One Care (D-SNP) Frequently Asked Questions

Tufts Health One Care, our Special needs dually eligible  plan for people ages 21 to 64, offers services in Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester counties. Use our Find a Doctor, Hospital or Pharmacy tool to search for doctors, hospitals or facilities, or community-based services in your area.

Long-term services and supports are offered to you to help with everyday tasks, such as taking a bath, getting dressed, making food and taking medicine. These services provide assistance so that you can stay at home instead of going to a nursing home or a hospital. Most of these services are provided in your home or the community, but they may be provided in a nursing home or hospital.

Within 90 days of becoming a member, the Cityblock Care Coordination team will reach out to you to schedule an in-person appointment for your health needs assessment. Your assessment will be completed in person, or telephonically at your request, by a registered nurse. After the assessment is complete, your care coordinator will work with you to create an individualized care plan.

Your care coordinator will then coordinate your care team by working with you and all of your health care providers. Your care team may include your medical care providers (such as a primary care provider or a mental health or substance use counselor), pharmacy professionals and social care coordinators. Your care team may also include advocates, family members, caregivers, friends, mentors and/or peer supports.

Based on your health needs assessment, your care coordinator will also help you connect with and coordinate any additional nonmedical resources you may need such as nonmedical transportation.

In most cases, your initial membership lasts one year, and you need to renew with the state each year to maintain your benefits. MassHealth will send you a reminder when it is time to renew your membership.

Please note: The state can renew your eligibility during the year, so pay attention to notifications that come directly from MassHealth or from the federal government.

Tufts Health One Care is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

As a Tufts Health One Care member, you get access to high-quality health care at no cost to you. Services include:*

• Visits to doctors and specialists, and hospital stays
• X-rays and lab tests
• Prescription medications and prescribed over-the-counter medications
• Dental services for preventive and medically necessary care
• Vision services
• Instant savings card for   select over--the--counter products**
• YMCA free membership**
• An individualized care plan

*This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan or read the Member Handbook.

**Flexible benefits are available if identified in your care plan. Please talk to your care coordinator for more information. 

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

As a Tufts Health One Care member, you can take advantage of our comprehensive health care benefits at no cost to you. There are no medical or pharmacy copayments, and no monthly premiums. There also is no balance billing for any covered service.

 
Please note: If you pay a premium to MassHealth for CommonHealth, you must continue to pay the premium to MassHealth to keep your coverage.

You may need prior authorization (approval) for certain services. To find detailed information about prior authorization requirements, please refer to Chapter 4 of our Tufts Health One Care Member Handbook.

Tufts Health Plan covers the following services offered by out-of-network providers:

• Emergency care or urgent care
• Care that our plan covers and our network providers cannot give to you
• Kidney dialysis services at a Medicare-certified dialysis facility when you are outside our service area or when your provider is unavailable or inaccessible for a short period of time

You can update your personal information, like address (residential/mailing), phone number or email address, 24/7 through your member portal, our self-service tool. All you need to create an account is your Tufts Health Plan member ID number and your date of birth.

To order a new member ID card 24/7, sign up for your member portal (link opens outside Tufts Health Plan's website), our self-service tool, or log in if you already have an account. All you need to create an account is your Tufts Health Plan member ID number and date of birth.

If you don't know your member ID number, call us at 1-855-393-3154 (TTY: 711), and we'll be happy to help. Once you order your new member ID card, you can expect to receive it in the mail within 15 business days.

We aim to provide high-quality, cost-effective options for drug therapy. We work with your providers and pharmacists to make sure we cover the most important and useful drugs for a variety of conditions and diseases. Covered drugs are provided at no cost to you. We cover first-time prescriptions and refills. We also cover some over-the-counter (OTC) drugs with a doctor's prescription.

To find out if we cover a specific drug, look it up in our List of Covered Drugs. We update the list every month. The list applies only to drugs you get at retail and specialty pharmacies. The list does not apply to drugs you get if you are in the hospital.