Seniors searching for healthcare coverage might only look for either Medicare or Medicaid. After all, it seems like most people only qualify for one or the other. But what happens when you need to find benefits for seniors who qualify for both Medicare and Medicaid in Ohio?
Ohio has a great dual-eligibility system already in place for those lucky seniors. After qualifying for both Medicare and Medicaid, seniors who enter this special Ohio Dual Eligible Medicare/Medicaid program will get extra coverage and benefits for their medical needs. Even better, certain insurers provide extra perks beyond what Medicaid covers that may make this a perfect fit for your healthcare needs.
Seniors who qualify for both Ohio Medicare and Medicaid, will have the cost of most medical visits, surgeries, and medications covered. With dual eligibility, both programs help to cover the gaps where the other one falls short. Contact us for specific details to learn more about healthcare plans that you may qualify for.
Have questions about the benefits of both Medicare and Medicaid in Ohio? Continue reading and you’ll learn:
- What is the MyCare Ohio Plan?
- What Is the Ohio Dual Eligible Medicare/Medicaid Program?
- How Do You Know if You Qualify for MCOP?
- Where is MCOP Available?
- MCOP Benefits and Services
- MCOP Managed Care Organizations
- How to Compare Benefits
What is the MyCare Ohio Plan?
The MyCare Ohio Plan (MCOP) is a special managed care program for Ohio residents who are enrolled in both Medicare and Medicaid. This programis mandatory for qualifying Ohio residents in one of the 29 participating counties that simplify medical care. Even if you aren’t in one of these participating counties, you still may qualify for a plan that includes both Medicaid and Medicare benefits.
In short, Medicare is a health coverage program funded by the federal government that Americans qualify for when they reach age 65 or because of certain disabilities.Medicaid is another government-funded healthcare coverage program, but it’s partially funded by state governments and may offer different benefits depending on a resident’s income and asset levels.
People who quality for MCOP benefit from a single point of contact for all of their health and long-term care services. The exact benefits vary based on the managed care organization, but generally encompass doctor visits, medical transportation, personal care assistants, and plenty of other services.
The advantage of being a part of MCOP means that both plans combined to cover your copayments, deductibles and coinsurance required for your healthcare needs. For instance, if Medicare covers the majority of the cost of the surgery, but requires you to make a copayment, Medicaid might cover that copayment so you don’t pay a dime for that surgery. In addition you may pay a small copay for your medication needs.
What Is the Ohio Dual Eligible Medicare/Medicaid Program?
As mentioned, you must qualify for both Medicare and Medicaid to be “dual eligible”.
Medicare’s eligibility requirements are straightforward. You must be:
- 65 years of age or older
- Or if under 65, you must be disabled according to the Medicare guidelines
Medicaid has varying eligibility requirements depending on your income and asset levels, which are:
- monthly income not greater than $783 if single and $1175 if married
- combined countable financial assets can’t exceed $2000 in value, although exceptions like your vehicle and home often do apply
Where is MCOP Available?
Right now, MCOP is available in 29 counties out of 88 throughout Ohio. The counties are:
- Butler
- Clark
- Clermont
- Clinton
- Columbiana
- Cuyahoga
- Delaware
- Franklin
- Fulton
- Geauga
- Greene
- Hamilton
- Lake
- Lorain
- Lucas
- Madison
- Mahoning
- Medina
- Montgomery
- Ottawa
- Pickaway
- Portage
- Stark
- Summit
- Trumbull
- Union
- Warren
- Wayne
- Wood
If you aren’t in one of these 29 counties, don’t worry, you may still qualify for a Dual Eligible Medicare-Medicaid plan that has extra benefits beyond what Medicaid covers.
Ohio Medicare/Medicaid Dual Eligible MCOP Benefits and Services
Because MCOP essentially ties both Medicare and Medicaid services and benefits under a single umbrella, beneficiaries get a ton of different services in their plans.
Doctor and hospital visits are obviously included, as are prescription medications. Dental and vision benefits are included as well, which become increasingly important as people grow older. Furthermore, case management, nursing home care, and rehabilitation services are included under the MCOP benefits, with the exact details depending on your managed care organization (more on that below).
If you want to have a more direct role in your care, MCOP permits this as well. For instance, beneficiaries can hire or terminate different personal care providers or home care assistants depending on their effectiveness. Furthermore, beneficiaries can hire family members or friends, but can’t hire spouses or legal guardians except under the most extreme circumstances.
In one scenario, this means that adult children who care for their parents might be compensated for those efforts.
What About Assisted Living or PASSPORT Waivers?
As an Integrated Care Delivery System (ICDS), MCOP allows those enrolled in the above waivers to continue receiving those benefits. Some of the benefits that these waivers provide include adult daycare, home modifications, meals delivered straight to the home, social work counseling, and much more.
Insurance Companies for Dual Eligible Ohio Medicare/Medicaid Beneficiaries
There are five managed care organizations (MCOs) that provide service for MCOP beneficiaries:
- Aetna
- Molina
- Buckeye Health Plan
- Care Source
- UnitedHealthcare
Seniors are limited to choosing different MCOs depending on their county, as most counties only have one or two providers available at a time.
If you’re not in a MCO approved county, you may be eligible for a Dual Eligible Plan still. Here’s a list of insurance companies in addition to the ones listed above that may offer a dual eligible plan for Ohio seniors:
- Humana
- Anthem
Contact us to see which Dual Eligible plans are available for your county.
Examples of Benefits you may qualify for
In addition to standard Medicare and Medicaid services, Dual Eligible plans provide a variety of benefits.
Here is a list of possible benefits for dual eligible beneficiaries:
- Weight management programs
- Non-emergency transport to and from medical providers and pharmacies
- Cell phones with free minutes
- Monthly allowance for over the counter medical items
- $0 copays for generic drugs
- Home delivered meals
- Home modifications for health conditions
- Adult daycare services
- Enhanced vision, dental and hearing benefits
- Access to registered nurses 24/7
- Physical therapy services
Not all plans offer the same benefits, so it’s important to use an independent insurance broker to compare plans to see which benefits may offer the most value for your situation.
How to Compare Benefits for Seniors Who Have Both Medicare and Medicaid in Ohio
Choosing one of the above plans can be tricky, even if you qualify for both Medicare and Medicaid. There are three criteria you should consider when you are comparing these plans:
- Payments. It’s always a good idea to make sure that MCOs don’t require you to pay more when you’re qualified under both Medicare and Medicaid.
- Financial Ratings. The ratings that an Ohio MCO has are crucial. You can look at the financial ratings to find a stable provider you can trust over the long-term.
- Rate Increases. If the price for your coverage is going to change, you should know about it! You should also try to choose an MCO with a good history of reasonable price changes or increases.
OhioMedicarePlans.com has all the resources you need to find the best plan available. Our licensed insurance agents can help Ohio residents who are dual eligible for Medicare and Medicaid compare the prices, rate increases or changes, and financial ratings for all the above plans to make sure they understand each option in its entirety. We can make the plans simple and ensure that you choose a plan that’s perfect for your current and future needs.
Plus, we offer free personalized assistance and will keep you updated on any changes for your Ohio dual Medicare or Medicaid coverage at no extra charge.
