CCA OneCare Sucks, Prescription Coverage, Resources

I think I’m going to switch Nick from CCA OneCare, that he’s had since January, back to plain old Medicare with Extra Help and MassHealth Standard.

Why?

• UMASS/Harrington will no longer be accepting CCA for primary care physicians as on January 1, 2025. Finding a new PCP is not something I wish to do, they’re hard to find, and I don’t think he’ll get an appointment before the new year. Nick HAS to have a PCP that he has seen, in place, at all times. And I really like his PCP, Dr. Gelman.
• Getting Supplies with CCA paying for them is a nightmare. It took months to get his tube feeding supplies, he never did get the correct syringes, Nick has had to purchase the extension sets several times, and now the supplier we were getting them through will no longer be supplying them (Medline – they were bought out). So we’re back to square one and I don’t know how long it will be before he gets tube feeding supplies again. He’ll have to pay out of pocket.
• Nick’s dentist doesn’t accept CCA OneCare. Nick’s been paying out of picket, and he goes every three months.

Resources

The whole reason why Nick was switched to CCA is that he was automatically switched. I allowed it to happen (didn’t opt out) because Medicare told me that they would no longer be covering one of his rather expensive medications and that Medicaid does not pick up (pay for) what Medicare does not cover as far as prescription drugs go.

Yesterday I spoke with someone at MassHealth about this. I tortured the poor woman, triple-checking that I heard her correctly….she said that as long as a drug is listed in the drugs covered by MassHealth, MassHealth will pick up what Medicare does not pay for. I will go one step further and speak with the pharmacy about this.

I also quizzed up the lady at MassHealth on if Nick gets a case worker with MassHealth. She said to try the following resources, as he is also covered by these (I had no idea!):

Department of Mental Health – 617-626-8000 – she said to call this place first

Department of Transitional Assistance (DTA) – they do SNAP benefits, something else (I forget what), and they can help with insurance! He does have SNAP. I was shocked that they can help with insurance!

List of drugs covered by MassHealth – go to Mass.gov, search for MassHealth Drug List.

The woman also asked if everything was all set on Medicare’s side, that she used to work that end of things. She mentioned that she’s a big fan of some of Medicare’s Advantage Plans.