Navigating the complexities of healthcare, especially when you qualify for both Medicaid and Medicare, can be overwhelming. If you’re an Ohio resident in this situation, you might be asking, “What Is My Care Program?” The answer could be MyCare Ohio, a specialized managed care program designed to simplify and enhance your healthcare experience. This guide provides a detailed overview of MyCare Ohio, answering frequently asked questions to help you understand if this program is right for you.
MyCare Ohio: An In-Depth Look
1. What Exactly is MyCare Ohio?
MyCare Ohio is a unique managed care program in Ohio tailored for individuals who are dually eligible for both Medicaid and Medicare. Instead of managing these benefits separately, MyCare Ohio offers a coordinated, team-based approach to your healthcare. Imagine having a dedicated team working together, with you at the center, to ensure all your health needs are met seamlessly.
This program is designed to provide all the benefits you’re accustomed to under both Medicare and Medicaid. This includes essential services like long-term care and behavioral health support. Crucially, MyCare Ohio plans may also offer extra benefits beyond standard coverage, adding even more value for its members.
When you enroll in MyCare Ohio, you have two distinct options for receiving your benefits:
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Dual-Benefits: Choosing a dual-benefits MyCare Ohio plan means the plan manages both your Medicare and Medicaid benefits. This integration comes with potential added advantages, such as reduced or even $0 co-pays for Medicare-covered prescription drugs and expanded transportation services to help you get to appointments.
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Medicaid-Only Benefits: Alternatively, you can opt for a MyCare Ohio plan that solely handles your Medicaid-covered services. In this scenario, your Medicare benefits remain separate, delivered either through traditional Medicare or a private Medicare Advantage (Part C) plan. You would continue to manage your prescription drug coverage through your existing Medicare Part D plan and any associated co-payments.
2. Why Should I Consider a Dual-Benefits MyCare Ohio Plan?
The most compelling reason to choose a dual-benefits MyCare Ohio plan is the enhanced coordination of care. Managing Medicare and Medicaid independently can be confusing and fragmented. There often isn’t a single point of accountability for your overall well-being. MyCare Ohio addresses this directly.
Enrolling in a dual-benefits plan means you simplify your healthcare management significantly. You’ll only need to carry a single medical coverage card, streamlining your interactions with healthcare providers. MyCare Ohio emphasizes:
- Single Point of Contact: Say goodbye to navigating multiple systems. MyCare Ohio provides a central point of contact for all your healthcare needs.
- Person-Centered Care: Your care is personalized and focused on your individual needs and preferences.
- Seamless Care Coordination: Experience smoother transitions between different healthcare services and settings.
- Simplified Navigation: Both members and healthcare providers benefit from easier navigation within the healthcare system.
- Wellness and Prevention Focus: MyCare Ohio emphasizes proactive care, including preventive services and community-based support, to keep you healthy.
The benefits package within a MyCare Ohio plan encompasses all services traditionally available through Medicare and Medicaid. This includes long-term care services, whether you need support in your community or in a nursing facility, as well as behavioral health services to address mental health and substance use needs.
Furthermore, MyCare Ohio plans have the option to include supplemental, value-added benefits. These extras can significantly enhance your coverage and might include benefits like:
- Additional transportation services beyond medically necessary appointments.
- Over-the-counter (OTC) medication allowances to help with everyday health needs.
- Member reward programs that incentivize healthy behaviors.
- Other unique benefits designed to improve member well-being.
To fully understand the specific benefits offered by a particular MyCare Ohio plan, it’s best to contact their member services department directly or carefully review their member handbook. This will give you a clear picture of what each plan offers beyond the standard Medicare and Medicaid benefits.
MyCare Ohio Enrollment: What You Need to Know
1. Am I Required to Enroll in MyCare Ohio?
No, enrolling in a MyCare Ohio plan to manage your Medicare benefits is not mandatory. You have the option to continue receiving your Medicare benefits as you currently do. However, in the designated MyCare Ohio counties, your Medicaid benefits will be managed exclusively through a MyCare Ohio plan.
Currently, MyCare Ohio is available in 29 counties in Ohio. It’s important to note that not all MyCare Ohio plans are offered in every participating county. To find out which plans are available in your specific area and understand your enrollment choices, you’ll need to select your county from the list provided on the MyCare Ohio program website. If your county isn’t listed, it unfortunately means MyCare Ohio is not currently available in your region.
Eligibility for MyCare Ohio Enrollment:
You must enroll in a MyCare Ohio plan if you meet all of the following criteria:
- You are 18 years of age or older.
- You reside in one of the 29 counties where MyCare Ohio is active.
- You currently have full Medicaid benefits and are enrolled in Medicare Parts A, B, and D.
Conversely, you are not eligible to enroll in MyCare Ohio if any of the following apply:
- You are under the age of 18.
- You do not live in one of the designated MyCare Ohio counties.
- You possess creditable third-party insurance (insurance that covers both inpatient hospital stays and doctor visits) besides Medicare or Medicare Advantage plans.
- You are currently enrolled in a Department of Developmental Disabilities (DODD) waiver, require an ICF-MR level of care, or reside in an intermediate care facility for individuals with intellectual disabilities (ICF-IID).
- You do not have full Medicaid benefits and are not enrolled in Medicare Parts A, B, and D.
Automatic Enrollment:
If you are eligible for MyCare Ohio and do not actively choose a plan yourself, a plan will be automatically selected for you to ensure you receive your Medicaid benefits through the program.
2. What If I Don’t Want MyCare Ohio to Manage My Medicare Benefits?
If you prefer to keep your Medicare benefits separate from MyCare Ohio, it’s essential to understand your options and seek guidance. The Ohio Department of Insurance offers a valuable resource: the Ohio Senior Health Insurance Information Program (OSHIIP).
OSHIIP provides free, unbiased health insurance information and personalized counseling to Medicare beneficiaries in Ohio. Their services include:
- Speaker’s Bureau: Educational presentations on Medicare, Medicaid, MyCare Ohio, Medicare Part D prescription drug coverage, Medicare Advantage options, Medicare supplement insurance, long-term care insurance, and other health insurance topics.
- Hotline Experts and Trained Volunteers: Direct assistance and answers to your questions about Medicare and related programs.
You can reach OSHIIP for assistance at:
- Toll-Free Number: 800-686-1578
- Fax Number: 614-752-0740
- Email: [email protected]
3. How Do I Choose the Right MyCare Ohio Plan?
Selecting the best MyCare Ohio plan for your needs requires careful consideration. Each plan offers a unique set of value-added benefits to attract members. To effectively compare plans and their offerings, it’s crucial to refer to the official MyCare Ohio plan comparison chart.
This chart provides a side-by-side comparison of key benefits, coverage details, and service areas for each plan, allowing you to make an informed decision based on your individual healthcare requirements and preferences. You can access the comparison chart at: comparison chart.
4. What Can I Expect After Enrolling in a MyCare Ohio Plan?
Once your enrollment in a MyCare Ohio managed care plan is confirmed, you can anticipate receiving important information in the mail. This typically includes:
- Welcome Letter: Confirmation of your enrollment and important program details.
- Member Identification (ID) Card: Your official MyCare Ohio ID card, which you’ll use to access healthcare services. Unlike traditional Medicaid fee-for-service, MyCare Ohio plans issue a permanent card that you keep for the duration of your enrollment, rather than monthly paper cards.
- Member Handbook: A comprehensive guide detailing your plan’s benefits, coverage rules, provider network, and how to access services.
In addition to these initial materials, your MyCare Ohio plan will also send you ongoing communications, such as:
- Information about your primary care physician and other in-network healthcare providers.
- Details about covered health services and the scope of your coverage.
- Newsletters with health tips, program updates, and member stories.
- Healthcare reminders for preventive screenings and appointments.
- Information about opportunities to earn wellness incentives by participating in healthy activities.
Replacing Your ID Card:
If you ever need to replace your MyCare Ohio ID card, you can easily request a new one by:
- Calling your MCP member services department.
- Accessing your MCP’s member services portal online. Many plans allow you to immediately print a temporary copy of your ID card directly from the member portal, providing instant access to your information.
If you request a replacement card by phone, it will typically arrive in the mail within 7-10 business days from the date of your request.
5. What Happens if I Move Out of a MyCare Ohio County?
If you are currently enrolled in a MyCare Ohio plan and move to a county that is not part of the MyCare Ohio program’s service area, your enrollment in MyCare Ohio will automatically end. This termination will take effect on the last day of the month in which you move.
You will receive further information and guidance regarding your Medicaid enrollment and how your benefits will be managed moving forward in your new county of residence. It’s important to proactively contact your MyCare Ohio plan and Medicaid to ensure a smooth transition of your healthcare coverage when you move.
Accessing Healthcare Services and Benefits Through MyCare Ohio
1. What Happens to My Existing Approved or Scheduled Medical Services? What if My Doctor is Not in the MyCare Ohio Network?
MyCare Ohio plans are designed to ensure a smooth transition of care, especially when you initially enroll. They are required to provide transition of care benefits for a range of services, including physician visits and pharmacy needs, even if your current providers are not initially contracted within the MyCare Ohio plan’s network.
This transition period is designed to give you time to establish care with in-network providers. After the transition period concludes, it’s generally necessary to utilize healthcare providers who are part of the MyCare Ohio plan’s provider network to ensure covered services and minimize out-of-pocket costs.
To find in-network providers, you have several options:
- Contact your MyCare Ohio plan’s member services department. They can provide you with a list of in-network providers and assist you in finding doctors or specialists in your area.
- Visit your MyCare Ohio plan’s website. Most plans have online provider directories that allow you to search for doctors, hospitals, and other healthcare providers within their network.
- Utilize the provider search tool available on the Medicaid Consumer Hotline website: http://www.ohiomh.com/home/findaprovider This website offers a central search tool to find Medicaid providers across various plans.
2. What Services Are Covered By My MyCare Ohio Plan?
MyCare Ohio managed care plans offer a comprehensive range of covered services. Importantly, they cover all the same services that are covered under traditional Medicaid fee-for-service. This includes a wide spectrum of medical, behavioral health, and long-term care services.
However, it’s important to be aware that MyCare Ohio plans may require prior authorization (prior approval) for certain services. This means that your healthcare provider may need to obtain approval from the MyCare Ohio plan before you can receive specific services.
Your MyCare Ohio plan’s member handbook is your best resource for understanding which services require prior authorization. Generally, your healthcare provider will handle the process of requesting prior authorization from the managed care plan on your behalf.
Appealing Service Denials:
If a prior authorization request is denied by your MyCare Ohio plan, you have the right to appeal the decision. The process for appealing a denial typically involves:
- Contacting your MyCare Ohio plan’s member services department. They can explain the appeals process and provide you with the necessary forms and information.
- Submitting a written appeal to your MyCare Ohio plan. You usually have a timeframe of 60 days from the date of the denial to file your appeal.
If your initial appeal is also denied by the MyCare Ohio plan, you have the further right to request a state hearing. This is a more formal appeal process where a hearing officer from the state Medicaid agency reviews your case. Your member handbook will provide detailed instructions on how to request a state hearing.
Transportation Assistance:
Transportation to healthcare appointments can be a significant challenge for some individuals. MyCare Ohio plans recognize this and offer transportation assistance in certain situations.
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Medically Necessary Transportation: If you need to travel 30 miles or more (one way) to reach a participating in-network provider because closer options are not available for the medically necessary treatment you require, your MyCare Ohio plan is required to assist you with transportation to and from your appointment.
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Enhanced Transportation Benefits: Beyond the required transportation for distant appointments, MyCare Ohio plans may also offer enhanced transportation benefits as a value-added service. These benefits can vary by plan and region and might include transportation to:
- Routine medical appointments.
- WIC (Women, Infants, and Children) program appointments.
- Visits to your County Department of Job and Family Services.
The availability and specifics of enhanced transportation benefits will be outlined in your MyCare Ohio plan’s member materials.
Arranging Transportation:
If you have full Medicaid eligibility and require transportation assistance to access medically necessary services, the process for arranging transportation depends on your specific circumstances.
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Contact Your MyCare Ohio Plan: If you are a member of a MyCare Ohio plan, you should contact your plan directly to arrange transportation in the following situations:
- You use a non-folding wheelchair or power scooter that does not easily fit in a standard vehicle, or you need to remain seated in your folding wheelchair during transport.
- You must travel 30 miles or more (one way) for medically necessary treatment because closer in-network providers are not available.
- You wish to utilize any value-added ride benefits offered by your MyCare Ohio plan.
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Contact Your County Department of Job and Family Services: Any Medicaid-eligible individual in Ohio can also contact their local County Department of Job and Family Services to request transportation assistance, regardless of MyCare Ohio enrollment.
For more in-depth information on transportation assistance options, you can refer to the Ohio Medicaid Transportation Assistance document: Transportation Assistance.
Questions and Support for MyCare Ohio Members
1. How Do I Contact My MyCare Ohio Plan’s Member Services?
Each MyCare Ohio plan has a dedicated member services department to assist you with questions, concerns, and accessing your benefits. Here are the member services contact numbers for each MyCare Ohio plan:
- Aetna Better Health of Ohio: 1-855-364-0974
- Buckeye Health Plan: 1-866-549-8289
- CareSource: 1-855-475-3163
- Molina HealthCare of Ohio, Inc.: 1-855-665-4623
- UnitedHealthcare Community Plan: 1-877-542-9236
2. How Can I File a Complaint Against My MyCare Ohio Plan?
If you are dissatisfied with any aspect of your MyCare Ohio plan, you have the right to file a complaint, also known as a grievance. You can file a grievance by:
- Contacting your MyCare Ohio plan’s member services department.
- Submitting a written grievance to your MyCare Ohio plan.
Your MyCare Ohio plan is obligated to investigate and respond to your grievance in accordance with Ohio Administrative Code Rule 5160-26-08.4. This ensures a formal process for addressing member concerns.
Additional Complaint Resources:
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Ohio Medicaid Consumer Hotline: You can also file a complaint by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680. This hotline serves as an independent point of contact for Medicaid consumers in Ohio.
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Office of the State Long-Term Care Ombudsman: The Office of the State Long-Term Care Ombudsman is a consumer advocacy program that can provide assistance and investigate complaints related to any aspect of care available through MyCare Ohio, particularly concerning long-term care services. You can contact an ombudsman by:
- Emailing: [email protected]
- Calling: 1-800-282-1206 (TTY Ohio Relay Service: 1-800-750-0750)
By understanding your rights and the resources available, you can effectively navigate any issues or concerns that may arise during your enrollment in MyCare Ohio. This comprehensive guide aims to answer your question, “what is my care program?” and empower you to make informed decisions about your healthcare in Ohio.
