By Marc Gilman
Questions? Call (800) 927-9326 or email
Key Takeaways
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Senior Care Options (SCO) and One Care both combine Medicare and MassHealth into a single plan, but they serve different age groups. One Care generally isn’t open to new enrollees once you turn 65.
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If you’re not already enrolled in One Care, turning 65 usually means your real choice is between SCO and MassHealth fee-for-service, not between SCO and One Care.
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Someone already enrolled in One Care can generally choose to stay enrolled after turning 65 as long as they keep meeting eligibility, rather than being required to switch to SCO.
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Both programs became Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) as of January 1, 2026, and SCO now requires enrollment in Medicare Parts A and B along with MassHealth Standard.
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Staying on One Care past 65 comes with a real tradeoff worth knowing: the Frail Elder Waiver (FEW) — MassHealth’s primary home-and-community-based services waiver — explicitly excludes anyone enrolled in a One Care plan. FEW benefits are available to all SCO members, but not to One Care members.
Are SCO and One Care Really Two Options at 65?
Not usually, and this is worth clearing up before anything else. SCO and One Care are both MassHealth programs that integrate Medicare and Medicaid benefits into a single plan with one card and one care team, but they’re built for different populations. One Care serves adults ages 21 to 64. SCO serves adults 65 and older.
For most people turning 65, this means One Care isn’t actually a live option to enroll in for the first time. If you’re approaching 65 and have never been on One Care, your real comparison is between SCO and MassHealth fee-for-service — not between the two integrated programs.
What If You’re Already on One Care When You Turn 65?
This is where it gets more nuanced. According to MassHealth’s own program comparison, someone already enrolled in One Care can generally continue in that plan past age 65, as long as they keep meeting eligibility — including maintaining MassHealth Standard or CommonHealth coverage. You’re not automatically required to switch to SCO just because you had a birthday.
But “allowed to stay” and “best off staying” aren’t the same question, and this is exactly where the Frail Elder Waiver distinction matters.
The Frail Elder Waiver: What You Give Up by Staying on One Care
Here’s the detail that deserves real attention if you’re 65 or older and weighing whether to stay on One Care: the Frail Elder Waiver explicitly cannot be combined with a One Care plan. MassHealth’s own Frail Elder Waiver eligibility rules state plainly that a FEW participant cannot be enrolled in another HCBS waiver, a One Care plan, or a PACE program at the same time.
SCO works differently. According to MassHealth’s official One Care and SCO comparison, FEW benefits are available to all SCO members — meaning if you’re 65+ and have needs that would qualify you for the Frail Elder Waiver (nursing-facility level of care while remaining in the community), SCO is the pathway that lets you actually access those benefits. One Care simply doesn’t offer that door.
This matters most for people with significant home-based care needs. FEW covers services like personal care, homemaker support, home health aides, respite care, home safety modifications, and more — precisely the kind of support someone aiming to stay independent at home is likely to need as care needs increase. Staying on One Care past 65 for convenience, or out of familiarity, means quietly closing off access to this entire category of benefit.
What Changed for SCO in 2026
As of January 1, 2026, both SCO and One Care transitioned to Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under a new five-year MassHealth contract. Alongside that shift, SCO’s eligibility requirements tightened: enrollees must now have both Medicare Part A and Part B, in addition to MassHealth Standard, to remain in an SCO plan. Members who didn’t meet the new Medicare requirement were transitioned to MassHealth Fee-for-Service — keeping their MassHealth Standard coverage, but losing SCO’s integrated care coordination in the process.
If you or a family member received a notice about this change, or is unsure whether current coverage still qualifies for SCO under the new rules, that’s worth confirming directly rather than assuming.
Why SCO’s Care Coordination Model Fits Home Health Needs Particularly Well
SCO assigns members a Geriatric Support Services Coordinator, who conducts home visits and helps coordinate care across medical, behavioral health, and long-term services and supports. One Care uses a comparable but differently structured role — a Long-Term Supports Coordinator. For someone whose primary concern is aging in place with home health support, SCO’s model — combined with its access to Frail Elder Waiver services — tends to align more directly with that specific need than continuing on One Care.
What To Do Next
The real question for most people isn’t which of two dual-eligible plans to pick — it’s whether SCO’s integrated, home-focused model, including access to the Frail Elder Waiver, is a better fit than remaining on MassHealth fee-for-service or staying on One Care past 65, especially when ongoing home health care or help with daily activities is part of the picture.
If you or a family member are approaching 65 with both MassHealth and Medicare, or you’re already on One Care and unsure whether to switch to SCO, reach out and we’ll work through what actually fits your situation.
Questions? Call (800) 927-9326 or email
Sources: MassHealth, Senior Care Options Eligibility (mass.gov); MassHealth, 2026 SCO Eligibility Changes (mass.gov); MassHealth, One Care and SCO Comparison, June 2023 (mass.gov); MassHealth Senior Care Options (SCO) Brochure (mass.gov); MassHealth Frail Elder Waiver Fact Sheet (mass.gov).
