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Instructions for Filling Out the One Care Online Enrollment Form

The One Care Online Enrollment Form tells MassHealth your decision to get your MassHealth and Medicare coverage through a One Care plan.

You have the right to ask questions before deciding if One Care is right for you. You will keep your Medicare and MassHealth benefits if you join a One Care plan.

One Care plans will cover all of your Medicare, MassHealth, and prescription drug benefits, including Medicare Part D. One Care plans will also provide care coordination and access to community-based services as described in the One Care Enrollment Guide. The One Care Enrollment Guide and other One Care enrollment materials can be downloaded from One Care Fact Sheets & Other Materials.

For more information visit the One Care website at: www.mass.gov/masshealth/onecare 

Use this online form to:

  •  Sign up for a new One Care plan
  •  Move from the One Care plan you have now to a different One Care plan, if available

Your new enrollment will take effect the first day of the month after you submit this form. 

Enroll in One Care Now

IMPORTANT:

  • If you got a letter from MassHealth telling you that you are being enrolled in a One Care plan, you must use the paper One Care Enrollment Decision Form to tell us you don’t want to be enrolled in One Care. You can also tell us you don’t want to be enrolled by calling MassHealth Customer Service (Monday–Friday, 8:00 a.m.– 5:00 p.m.): at 1-800-841-2900 or TTY: 1-800-497-4648 (for people who are deaf, hard  of  hearing, or speech disabled).You have 60 days from the date you got the first letter to fill out the application form and make a different choice before your enrollment in One Care takes effect. (You can also fill out the One Care Choice Form that came with your mailing).
  • If you are already enrolled in One Care and decide you no longer want to be enrolled, you will need to use the paper One Care Enrollment Decision Form or call MassHealth Customer Service.

If you have questions, you can also visit the Important One Care Contacts page for more resources.

One Care Enrollment Decision Form

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