MassHealth-Medicare One Care Plan

Welcome to Tufts Health One Care

Tufts Health One Care is a plan that brings your MassHealth and Medicare benefits under one care option. Tufts Health One Care is a simpler, better way to manage your health, and you’ll get more benefits at $0 cost to you.

This welcome kit has all the information you need about your health plan benefits. Visit TuftsHealthOneCare.org to see your Member Handbook, Summary of Benefits, List of Covered Drugs, Provider and Pharmacy Directory, and Annual Notice of Changes. 

 

Your benefits are waiting. Get started below!

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woman in a wheelchair working at a desk

Join our member portal and choose a Primary Care Provider (PCP)

Our member portal is the easiest way to get the information you need at any time. Find a health care provider, view your new member ID card and more. Sign up at TuftsHealthPlan.com/MemberLogin.

You also can download the Tufts Health Plan app to start using the portal on your smartphone.

You will need to have a primary care provider (PCP) who is part of our network. Your PCP is the person you will see for much of your care. If your current PCP is in our network then you can keep your PCP. He or she helps keep you healthy. If you want to switch your PCP, you can use the member portal to choose a new PCP.

woman speaking with her primary care provider

Find a PCP or other provider

You can choose from our network of excellent and trusted health care providers. Visit TuftsHealthOneCare.org to find a doctor, hospital or other provider. See if the doctors you see now are in our network or search for new ones.

You also can call us at 1-855-393-3154 (TTY: 711) and follow the prompts. Our member services team or your care manager can help you find a provider who is right for your age and health concern.

About your plan

With Tufts Health One Care, you have a team that is dedicated to you. We are excited to help you get the services and support you need.

family at home

Your member handbook and summary of benefits

Your handbook and benefits summary have details about what your plan covers, your rights and much more. Go to TuftsHealthOneCare.org to view or download the Member Handbook and Summary of Benefits. You also can find our Provider and Pharmacy Directory, List of Covered Drugs, and Annual Notice of Changes.

To get printed copies, call us at 1-855-393-3154 (TTY: 711). We can also give you a copy in other formats, such as large print or braille, or in the language you prefer. You can also call Member Services to request future mailings in your preferred language or alternate format. We will keep your standing request in our records so that you will not need to make a separate request each time. If you need to change your standing request at any time, please call 1-855-393-3154 (TTY: 711).

Your member ID card

We will send you a member ID card in the mail. You’ll get it shortly before your plan starts. If any information on your card(s) is wrong, please call member services at 1-855-393-3154 (TTY: 711) and let us know.

Bring your Tufts Health One Care member ID card when you visit your providers or pick up drugs at the pharmacy.

Covered drugs

Your plan covers a broad range of prescription and over-the-counter  drugs. Some drugs need prior approval (authorization). For a full list of drugs your plan covers, visit TuftsHealthOneCare.org and check the current List of Covered Drugs. For a full list of drugs your plan covers, visit TuftsHealthOneCare.org and check the forms and documents section. Or call us at 1-855-393-3154 (TTY: 711).

My Ombudsman

My Ombudsman is an independent, free program that helps members and their families and caregivers access services provided by MassHealth and your One Care plan.

The program also:

  • Provides members with information and resources
  • Looks into member problems
  • Helps resolve members’ concerns

To contact My Ombudsman, call 1-855-781-9898 (TTY: 711).

Frequently asked questions

Need help understanding your health plan? We can help.

You pay $0.

One Care is at no cost to members as it combines your Medicare and MassHealth benefits. You do not have to pay a premium*, deductible or co-payments when you get services from an in-network doctor or other health care provider. 

*Note: If you already pay a premium to MassHealth for CommonHealth, you must keep paying the premium to MassHealth to keep your coverage.

Your health plan covers all the medical, behavioral health, dental and vision benefits of Medicare and MassHealth.

If you have a question about a specific benefit:

  • Check the Member Handbook or Summary of Benefits. You can find them at TuftsHealthOneCare.org in the forms and documents section.
  • Call our Member Services team at 1-855-393-3154 (TTY: 711).

You pay $0 for all your prescription drugs covered by Tufts Health One Care.

Checking our network is easy. Use our provider search tool at Tuftshealthplan.com/OneCareProviders to search our network of excellent and trusted doctors, hospitals and pharmacies.

Plus, there are a few more things you can do to choose the right health care provider for you:

  • Talk to your current primary care provider (PCP). Your PCP can make sure you get the right care and see the right provider for your needs. If your current PCP is in the Tufts Health One Care network, you can continue to see your PCP
  • Think about what matters to you. For example, you may need to search for a provider’s specialty, office location and accessibility, gender or languages spoken. You can find this information listed by provider on our website’s provider search tool.
  • If you need to, update your PCP with Tufts Health One Care. As a member, you have been assigned to a PCP who is in our network. We sent your PCP’s name and contact information with your member ID card. You can change your PCP at any time.

Health care can be complicated. These helpful resources can help you find the information you need:

  • Cityblock care coordinator — If you have questions navigating your care. Call Cityblock at 1-833-904-2273.
  • SHINE, or Serving the Health Insurance Needs of Everyone — SHINE counselors give free advice and can work with you and your caregivers to help you understand your health insurance. They are trained to assist people with disabilities who have Medicare and MassHealth. You can reach a counselor by phone at 1-800-243-4636 or on the web at http://www.mass.gov/health-insurance-counseling
  • My Ombudsman — If you have questions, concerns, or problems related to the One Care program, contact My Ombudsman. My Ombudsman’s staff can answer your questions or refer you to the right place to find what you need. Call My Ombudsman at 1-855-781-9898 or email [email protected].
  • Tufts Health One Care Member Services — Our team can help you understand your benefits, find a provider and more. We have bilingual staff. We also have translation services if your first language is not English. Translation services are free. You can reach our member services team at 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m., excluding holidays.

Covered services and benefits

You can get all the medical, behavioral health, pharmacy, vision and dental benefits of MassHealth and Medicare at no cost to you.

pharmacist speaking with customer

This includes:

  • Yearly checkups and provider visits
  • In-home urgent care for acute care
  • Hospital stays
  • Mental health and substance use disorder services
  • Prescriptions
  • Eye exams and eyeglasses
  • Long-term services and supports
  • Care management services
  • Transportation to medical appointments
  • Durable medical equipment including assistive technologies

This is just a sample of your benefits. See your Member Handbook and Summary of Benefits for a complete list. You can find them at TuftsHealthOneCare.org.

Your Cityblock Health care team

Tufts Health Plan collaborates with Cityblock Health to bring you personalized care management services and compassionate care — at no out-of-pocket-cost to you.

With Cityblock, you'll have a dedicated team of doctors, nurses, mental health advocates, and social workers who will work with you, listen, and do whatever it takes to get you the care you need.

Your Cityblock team will:

  • Meet with you at home, in the community, by phone or on video to make sure you get the health care services you need
  • Get to know you and understand your unique needs and develop a personalized care plan
  • Provide in-home urgent care for acute care with fully licensed providers
  • Help you with everyday things, such as getting quick answers from a doctor, groceries or rides to your appointments

Cityblock will reach out to you to tell you more about their services and to schedule a visit at your home or in the community. To get started now, call your care team today at 1-833-904-2273 (TTY: 711).

Getting care

Guidance for when you need care

provider speaking with her patient

Care during regular office hours

Call your primary care provider (PCP), your behavioral health specialist or your Cityblock care team to schedule an appointment during business hours.

Care after hours or urgent care

Call your PCP’s or behavioral health provider’s office or your Cityblock care team for advice if you need care after hours or in an urgent situation that is not an emergency. Cityblock offers in-home urgent care services so you can get the care you need without leaving home or spending hours waiting in the emergency room.

Or you can visit a MinuteClinic walk-in clinic found in some CVS stores. Visit minuteclinic.com to find a site near you.

Talk to an on-call care coordinator*

Call the Cityblock Health on-call care coordinator anytime at 1-833-904-2273 (TTY: 711) if you:

  • Need help deciding whether or not you need an in-home urgent care visit or should go to the emergency room
  • Want advice about treatment options
  • Have questions about drugs or procedures

* This service does not replace your PCP or other providers.

Emergency care

Call 911 right away if you need emergency care* for:

  • Chest pain
  • Uncontrolled bleeding
  • A drug overdose
  • A mental health or substance use crisis

* These examples are not a complete list of when you should seek emergency care.

Get care in your own language

Our Provider and Pharmacy Directory shows if a provider speaks languages other than English. Check the Provider and Pharmacy Directory at TuftsHealthOneCare.org.

If you need an interpreter for a medical, behavioral health or dental visit, we can help. Please call member services at 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. Call at least 72 hours before your visit. If you need an American Sign Language interpreter, please call at least two weeks prior to your visit.

Getting a ride

You can get rides to medical appointments at no cost to you. Tufts Health One Care covers transportation for medical reasons, including rides to and from medical appointments, urgent care centers and more.

woman riding in a car as a passenger

We also cover transportation to community services and activities that help you maintain your independence when these needs are included in your care plan.

How to schedule a ride

We work with Coordinated Transportation Solutions (CTS) to offer you covered rides. You can arrange for a ride from CTS in three ways:

When you make a reservation:

  • Be sure to ask about expected pick-up and wait times
  • Call to schedule a ride 48 hours in advance
  • You may schedule a same-day ride in some situations. For example:
    • Follow-up appointments
    • Hospital admissions or discharges
    • Outpatient surgery
    • Appointments for new medical conditions
    • Visits to urgent care centers
  • CTS will remind you of your scheduled ride the night before
  • A CTS driver will call you when he or she arrives to pick you up

To learn more about transportation services, including how to access them during an emergency, look in your Member Handbook.

Contact us

We want to make it easy for you to get the information and services you need

smiling customer service representative

Member services

You can reach our member services team at 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m., excluding holidays. Our team can help you:

  • Understand your benefits and coverage
  • Find a provider or urgent care clinic
  • Get new a member ID card if you lose yours

We have bilingual staff. We also have translation services if your first language is not English.

Website

Our website is another great way to learn about your plan. Visit TuftsHealthOneCare.org to view your plan details. You also can:

  • Find a provider or pharmacy
  • Search for a drug on the List of Covered Drugs
  • Get benefit details
  • View or download a Member Handbook or Summary of Benefits

Member portal

Our member portal is an easy way to find the information you need any time! You can search for a provider or choose a PCP (primary care provider). You can also view your new member ID card and more. Sign up at TuftsHealthPlan.com/MemberLogin.