Jane Dotson
In Ohio, it is possible to have both Medicaid and private health insurance. Medicaid eligibility is primarily based on income level, and having private insurance will not restrict Medicaid benefits. Combining your existing private insurance with Medicaid can significantly reduce premium costs and provide a more comprehensive range of coverage options. However, it is important to understand the coordination of benefits (COB) between the two types of insurance. In most cases, your private insurance will be the primary coverage, and Medicaid will serve as supplemental or wrap-around coverage, paying for any remaining balance after your private insurance has paid its share. Additionally, once you are eligible for Medicaid, you may no longer qualify for premium tax credits or savings on your Marketplace plan. Therefore, it is essential to carefully consider the advantages and disadvantages of maintaining both coverages and ensure compliance with your state's regulations on combining Medicaid and private insurance benefits.
| Characteristics | Values |
|---|---|
| Who can enroll in Medicaid in Ohio | Adults under age 65 with a household income up to 138% of the federal poverty level |
| How to enroll in Medicaid in Ohio | Check eligibility on the Ohio Medicaid website or call 1-800-318-2596 |
| Medicaid coverage | Doctor visits, hospital care, prescriptions, immunizations, prenatal care, vision, dental, substance abuse and mental health services |
| Medicaid benefits | No or lower co-payments, 24-hour medical advice phone line, help coordinating care for individuals with special health care needs, annual physical exams for adults, emergency or non-emergency transportation |
| MyCare Ohio | A plan that includes all benefits available through traditional Medicare and Medicaid programs, including long-term care services and behavioral health services |
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What You'll Learn
MyCare Ohio plan benefits
In Ohio, most individuals with Medicaid must join a managed care plan (MCP) to receive their healthcare. MCPs are private healthcare insurance companies that provide medically necessary healthcare. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package.
The MyCare Ohio plan is a managed care program designed for Ohio residents who receive both Medicaid and Medicare benefits. The plan benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services in the community, in a nursing facility, and behavioral health services.
MyCare Ohio dual-benefits members only have to carry one medical coverage card. MyCare Ohio offers one point of contact, person-centered care, seamless care across services and settings, easy navigation for members and providers, and wellness, prevention, coordination, and community-based 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.
MyCare Ohio members will continue to receive prescription drugs through their Part D plans and any associated co-payments. Members are eligible to receive added benefits, such as $0 copayments for prescription drugs covered by Medicare, additional transportation services, and more.
The MyCare Ohio plan is currently only available in 29 counties.
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Medicaid eligibility and enrollment
In Ohio, Medicaid eligibility and enrollment are open to specific groups. Firstly, low-income adults without dependent children are eligible for coverage. The income threshold for this group is set at 138% of the federal poverty level. This includes adults under 65, with children eligible at 206% and pregnant women at 200%. Certain low-income individuals who are blind, disabled, or aged 65 and over can also enroll, but they must have low asset/resource levels. Additionally, Ohio's Children's Health Insurance Program (CHIP) covers children up to age 19 with household incomes up to 200% of the poverty line.
For seniors, there are three categories of long-term care programs: Institutional/Nursing Home Medicaid, Medicaid Waivers/Home and Community-Based Services (HCBS), and Qualified Income Trusts (QITs) or Miller Trusts. The first is an entitlement, while the second is not and has a limited number of participants. The third, QITs, allows individuals over the income limit to become income-eligible by depositing "excess" income into a trust.
Enrollment in Medicaid is year-round, and one can check their eligibility and enroll online at HealthCare.gov or the Ohio Benefits website. Alternatively, one can enroll by phone at 1-800-318-2596 or 800-324-8680. After approval, individuals will receive a welcome letter, a member identification card, and a member handbook in the mail.
In Ohio, most individuals with Medicaid must join a managed care plan (MCP) to receive their healthcare. MCPs are private healthcare insurance companies that provide medically necessary health care. They offer benefits such as 24-hour medical advice phone lines, coordination of care for special needs, and no or lower co-payments. MyCare Ohio is one such MCP, offering benefits such as long-term care services and behavioral health services.
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Medicaid-covered services
In Ohio, most individuals with Medicaid must join a managed care plan (MCP) to receive their healthcare. MCPs are private healthcare insurance companies that provide medically necessary healthcare. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package.
- Long-term care services, including home and community-based "waiver" services, assisted living services, and long-term nursing home care.
- Healthchek screenings for children from birth to under 21 years of age, which help find problems or possible problems early on.
- Transportation services to healthcare appointments for those with non-folding wheelchairs or power scooters that don't fit in standard vehicles.
- No or lower co-payments for certain services, such as dental services, routine eye examinations, eyeglasses, and non-emergency services provided in a hospital emergency room.
- Help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare.
- Prescription drugs through Part D plans and any associated co-payments.
- Behavioral health services.
- Supplemental "value-added" benefits, such as additional transportation, over-the-counter allowances, and member rewards.
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Medicaid and CHIP coverage
In Ohio, most individuals with Medicaid must join a managed care plan (MCP) to receive their healthcare. MCPs are private healthcare insurance companies that provide medically necessary healthcare. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package.
Once enrolled in an MCP, individuals will receive a welcome letter, a member identification card, and a member handbook in the mail. They will also receive a directory of all doctors, specialists, hospitals, and other healthcare professionals who are in the MCP, along with their addresses and telephone numbers.
MCPs provide a range of benefits, including:
- 24-hour toll-free medical advice phone line
- Help with coordinating care for individuals with special healthcare needs
- No or lower co-payments
- Annual physical exams for adults
- Medically necessary emergency or non-emergency ambulette transportation
Ohio also offers the MyCare Ohio plan, which includes all the benefits of traditional Medicare and Medicaid programs, including long-term care services in the community, in a nursing facility, and behavioral health services. MyCare Ohio is currently available in 29 counties.
Ohio enacted Medicaid in July 1966 and implemented the Children's Health Insurance Program (CHIP) in 1998. CHIP initially covered children up to age 19 with household incomes up to 150% of the poverty level, but this was later increased to 200%. The federal government pays 67% of the cost of Ohio's traditional Medicaid program, while the state pays the remainder. For the years 2014-2016, the federal government paid 100% of the cost of covering the newly eligible population under the ACA's Medicaid expansion guidelines, which has now declined to 90%.
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Medicaid and private insurance
In Ohio, most individuals who have Medicaid must join a managed care plan (MCP) to receive their health care. An MCP is a private health-care insurance company that provides medically necessary health care. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package.
Medicaid and CHIP (Children's Health Insurance Program) provide free or low-cost health coverage to some low-income people, families, children, pregnant women, the elderly, and people with disabilities. Some states have expanded their Medicaid programs to cover all people below certain income levels.
In Ohio, adults under 65 with a household income up to 138% of the federal poverty level can enroll in Medicaid. The federal government pays 67% of the cost of Ohio's traditional Medicaid program, and the state pays the remainder. However, the state gets a better deal when it comes to Medicaid expansion. For 2014–2016, the federal government paid 100% of the cost of covering the population that was newly eligible under the ACA's Medicaid expansion guidelines. That percentage has since declined to 90% as of 2020.
Medicaid-only benefits include prescription drugs through Part D plans and any associated co-payments. Medicare benefits can be provided through traditional Medicare or through a private insurance company, commonly referred to as a "Part C" plan. MyCare Ohio is a plan that offers dual benefits of Medicare and Medicaid services. MyCare Ohio is currently only available in 29 counties.
If you have full Medicaid eligibility and are having difficulty accessing a medically necessary service, you may request transportation assistance. Medicaid managed care and MyCare Ohio plans can offer free transportation to their members as an additional benefit.
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Frequently asked questions
Yes, you can have both Medicaid and private insurance in Ohio. In many cases, your private insurance plan will be the primary coverage, and your Medicaid coverage will be supplemental.
You can apply for Medicaid and, if eligible, combine your existing private insurance plan with it.
Combining private insurance with Medicaid can significantly reduce premium costs and open up a more comprehensive range of coverage options.
