The One Care program in Massachusetts is a comprehensive health care program for individuals who are eligible for both Medicare and MassHealth (Medicaid). This program aims to streamline care by coordinating services and benefits through a single plan. This article provides a detailed guide on understanding enrollment, disenrollment, and key aspects of the One Care program.
How to Disenroll from the One Care Program
If you are enrolled in the One Care program and wish to disenroll, you have several options to do so while maintaining your Medicare and MassHealth benefits. It’s important to note that individuals over 65 who leave One Care cannot re-enroll later.
To initiate disenrollment, contact MassHealth or Medicare directly and express your intention to leave your current One Care plan.
Contacting MassHealth:
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Call MassHealth Customer Service: Reach out to MassHealth Customer Service at 1-800-841-2900, Monday through Friday, from 8 am to 5 pm. TTY users can call 1-800-497-4648.
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Submit an Enrollment Decision Form: Obtain this form from the MassHealth website (www.mass.gov/one-care) or request it by phone from your One Care plan.
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Contact MassHealth After Hours: If MassHealth Customer Service is unavailable, contact Medicare at 1-800-MEDICARE (1-800-633-4227), available 24/7. TTY users should call 1-877-486-2048. This number also allows you to enroll in alternative Medicare health or prescription drug plans. Detailed information about accessing Medicare services after leaving One Care can be found in your Member Handbook/Evidence of Coverage.
Your One Care coverage will terminate at the end of the month in which your disenrollment request is received.
Involuntary Disenrollment from One Care
There are circumstances under which MassHealth or Medicare may involuntarily terminate your One Care enrollment:
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Loss of Medicare Part A and Part B Coverage: A lapse in your Medicare Part A and Part B coverage will result in disenrollment.
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MassHealth Ineligibility: One Care eligibility requires dual enrollment in both Medicare and MassHealth. Losing MassHealth eligibility will trigger disenrollment from One Care.
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Enrollment in HCBS Waiver Program: Joining a MassHealth Home and Community Based Services (HCBS) Waiver program necessitates disenrollment from One Care.
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Relocation Outside Service Area: Moving outside the designated One Care service area will lead to disenrollment.
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Residence in an Intermediate Care Facility: Residing in an Intermediate Care Facility managed by the Massachusetts Department of Developmental Services will result in disenrollment.
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Incarceration: Imprisonment due to a criminal offense will lead to disenrollment.
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Non-U.S. Citizenship or Unlawful Presence: Maintaining One Care membership requires U.S. citizenship or lawful presence in the United States. The Centers for Medicare & Medicaid Services (CMS) will notify the plan of ineligibility based on this criterion, leading to disenrollment.
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Duplicate Coverage: Having other comprehensive health or prescription drug insurance will result in disenrollment from One Care.
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Member ID Card Misuse: Allowing another person to use your Member ID card to receive care is grounds for disenrollment and potential investigation by relevant authorities.
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Disruptive Behavior: Continuous disruptive behavior that interferes with care delivery to yourself or other members may lead to disenrollment, pending approval from Medicare and MassHealth.
Conclusion
The One Care program in Massachusetts offers a valuable integrated care solution for eligible individuals. Understanding the processes for voluntary and involuntary disenrollment ensures informed decision-making about your healthcare coverage. For any questions or further information, contact your One Care plan directly or consult the resources provided by MassHealth and Medicare.
