OneCare (HMO D-SNP)

Benefits

The OC evidence of coverage has a complete list of 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.

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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_24WEB001_2024_A (Accepted 9/19/2023)

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