- MyCare Ohio FAQ
MyCare Ohio FAQ
MyCare Ohio Frequently Asked Questions
1. What is MyCare Ohio?
MyCare Ohio is a managed care program designed for Ohioans who receive BOTH Medicaid and Medicare benefits. This program has a team approach to coordinating your care based on your needs – a team with you at the center.
The MyCare Ohio plan that you choose will provide all of the same benefits that Medicare and Medicaid offer, including long-term care services and behavioral health. Plus, your MyCare Ohio plans may include additional services to their members. There is no additional cost to participate in this program.
You have two choices for receiving your MyCare Ohio benefits:
Dual-Benefits: A MyCare Ohio plan provides both the Medicare and Medicaid benefits for members. Members are eligible to receive added benefits of the plan, such as $0 copayments for prescription drugs covered by Medicare, additional transportation services, etc.
Medicaid-Only Benefits: A MyCare Ohio plan only covers Medicaid-covered services. Members will continue to receive prescription drugs through their Part D plans and any associated co-payments. Your Medicare benefits would be provided through traditional Medicare or through a private insurance company, commonly referred to as a “Part C” plan.
2. How do I know if I must enroll and which plan to choose?
MyCare Ohio is only available in 29 counties. Not all plans are available in each of the 29 counties. Choose your county to find out which plans are available in your area and your enrollment options. Please note that if your county is not in the list, it means that MyCare Ohio is not available in your county.
Plans available in Hamilton county.
3. Do I have to sign up for MyCare Ohio?
You must enroll in a MyCare Ohio plan if you:
Are 18 or older; and
Live in one of the 29 demonstration counties; and
Currently have full Medicaid and Medicare parts A, B, and D.
You cannot enroll in a MyCare Ohio plan if you:
Are under 18
Do not live in one of the demonstration counties
Have creditable (covers both inpatient hospital stays and doctor visits) third party insurance, other than Medicare or Medicare Advantage plans
Are enrolled in a Department of Developmental Disabilities (DODD) waiver, have an ICF-MR level of care, or live in an intermediate care facility for individuals with intellectual disabilities (ICF-IID).
Do not have full Medicaid benefits and do not have Medicare parts A, B, and D.
If you are eligible for MyCare Ohio and do not make a choice of a MyCare Ohio plan, a plan will be selected for you.
4. Do I have to have the MyCare Ohio plan cover my Medicare benefits?
You do not have to receive your Medicare benefits from your MyCare Ohio plan. You may choose to continue to receive your Medicare benefits in the way you do today. However, your Medicaid benefits will only be available through a MyCare Ohio plan.
The Ohio Department of Insurance provides Medicare beneficiaries with free, objective health insurance information and one-on-one counseling through its Ohio Senior Health Insurance Information Program (OSHIIP). OSHIIP’s speaker’s bureau, hotline experts and trained volunteers educate consumers about Medicare, Medicaid, MyCare Ohio, Medicare prescription drug coverage (Part D), Medicare Advantage options, Medicare supplement insurance, long-term care insurance and other health insurance matters.
Toll Free Number: 800-686-1578
Fax Number: 614-752-0740
5. Why should I elect to receive dual-benefits from a MyCare Ohio plan?
Among many reasons, the primary benefit is coordination of all of a person’s services, both medical and behavioral and long-term care. The current Medicare and Medicaid services are confusing and difficult to navigate and there is not a single entity which is accountable for the whole person. MyCare Ohio dual benefits members also only have to carry one medical coverage card. MyCare Ohio offers members: one point of contact, person-centered care, seamless across services and settings, easy navigation for members and providers, and wellness, prevention, coordination and community-based services. MyCare Ohio dual-benefits enrollment integrates care coordination through a care team, led by the member, to ensure that all parties are knowledgeable of and involved in a member’s care.
The MyCare Ohio plan benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services both in the community and in a nursing facility as well as behavioral health services. MyCare Ohio plans may also elect to include supplemental ‘value-added’ benefits in their benefit packages, such as additional transportation, over-the-counter allowances, member rewards, and other benefits. Members should contact their plans’ member services or consult their member handbooks to learn more about their MyCare Ohio plan benefits.
6. What about medical services I already have approved or scheduled? What if my doctor or hospital is not in the MyCare Ohio plan network?
MyCare Ohio plans are required to provide transition of care benefits for non-contracted providers of many services, including physician and pharmacy. After the transition period, members must utilize providers who are within the MyCare Ohio plans provider network. Members can contact their plans’ Member Services department, visit the plans’ websites, or utilize the provider search available on the Medicaid Consumer Hotline at http://www.ohiomh.com/home/findaprovider
7. How can I arrange transportation?
If you have full Medicaid eligibility and you are having difficulty in getting to a medically necessary service, then you may request transportation assistance. The type of assistance available may depend on whether you are a member of a Medicaid managed care or MyCare Ohio plan, in which county you live, and whether you are bringing along a non-folding wheelchair or power scooter that doesn't fit easily in a standard vehicle.
Medicaid managed care and MyCare Ohio plans can offer free transportation to their members as an additional benefit above and beyond what the state requires. This "value-added" benefit can be limited to a specific number of trips a year. Members may take these trips to get to healthcare appointments and other services as well, but no one is required to use them up or even to use them at all. Any Medicaid-eligible individual may contact the local CDJFS to request transportation assistance.
If you are a member of a Medicaid managed care or MyCare Ohio plan, then contact your plan in any of the following circumstances:
- You use a non-folding wheelchair or power scooter that doesn't fit easily in a standard vehicle or you need to sit in your folding wheelchair during transport.
- You must travel 30 miles or more (one way) because the medically necessary treatment covered under your plan is not available at a closer location.
- You have a value-added ride available that you want to use.
More information on Transportation Assistance
8. How can I reach my MyCare Ohio plan’s member services?
The Member Services Numbers for MyCare Ohio Plans:
Aetna Better Health of Ohio: 1-855-364-0974
Buckeye Health Plan: 1-866-549-8289
Molina HealthCare of Ohio, Inc.: 1-855-665-4623
UnitedHealthcare Community Plan: 1-877-542-9236
9. I am currently enrolled in a MyCare Ohio plan but I recently moved to a county that is not part of the MyCare Ohio program. What happens now?
When you move to a county that does not have MyCare Ohio, enrollment in MyCare Ohio will end on the last day the month.
10. What should I expect to receive from my MCP as a new member?
Once you are enrolled in a MCP, you will get a welcome letter and your member identification (ID) card in the mail. MCPs send one permanent card when you enroll, instead of the monthly paper card that is sent by Medicaid FFS. Keep this card while you are on the plan. The MCP will also send you information about your doctors, health services, and scope of coverage. As an MCP member, you can also request a member handbook. You will also receive other communications from your MCP, including newsletters, health care reminders, opportunities to earn wellness incentives, and more.
If you need to replace your ID card, you can get a new card by either calling your MCP Member Services Department or by signing up with your MCP in their Member Services Portal. You can print a copy of your ID card immediately from the MCP portal. If you order a card via telephone, it should arrive in the mail in 7-10 business days from the date of your request.
11. What services are covered by my MCP?
MCPs cover all the same services that are covered by Medicaid FFS, but they may require prior approval for services. Your plan’s member handbook will tell you what services require prior approval. Your provider requests prior approval from the MCP. If the request is denied, you can ask your MCP for an appeal by calling Member Services Department or writing to your MCP. You must request your appeal within 60 days following the denial. If your appeal is denied, you can ask for a State Hearing.
If you need help to get to a medical appointment, your MCP may be able to help you. If your medical appointment is 30 or more miles away from your home, and there aren’t any closer participating network providers, your MCP is required to assist you with getting to and from your appointment, if you need help. MCPs also offer enhanced transportation benefits, which vary by region, to help you with transportation to medical appointments, WIC appointments, and visiting your local Department of Job and Family Services.
12. How can I file a complaint against my MCPs?
If you are not satisfied with your MCP, you can make a complaint. You can contact your MCP’s Member Services Department or write to your MCP to file a grievance. Your MCP must research and respond to your grievance in accordance with Ohio Administrative Code Rule 5160-26-08.4.
You can also make a complaint by calling the Medicaid Consumer Hotline at 1-800-324-8680.
The Office of the State Long-Term Care Ombudsman is a consumer advocacy program that can help with concerns about any aspect of care available through MyCare Ohio. Ombudsman provide information and investigate complaints impacting MyCare Ohio consumers. Contact an ombudsman by emailing MyCareOmbudsman@age.ohio.gov or by calling 1-800-282-1206 (TTY Ohio Relay Service: 1-800-750-0750).