Navigating the complexities of healthcare can be particularly challenging for individuals who qualify for both Medicaid and Medicare. The MyCare Ohio program was established to simplify this process, offering a coordinated approach to care. Within this framework, Aetna Better Health of Ohio provides a demonstration health care program designed to meet the unique needs of dual-eligible individuals. This article addresses frequently asked questions to help you understand MyCare Ohio and the benefits offered, particularly through programs like Aetna Better Health of Ohio.
MyCare Ohio: An Overview
1. What is MyCare Ohio?
MyCare Ohio is a specialized managed care program in Ohio created for individuals who are eligible for both Medicaid and Medicare. It’s structured around a team-based approach to healthcare, ensuring your care is coordinated and centered on your individual needs. You are at the heart of this team.
The MyCare Ohio plan you choose will encompass all the standard benefits of both Medicare and Medicaid. This includes essential services like long-term care and behavioral health support. Furthermore, MyCare Ohio plans, such as those offered by Aetna Better Health of Ohio, may also provide extra benefits to enhance member well-being.
When enrolling in MyCare Ohio, you have two main options for receiving your benefits:
- Dual-Benefits: Opting for a dual-benefits MyCare Ohio plan means that one plan manages both your Medicare and Medicaid benefits. This option often unlocks additional advantages, such as reduced or eliminated co-pays for Medicare-covered prescription drugs and expanded transportation services. Aetna Better Health of Ohio is a provider of dual-benefit plans.
- Medicaid-Only Benefits: Choosing a Medicaid-only MyCare Ohio plan means that only your Medicaid-covered services are managed through the plan. Your Medicare benefits will remain separate, delivered through traditional Medicare or a private Medicare Advantage (Part C) plan. Prescription drug coverage will continue through your existing Medicare Part D plan, with any associated co-payments.
2. Why Choose a Dual-Benefits MyCare Ohio Plan?
The most significant advantage of a dual-benefits MyCare Ohio plan, including those from Aetna Better Health of Ohio, is the enhanced coordination of all your healthcare services. This encompasses medical, behavioral health, and long-term care needs. The traditional Medicare and Medicaid systems can be intricate and fragmented, often lacking a unified approach to individual care. MyCare Ohio addresses this by providing a single, accountable entity focused on your holistic well-being.
With a dual-benefits MyCare Ohio plan, you simplify your healthcare management by needing only one medical coverage card. Aetna Better Health of Ohio and other MyCare Ohio plans offer a single point of contact for your care, ensuring person-centered attention, seamless transitions between services and care settings, and streamlined navigation for both members and healthcare providers. The emphasis is on wellness, preventative care, care coordination, and access to community-based services.
Enrolling in a dual-benefits MyCare Ohio program integrates care coordination through a dedicated care team, with you as the central figure. This ensures that everyone involved in your care is well-informed and actively participating in your health journey.
The benefits package under MyCare Ohio includes all benefits traditionally available through Medicare and Medicaid, such as community-based and nursing facility long-term care, and behavioral health services. MyCare Ohio plans may also choose to incorporate supplemental, value-added benefits. These could include extra transportation allowances, over-the-counter medication credits, member reward programs, and other beneficial services. For detailed information on the specific benefits offered by Aetna Better Health of Ohio and other plans, it’s recommended to contact their member services department or consult your member handbook.
MyCare Ohio Enrollment: What You Need to Know
1. Is MyCare Ohio Enrollment Mandatory?
No, enrolling in a MyCare Ohio plan to manage your Medicare benefits is not compulsory. You have the option to continue receiving your Medicare benefits as you currently do. However, if you are eligible, your Medicaid benefits will be exclusively available through a MyCare Ohio plan.
Currently, MyCare Ohio is accessible only in 29 designated counties in Ohio. Furthermore, not every MyCare Ohio plan operates in all of these counties. To determine the plans available in your area and your enrollment options, you need to specify your county of residence. If your county is not listed, it indicates that MyCare Ohio is not yet available in your region.
Enrollment in a MyCare Ohio plan is mandatory if you meet the following criteria:
- Are 18 years of age or older.
- Reside in one of the 29 participating demonstration counties.
- Are currently entitled to full Medicaid benefits and Medicare Parts A, B, and D.
Conversely, you are not eligible to enroll in MyCare Ohio if you:
- Are under the age of 18.
- Do not live in one of the demonstration counties.
- Possess creditable third-party insurance (covering both inpatient hospital stays and doctor visits) other than Medicare or Medicare Advantage plans.
- Are 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).
- Do not have full Medicaid benefits and Medicare Parts A, B, and D.
If you are eligible for MyCare Ohio and do not actively select a plan, one will be automatically chosen for you to ensure you receive continuous coverage.
2. Opting Out of Medicare Coverage Through MyCare Ohio
If you prefer not to have your Medicare benefits managed through a MyCare Ohio plan, resources are available to assist you. The Ohio Department of Insurance offers the Ohio Senior Health Insurance Information Program (OSHIIP). OSHIIP provides free, unbiased health insurance information and personalized counseling to Medicare beneficiaries.
OSHIIP’s services include a speaker’s bureau, hotline experts, and trained volunteers who educate consumers on various topics including Medicare, Medicaid, MyCare Ohio, Medicare Part D prescription drug coverage, Medicare Advantage options, Medicare supplement insurance, long-term care insurance, and other health insurance-related matters. You can reach OSHIIP through the following contact methods:
- Toll-Free Number: 800-686-1578
- Fax Number: 614-752-0740
- Email: [email protected]
3. How to Select the Right MyCare Ohio Plan?
Each MyCare Ohio plan, including Aetna Better Health of Ohio, offers a unique set of value-added benefits to its members. To effectively compare the benefits across different plans and find one that aligns with your needs, it’s helpful to utilize a comparison chart.
4. What to Expect Upon Enrollment in a Managed Care Plan?
Once you enroll in a MyCare Ohio managed care plan, such as Aetna Better Health of Ohio, you will receive a welcome packet in the mail. This packet typically includes a welcome letter, your member identification (ID) card, and a member handbook. Unlike the monthly paper Medicaid cards, managed care plans issue a permanent ID card upon enrollment, which you should keep for the duration of your plan membership.
The managed care plan will also provide you with detailed information about your network of doctors, available health services, and the scope of your coverage. Expect ongoing communication from your plan, including newsletters, health reminders, opportunities to earn wellness incentives, and other relevant updates.
Should you need a replacement ID card, you can request one by contacting your Managed Care Plan (MCP) member services department or through the member services portal online. Many plans allow you to print a temporary copy of your ID card immediately from the member portal. If you request a physical card by phone, it generally arrives within 7-10 business days from your request date.
5. Moving Out of a MyCare Ohio Service Area
If you are currently enrolled in a MyCare Ohio plan but move to a county that is not part of the MyCare Ohio program’s service area, your enrollment in MyCare Ohio will end on the last day of the month in which you move. You will be provided with further details regarding your Medicaid enrollment moving forward to ensure a smooth transition in your coverage.
Accessing Healthcare Services and Benefits
1. Transitioning Existing and Scheduled Medical Services
If you have pre-approved or scheduled medical services when you enroll in MyCare Ohio, or if your current doctor or hospital is not within the MyCare Ohio plan network, MyCare Ohio plans are mandated to offer transition of care benefits. This applies to non-contracted providers for various services, including physician and pharmacy services. Following this transition period, you will need to utilize healthcare providers who are within your chosen MyCare Ohio plan’s provider network.
To find out if your current providers are in-network or to search for new providers within the network, you can contact your plan’s member services department, visit the plan’s website, or use the provider search tool available on the Medicaid Consumer Hotline website at http://www.ohiomh.com/home/findaprovider.
2. Services Covered Under MyCare Ohio Managed Care Plans
Managed care plans within MyCare Ohio cover all the same services that are covered under traditional Medicaid fee-for-service. However, some services may require prior authorization from your plan before you can receive them. Your plan’s member handbook will specify which services necessitate prior approval.
Typically, your healthcare provider will request prior authorization from the managed care plan on your behalf. If a request for prior authorization is denied, you have the right to appeal this decision. You can initiate an appeal by contacting your managed care plan’s member services department or by writing to your plan. The appeal must be requested within 60 days of the denial. If your initial appeal is unsuccessful, you have the option to request a state hearing to further review the decision.
If you require assistance with transportation to medical appointments, your MyCare Ohio managed care plan may be able to help. If your medical appointment is 30 miles or more from your home and there are no closer participating network providers, your plan is required to assist with transportation if you need it. Furthermore, managed care plans often offer enhanced transportation benefits that go beyond these requirements. These additional benefits, which can vary by region, may cover transportation to a broader range of appointments, including medical, WIC, and visits to your County Department of Job and Family Services.
3. Arranging Transportation Services
If you are fully Medicaid eligible and face difficulties accessing medically necessary services due to transportation issues, you can request transportation assistance. The type of assistance available can depend on several factors, including whether you are enrolled in a Medicaid managed care or MyCare Ohio plan, your county of residence, and specific needs such as requiring transport for a non-folding wheelchair or power scooter.
Medicaid managed care and MyCare Ohio plans may offer free transportation as a value-added benefit, exceeding state-mandated requirements. These enhanced benefits might be limited to a certain number of trips per year. You can use these trips for healthcare appointments and other necessary services, but you are not obligated to use them. Any Medicaid-eligible individual can also contact their local County Department of Job and Family Services to request transportation assistance directly.
If you are a member of a Medicaid managed care or MyCare Ohio plan, it is advisable to contact your plan in the following situations:
- You use a non-folding wheelchair or power scooter that does not fit easily into a standard vehicle, or you need to remain seated in your folding wheelchair during transport.
- You must travel 30 miles or more (one way) because the necessary medical treatment covered under your plan is not available closer to home.
- You wish to utilize a value-added ride benefit offered by your plan.
For more detailed information, refer to resources on Transportation Assistance.
Questions and Support
1. Contacting MyCare Ohio Plan Member Services
For direct assistance and specific inquiries, you can reach out to the member services department of your MyCare Ohio plan. Here are the contact numbers for some major plans:
- 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. Filing a Complaint Against Your Managed Care Plan
If you are dissatisfied with any aspect of your managed care plan, you have the right to file a complaint. You can do this by contacting your managed care plan’s member services department or by sending a written grievance to your plan. Your managed care plan is required to investigate and respond to your grievance in accordance with Ohio Administrative Code Rule 5160-26-08.4.
Additionally, you can also register your complaint by contacting the Ohio Medicaid Consumer Hotline at 1-800-324-8680.
The Office of the State Long-Term Care Ombudsman serves as a consumer advocacy program and can provide assistance with concerns related to any aspect of care received through MyCare Ohio. Ombudsmen offer information and investigate complaints affecting MyCare Ohio consumers. You can contact an ombudsman by email at [email protected] or by phone at 1-800-282-1206 (TTY Ohio Relay Service: 1-800-750-0750).
