can disenroll you for various reasons, such as moving outside the plan's service area or losing Medicare eligibility. Therefore, it's essential to review your options regularly to ensure you maintain the desired Medicare health and drug coverage.
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CalOptima's OneCare plans offer supplemental services
CalOptima Health is the largest health insurance company in Orange County, California. It manages Medi-Cal, California's Medicaid program, which provides comprehensive medical services for low-income individuals, including families with children, seniors, people with disabilities, pregnant women, and those with specific diseases.
CalOptima Health offers a Medicare Advantage plan called OneCare for those who qualify for both Medi-Cal and Medicare. OneCare is a dual-eligible special needs plan (D-SNP) that combines Medicare Part A (hospital), Medicare Part B (medical), and Part D (prescription drugs) into one plan. This means that members can receive their Medi-Cal and Medicare benefits and services in one place, making it easier to access the care they need.
OneCare offers two plan options: OneCare Complete and OneCare Flex Plus. Both plans bring together Medicare and Medi-Cal benefits, but each has unique features to meet the diverse needs of its members. For example, the OneCare Flex Plus grocery benefit is a supplemental program for eligible chronically ill members. This plan provides more flexible benefits, enhancing members' care.
OneCare plans offer supplemental services, adding value to the care received by members. These services include the option to see an out-of-network provider if a required service is unavailable within the network. Members can retain their current Medi-Cal or Medicare provider, even if they are out-of-network, as long as the provider is willing to work with CalOptima. This flexibility ensures that members can continue receiving care from their preferred providers.
In summary, CalOptima's OneCare plans provide a comprehensive Medicare Advantage program that integrates Medi-Cal and Medicare benefits. The plans offer supplemental services, such as the grocery benefit for the chronically ill and the flexibility to utilize out-of-network providers. These features enhance the accessibility and quality of care for members, ensuring they can focus on their health and well-being.
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Medicare Advantage is for those eligible for both Medicare and Medi-Cal
CalOptima Health's OneCare Medicare Advantage Plan is a dual-eligible special needs plan (D-SNP) that combines Medicare and Medi-Cal benefits. It is designed for those who are eligible for both Medicare and Medi-Cal, also known as "dual eligibles" or "Medi-Medis".
Medicare Advantage, also known as Part C, is an alternative way to get the coverage provided by Original Medicare (Part A and Part B). It combines Medicare Part A (hospital coverage), Medicare Part B (medical coverage), and Part D (prescription drug coverage) into a single plan. By enrolling in a Medicare Advantage Plan, individuals can receive their Medicare and Medi-Cal benefits and services in one place, making it easier to access the care they need.
In California, individuals may be eligible for both Medicare and Medi-Cal. Medicare is a federal health insurance program available to eligible individuals throughout the United States who are over 65 or have specific disabilities. On the other hand, Medi-Cal is California's Medicaid program, providing health coverage to individuals and families who meet certain income and residency requirements. While income is a factor for Medi-Cal eligibility, it does not impact eligibility for Medicare.
For those with both Medicare and full Medi-Cal coverage, most health care costs are covered. Medi-Cal may provide coverage for services that Medicare does not, such as basic vision and hearing, dental, non-emergency transportation, and personal care services. Additionally, Medi-Cal will cover Medicare Part A and B deductibles and copayments, as well as the monthly Medicare Part B premium.
Individuals enrolled in a D-SNP through CalOptima Health's OneCare plan do not have copays, coinsurance, or premiums associated with other types of Medicare Advantage plans. This plan offers flexibility and support to meet the unique needs of its members.
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Frequently asked questions
CalOptima Health is the largest health insurance company in Orange County, California. It manages Medi-Cal, California's Medicaid program, which pays for comprehensive medical services for low-income individuals, including families with children, seniors, people with disabilities, pregnant women, and those with specific diseases.
Cal Optima's OneCare plan is a Medicare Advantage plan that combines the benefits of Medi-Cal and Medicare for seniors and people with disabilities. OneCare offers two options: OneCare Complete and OneCare Flex Plus. Both options bring Medicare and Medi-Cal benefits together, including supplemental services, so that members can access the care they need.
You may be eligible for Medicare if you are 65 or older, or if you are under 65 and have a qualifying disability or certain medical conditions.
