What One Care eligible patients who use a Partners HealthCare primary care doctor need to know
If you have received a mailing from MassHealth notifying you that you are eligible to enroll in the One Care program, and you receive your primary care from a doctor that is affiliated with Partners HealthCare, it is important for you to know that Partners HealthCare primary care doctors are not participating in the One Care program.
This means that if you use a primary care doctor affiliated with Partners HealthCare and enroll in One Care, you will need to find a new primary care doctor.
Read the FAQs below to see how to:
- find out if your doctor is Partners HealthCare doctor.
- opt-out of One Care and keep your Partners HealthCare doctor
- find a new primary care physician who participates in One Care if you chose to enroll in One Care
About One Care, for Patients of Partners HealthCare Primary Care Doctors
MassHealth is offering a new plan to people who now have insurance through both MassHealth and Medicare. The new program is called One Care: MassHealth + Medicare. If you are eligible for this program, you should have received information by mail from MassHealth.
One Care is offering new insurance plans through Commonwealth Care Alliance, Fallon Total Care, and Network Health. These plans would replace the insurance you have now.
Partners HealthCare affiliated primary care doctors do not accept any of these new insurance plans. Therefore, if you enroll in One Care, and your primary care doctor is a Partners doctor, you will need to find a new primary care doctor.
However, Partners HealthCare hospitals and specialists are in the provider network for the Commonwealth Care Alliance One Care plan. This means that you may select the Commonwealth Care Alliance One Care plan and still have access to hospital and specialty care. Partners HealthCare is committed to serving patients who are on MassHealth and Medicare, and is exploring a way to add our primary care doctors to this contract.
You have a choice about One Care. There are two things you can do.
1. If you would like to stay with your Partners HealthCare affiliated primary care doctor, you will need to opt out of choosing a new plan. This means:
- You will keep the doctor you have now
- You will still have insurance through Medicare and MassHealth
- You will not choose insurance through Commonwealth Care Alliance, Fallon Total Care, or Network Health
To do option #1: Call MassHealth at 1-800-841-2900 or mail back the enrollment paperwork that MassHealth sent you. Choose not to enroll in One Care.
2. You can choose one of the new plans and pick a new primary care doctor.
To do option #2: Call MassHealth at 1-800-841-2900 or mail back the enrollment paperwork that MassHealth sent you. Choose a One Care plan. Contact your new One Care plan and ask them to help you find a new doctor.
More Information About One Care
More information can be found on the MassHealth One Care website.
If you would like to talk to someone about your options please call:
MassHealth Customer Service at 1-800-841-2900 (or TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled)
SHINE at 1-800-243-4636 or TTY: 1-800-872-0166 (for people who are deaf, hard of hearing, or speech disabled).
In addition, the One Care Ombudsman is an independent program that helps individuals, their significant others, and representatives address concerns or conflicts that may interfere with their enrollment in One Care or their access to One Care benefits and services. You may call them at 1-855-781-9898 or visit the One Care Ombudsman website.