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TotalCare is the Alliance’s Medicare Advantage Dual Special Needs Plan (D-SNP) and contracts with Medicare and Medi-Cal to provide the benefits of both programs to Alliance members that enroll in the plan. It is for people 65 years old and over and for some people younger than 65 with certain disabilities. To be eligible for the TotalCare plan, you must be enrolled in Medicare (Parts A and B) and have Medi-Cal through the Alliance. 

D-SNPs are a type of Medicare Advantage HMO plan for people who qualify for both Medicare and Medicaid (Medi-Cal). Medicare is mainly for people 65 and older, while Medi-Cal helps people with low income. D-SNPs coordinate your health care and often include extra benefits that Original Medicare doesn’t have. 

Some advantages of this type of plan include: 

• One plan that manages all your care. 
• Extra benefits beyond standard Medicare and Medi-Cal coverage. 
• A single member ID card and member handbook with details about both programs. 
• Care coordination and case management through a care manager who is your main point of contact. 
• Clearer communication for you and your providers. 
• Access to specialists who accept both Medicare and Medi-Cal. 

Learn more about Medicare and D-SNPs 

When you enroll in Medicare, you get Parts A and B. It is the basic health insurance that you get from the government when you turn 65 or have certain disabilities. 

• Part A helps pay for hospital care. 
• Part B helps pay for doctor visits and other medical services. 
• You can usually see any doctor in the U.S. who accepts Medicare. 
• You may have to pay deductibles and part of the cost for services. 
• It does not include prescription drug coverage unless you add a separate Part D plan. 

TotalCare (HMO D-SNP) is a Medicare Advantage plan (also known as Part C) for people who have both Medicare and Medicaid. 

• It combines Medicare Parts A and B into one plan. 
• It includes prescription drug coverage. 
• It offers extra benefits, like a flexible spending card, access to the Silver&Fit® Healthy Aging and Exercise program, extra vision coverage and worldwide ER/urgent care coverage. 
• You need to use doctors and hospitals in the plan’s network. 

In short, Original Medicare is the basic plan, and TotalCare is a special plan that combines Medicare and Medi-Cal benefits, coordinates your care, and offers drug benefits and extra health benefits. 

If you already get benefits from Social Security, the Railroad Retirement Board, or a federal retiree program, you will be signed up for Medicare automatically. Your Medicare card will arrive about three months before your coverage begins.  

If you’re not automatically enrolled, you’ll need to sign up for Medicare yourself during your Initial Enrollment Period (IEP). IEP is a seven-month period that starts three months before you turn 65, includes your birthday month, and ends three months after your birthday month. When you sign up during this period can affect when your Medicare coverage begins and when you receive your Medicare card. 

No. You can choose whether to enroll in TotalCare. It’s up to you.

No. TotalCare includes Part D drug coverage. TotalCare covers both brand name and generic drugs when they are filled at a pharmacy in the network. You may have a small copay for some drugs. Learn more.  

If you are in a D-SNP plan like TotalCare, you can usually change plans because you have both Medicare and Medi-Cal. 

When you can change plans: 

• From October 15 to December 7 during the Annual Enrollment Period. 
• Any time, if you qualify for a special enrollment period. 
• If you have both Medicare and full Medi-Cal, you may also be able to change plans once a month if you  join a qualifying integrated Dual Special Needs Plan (D-SNP). This is called a Special Enrollment Period (SEP). You can use this option to join certain plans that coordinate your Medicare and Medi-Cal benefits. 

How to change plans: 

• Call 1-800-MEDICARE (1-800-633-4227). 
• Sign up for a new plan by phone or online. 
• Contact the new plan directly to enroll. 

SSDI may have told you this if you are receiving Supplemental Security Income (SSI) or because their automated system successfully auto-renews coverage using federal tax and income databases.

Specific reasons for this information include:

• Automatic Enrollment via SSI: In California, SSDI and SSI are different programs. If you are actually receiving SSI, you automatically qualify for full-scope Medi-Cal without the need for county renewals. Social Security handles your health coverage eligibility directly.
• Data Auto-Renewal: The state of California attempts to automatically renew Medi-Cal coverage by checking available information through the federal data hub. If the county verifies your income level and data electronically, no manual renewal paperwork is required, and you will receive a Notice of Action confirming continued coverage.

If you move to a new address within TotalCare’s coverage area (Mariposa, Merced, Monterey, San Benito and Santa Cruz counties), you can stay in TotalCare. You will need to contact both the Alliance and your county’s Medi-Cal office if you move. 

You can notify TotalCare by:  

• Calling Member Services 833-530-9015 (TTY: 800-735-2929 (Dial 711))  
• Updating your contact information online 

If you move to a new address outside of TotalCare’s coverage area, you will no longer be eligible for TotalCare and you will be disenrolled from the plan.  

You don’t have to do anything. If you want to learn more about the TotalCare plan, you can call 833-530-9361 to talk to a local representative who can answer your questions and help you enroll in the plan.

When you enroll in the TotalCare plan, we will help you choose a PCP that is in the TotalCare network. You will usually see your PCP first for most of your routine health care needs. Your PCP may refer you to a specialist. Some services also need approval from TotalCare before you get care. This is called prior authorization. If approval is required and you do not get it first, you may have to pay for the service. To see a full list and to learn more, check your Evidence of Coverage (Member Handbook). 

Some services don’t need a referral, like emergency or urgent care, certain vaccines and routine care for women (like checkups or screenings). 

To find a provider, you can use our online Provider Directory or download our Provider Directory. You can also call Member Services and we will help you find the right PCP or other provider.