UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) Frequently Asked Questions

Call 9-1-1 or go to the nearest hospital or emergency facility if you think you need emergency care. 

The basic requirements for coverage:

Residency

You must be a resident of Massachusetts to get MassHealth or other health care benefits that are funded by the Commonwealth.

You meet residency requirements if:

• You live in Massachusetts and either intend to live in Massachusetts, with or without a fixed address, or have moved to Massachusetts for a job or to look for one.

You do not meet residency requirements for MassHealth if you are visiting Massachusetts:

• For personal pleasure, such as for vacation, or
• To receive medical care in a setting other than a nursing facility

Citizenship or immigration status

To get the most MassHealth, Health Safety Net, or Children's Medical Security Plan coverage, your citizenship or satisfactory immigration status must be verified.

MassHealth may conduct information matches with state and federal agencies. If you do not provide this information, you may be considered for fewer benefits.

If electronic sources are unable to verify your declared status, you may be asked to provide documentation.

For more details about U.S. Citizenship and Immigration Rules, see the Member Booklet for Health and Dental Coverage and Help Paying Costs.

Financial

You must be financially eligible to qualify for MassHealth, the Health Safety Net, or the Children's Medical Security Plan.

To determine if you meet the financial requirements, MassHealth will consider:

• Your Modified Adjusted Gross Income, called MAGI 
• Who is in your household

To apply online, go to the Massachusetts Health Connector and create a user account: https://www.mahealthconnector.org/

To apply in-person, visit your local MassHealth Enrollment Center or MassHealth Connector Office

To apply by phone, call MassHealth Customer Service Center: 1-800-841-2900; TTY: 1-800-497-4648

To apply by mail: https://www.mass.gov/doc/massachusetts-application-for-health-and-dental-coverage-and-help-paying-costs-0/download

To apply by fax: https://www.mass.gov/doc/massachusetts-application-for-health-and-dental-coverage-and-help-paying-costs-0/download 

• Social Security numbers, if you have them, for every household member who is applying
• Federal tax returns
• If you file information about citizenship or national status or immigration status
• Employer and income information for everyone in your household (for example, from paystubs or wage statements)
• Information about any job-related or other health insurance that you are currently enrolled in or have access to

• You have the right to choose a primary care provider (PCP) in the plan’s network. A network provider is a provider who works with the health plan.
• We do not require you to get referrals.
• You have the right to get covered services from network providers within a reasonable amount of time. This includes the right to get timely services from specialists. If you cannot get services within a reasonable amount of time, we have to pay for out-of-network care.
• You have the right to get emergency services or urgent care without first getting authorization (prior approval) in an emergency.
• You have the right to get your prescriptions filled without long delays at any of our network pharmacies.
• You have the right to know when you can use an out-of-network provider.
• You have the right to have privacy during treatment and to expect confidentiality of all records and communications.
• You have the right to get information and to control how your PHI is used. We will give you a written notice that tells about these rights. The notice is called the “Notice of Privacy Practice.” The notice also explains how we protect the privacy of your PHI.
• You have the right to look at your medical records and to get a copy of your records. We are allowed to charge you a fee for making a copy of your medical records.
• You have the right to ask us to update or correct your medical records. If you ask us to do this, we will work with your health care provider to decide whether the changes should be made.
• You have the right to know if and how your PHI has been shared with others. If you have questions or concerns about the privacy of your PHI, call the Member Engagement Center.
• You have the right to leave the plan. No one can make you stay in our plan if you do not want to. You can contact the MassHealth Customer Service Center at 1-800-841-2900 or TTY: 1-800-497-4648 (for people who are deaf, hard of hearing, or speech disabled) and ask to leave the plan. You can also call 1-800-Medicare to enroll in a Medicare Advantage or prescription drug plan and leave our plan.
• You have the right to get full information from your doctors and other health care providers when you get services.
• You have the right to get information about appeals and complaints that other members have filed against our plan. To get this information, call the Member Engagement Center.

As a member of the plan, you have a responsibility to do the things that are listed below.

• Tell us about any other health or prescription drug coverage you have. We are required to make sure you are using all of your coverage options when you get health care. Please call the Member Engagement Center if you have other coverage.
• Tell your doctor and other health care providers that you are enrolled in our plan. Show your Member ID Card every time you get services or drugs.
• Help your doctors and other health care providers give you the best care.
• Choose a primary care provider.
  • Call your primary care provider or Care Coordinator when you need health care or within forty-eight hours of any emergency or out-of-network treatment.
  • Give them the information they need about you and your health that is complete and accurate.
  • Learn as much as you can about your health problems. Follow the treatment plans and instructions that you and your providers agree on.
  • Make sure your doctors and other providers know about all of the drugs you are taking. This includes prescription drugs, over-the-counter drugs, vitamins, and supplements.
  • Make sure you ask any questions that you have. Your doctors and other providers must explain things in a way you can understand. If you ask a question and you do not understand the answer, ask again.
  • Understand the role of your primary care provider, your Care Coordinator, and your Interdisciplinary Care Team (also referred to as Care Team) in providing your care and arranging other health care services that you may need.
  • Follow the Individualized Care Plan (ICP) you and your Care Team agree to.
  • Understand your benefits and what is covered and know what is not covered.
• Be considerate. We expect all our members to respect the rights of other patients. We also expect you to act with respect in your doctor’s office, hospitals, other providers’ offices, and in your home when your providers are visiting you.
• Pay what you owe. As a plan member, you are responsible for these payments:
• If you get any services or drugs that are not covered by our plan, you must pay the full cost.
• If you disagree with our decision not to cover a service or drug, you can make an appeal.
• Tell us if you move. If you are going to move, it is important to tell us right away. Call the Member Engagement Center.
• Tell us if your personal information changes. It is important to tell us right away if you have a change in personal information such as telephone, marriage, additions to the family, eligibility, or other health insurance coverage.

Call the Member Engagement Center at 1-866-633-4454, TTY 711 for help if you have questions or concerns.

As long as you are still eligible for Medicare and MassHealth, you can leave UnitedHealthcare Connected for One Care without losing your Medicare and MassHealth benefits. If you are over age 65 and you decide to leave One Care, you will not be able to enroll in a One Care plan later.

If you think you want to end your membership in our plan, there are a few ways you can get more information about what will happen, and how you can still get Medicare and MassHealth services.

• Call MassHealth Customer Service at 1-800-841-2900, Monday – Friday, 8 am – 5 pm, TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-497-4648. 
• Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing or speaking) may call 1-877-486-2048.

Click here to learn about Appeals and Grievances

Medicare Complaint Form

Contact the Member Engagement Center 1-866-633-4454, TTY 711, 8 am - 8 pm, local time, 7 days a week.

Where Can I Mail a Complaint?

You can call the Member Engagement Center at 1-866-633-4454, TTY 711

Or you can submit a written complaint/appeal to the following addresses:

Part C/Medicaid appeal: 

UnitedHealthcare Community Plan 

Attn: Complaint and Appeals Department:

P.O. Box 6103 

MS CA124-0187 

Cypress, CA 90630-0023

Fax: 1-844-226-0356

Part D Appeals:

UnitedHealthcare Community Plan

Attn: Part D Standard Appeals

P.O. Box 6106

MS CA124-0197

Cypress, CA 90630-0023 

 Standard Fax: 1-866-308-6296

Part C/Medicaid/Part D Grievance:

UnitedHealthcare Community Plan

Attn: Complaint and Appeals Department:

P.O. Box 6103

MS CA124-0187

Cypress, CA 90630-0023

Fax: 1-844-226-0356

You can file an external complaint with Medicare by calling 1-800-MEDICARE or TTY 1-877-486-2048, 24 hours a day/7 days a week.

If you lose your UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) Plan ID card, call the Member Engagement Center right away at 1-866-633-4456. We will send you a new one. Call TDD/TTY 711 for hearing impaired.