OneCare Complete 2027: Flex Card Rises by $3 a Quarter; Gym Rides Change

What is OneCare Complete?

CalOptima Health OneCare is a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) for people who qualify for both Medicare and Medi-Cal.

CalOptima says people enrolling in OneCare must live in Orange County and be at least 21. They need Medicare Parts A and B, full Medi-Cal without a Share of Cost, and must be U.S. citizens, U.S. nationals, or eligible noncitizens. OneCare Complete is the plan whose 2027 benefits are listed on CalOptima’s official website.

The OneCare Complete Evidence of Coverage (EOC) says members with Medi-Cal do not pay a monthly premium, including the Medicare Part B premium, and do not have a deductible. These terms apply to people who qualify for the plan; they are not general Medicare benefits for everyone.

The Flex Card increases by $3 a quarter

CalOptima’s Annual Notice of Change (ANOC) lists a $167 quarterly allowance for 2026 and $170 for 2027. Unused funds do not roll over to the next quarter.

CalOptima says the card can be used for over-the-counter (OTC) items, such as cold medicine, acetaminophen, and bandages. Alcohol, tobacco, sugary drinks, and other unapproved items are excluded.

Healthy food and produce are a separate, conditional benefit. CalOptima classifies this as a Special Supplemental Benefit for the Chronically Ill (SSBCI). Its 2027 form requires a provider to confirm both a qualifying chronic condition and a high risk of hospitalization or other adverse health outcomes. Not every member with a chronic condition qualifies. Eligible members must have a CalOptima form completed by a provider.

Gym transportation changes

The ANOC compares the two years this way:

• 2026: Unlimited trips to gyms within a 10-mile radius.
• 2027: Members who qualify for SSBCI can get 300 one-way trips to gyms and grocery stores within a 10-mile radius.

Transportation to medically necessary services is a separate benefit. The EOC says trips to plan-approved locations for covered medical services remain unlimited, subject to CalOptima’s scheduling rules. The new limit applies to nonmedical trips to gyms and grocery stores, not every ride to a medical appointment.

Dental coverage adds preventive services

The ANOC says preventive cleanings were not covered in 2026; in 2027, the plan covers one preventive cleaning per year. The annual limit for oral exams increases from one to two. The EOC lists the specific services and limits; some services may require authorization or have medically necessary exceptions.

Part D drugs still have plan rules

CalOptima’s pharmacy page says members pay nothing for covered Part D drugs. The drug must be medically necessary, filled at a network pharmacy or through home delivery, and comply with the plan’s rules. The Summary of Benefits lists $0 for Tier 1 generic and brand-name drugs for a 30-day supply, while noting that limits on covered drug types may apply.

Each plan has its own list of covered drugs, called a formulary. Some drugs require prior authorization; others require step therapy, which means trying another medicine first. Members should search for each medicine in the OneCare Complete 2027 formulary and ask the plan about any restrictions.

What to check in the plan documents

The online benefits page is a quick overview, not a replacement for the EOC and Summary of Benefits. Those documents explain limits, eligibility, networks, and how to use each benefit. The ANOC flags changes, but it does not tell a member whether a specific medicine is on the formulary.

OneCare Complete is a specific plan for people who qualify for both Medicare and Medi-Cal. This article compares CalOptima’s published documents; it does not rank plans or recommend enrolling in or switching plans.