OneCare (HMO D-SNP)

Benefits

The OneCare Complete and OneCare Flex Plus Member Handbooks have a complete list of benefits.

2025 Benefits

Enjoy Options With CalOptima Health OneCare Complete (HMO D-SNP), a Medicare Medi-Cal Plan or CalOptima Health OneCare Flex Plus (HMO D-SNP), a Medicare Medi-Cal Plan

Choose from 1 of our 2 CalOptima Health OneCare options to get full health care at no extra cost. Our OneCare Complete plan offers support to fit your needs, while our OneCare Flex Plus plan enhances your care with more flexible benefits. Both options bring your Medicare and Medi-Cal benefits together, so you can focus on what’s most important — your health.

The OneCare Complete and OneCare Flex Plus Member Handbooks have a complete list of benefits.

Choose the CalOptima Health OneCare option that’s right for you:

OneCare Complete

CalOptima Health OneCare Complete (HMO D-SNP), a Medicare Medi-Cal Plan

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Flex Card: over-the-counter items and groceries

$135 per quarter and no rollover of unused funds

Prescription Medicines Icon

Prescription Medicines (Part D premium coverage)

No copays

Vision Icon

Vision

Annual exam and up to $300 for eyeglasses or contact lenses every year

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Hearing

$1,000 of hearing hardware above the Medi-Cal limit of $1,510

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Comprehensive Dental**

Yes

Gym Icon

Fitness Benefit

Yes

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Transportation

Unlimited trips to and from the gym and 100 one-way trips to grocery stores (10-mile radius)

Worldwide Emergency Room Coverage Icon

Worldwide Emergency Room Coverage

$100,000

Annual Physical Exam Icon

Annual Physical Exam

Once every 12 months

In-Home Support Services Icon

In-Home Support Services — Companion Care

Up to 90 hours

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Erectile Dysfunction Medicines

OneCare Flex Plus

CalOptima Health OneCare Flex Plus (HMO D-SNP), a Medicare Medi-Cal Plan

Flex Card Icon

Flex Card: over-the-counter items and groceries

$245 per quarter and no rollover of unused funds*

Prescription Medicines Icon

Prescription Medicines (Part D premium coverage)

Standard Part D copays based on low-income status up to $4.90 for generics and $12.15 for brands

Vision Icon

Vision

Annual exam and up to $300 for eyeglasses or contact lenses every year

Hearing Icon

Hearing

$1,000 of hearing hardware above the Medi-Cal limit of $1,510

Dental Icon

Comprehensive Dental**

Yes

Gym Icon

Fitness Benefit

Yes

Transportation Icon

Transportation

Unlimited trips to and from the gym (10-mile radius)

Worldwide Emergency Room Coverage Icon

Worldwide Emergency Room Coverage

$100,000

Annual Physical Exam Icon

Annual Physical Exam

Once every 12 months

In-Home Support Services Icon

In-Home Support Services — Companion Care

Pill Icon

Erectile Dysfunction Medicines

4 pills per month

*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.

**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.

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2025 CalOptima Health OneCare Complete summary of benefits (Updated 8/1/2024)  Download PDF Icon This is a summary. Please see the CalOptima Health OneCare Complete Member Handbook for the full benefits list.

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2025 CalOptima Health OneCare Flex Plus summary of benefits (Updated 8/1/2024)  Download PDF Icon This is a summary. Please see the CalOptima Health OneCare Flex Plus Member Handbook for the full benefits list.

2024 Benefits

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Health services

  • “Welcome to Medicare” preventive visit (1 time only)
  • Primary care doctor visits
  • Medical specialist visits
  • Hospital and emergency care
  • Rehabilitation services
  • Immunizations
  • Drugs
  • Over the Counter (OTC) Items
  • Laboratory services
  • Hospice
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Behavioral health services

  • Inpatient mental health care
  • Outpatient mental health care
  • Outpatient substance abuse services
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Other services and supplies

  • Hearing aids
  • Oxygen equipment and supplies
  • Home health services
  • Medical supplies
  • Chiropractic services
  • Foot care
  • Wheelchairs, walkers, crutches, etc.
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Vision care

  • Routine eye exams
  • Eyeglasses or contact lenses
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Transportation

  • Ambulance services
  • Non-emergency medical transportation
  • Non-medical transportation to gym
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Long-term services and supports

  • Multipurpose senior services program
  • Community-based adult services
  • Nursing facility care
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Download the 2024 OneCare summary of benefits (Updated 8/15/2023) Download PDF Icon This is a summary, please see the OC evidence of coverage for the full benefits list.

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Over-the-Counter (OTC) Benefits Learn how to order OTC products online, by mobile app, by phone or by mail.

Other Benefits

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Nurse Advice Phone Line Download PDF Icon We want you to be able to get answers when you or your loved ones are sick, not feeling good or are injured.

Dental Care: Preventive and restorative dental services are provided through Medi-Cal. For benefits or to find a dentist, call Medi-Cal at 1-800-322-6384 or visit www.dental.dhcs.ca.gov.

Out-of-network coverage

Most services will be provided by our network providers. If you need a covered service that cannot be provided within our network, OneCare (HMO D-SNP) will pay for the cost of an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider, when necessary. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for a period of time if he or she agrees to work with OneCare.

Emergency services coverage

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

Access to care during a disaster or public health emergency

If the Governor of California, the U.S. Secretary of Health and Human Services or the President of the United States declares a state of disaster or public health emergency in Orange County, you are still entitled to care from OneCare.


Most services will take place within our network of providers. If you need a covered service that cannot be provided within our network, OneCare will pay for the cost of an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for a period of time if they agree to work with OneCare.

During a declared disaster or public health emergency, if you cannot use a network provider, we will allow you to get care from out-of-network providers at no cost to you. If you cannot use a network pharmacy during a declared disaster or public health emergency, you will be able to fill your prescription drugs at an out-of-network pharmacy.

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To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H5433_25WEB001_M_2025 (Accepted 9/17/2024)

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