Jane Dotson
Ohio's Medicaid program provides health care coverage for over 3 million people, or about 26% of the state's population. The program is jointly funded by the state and federal governments and offers free or low-cost medical benefits to eligible low-income individuals, pregnant women, infants, children, older adults, and people with disabilities. In this context, the question of whether Ohio Medicaid covers insurance premiums is pertinent, especially for those seeking financial assistance for healthcare.
| Characteristics | Values |
|---|---|
| Who is eligible for Ohio Medicaid? | Eligible Ohioans with low income, pregnant women, infants and children, older adults and individuals with disabilities |
| How to apply for Ohio Medicaid? | Apply online using the self-service Ohio Benefits Portal, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or by visiting your local Department of Job and Family Services (JFS) office |
| What is OhioRISE? | A specialized managed care program for youth with complex behavioral health and multisystem needs |
| What is MyCare Ohio? | A managed care program for Ohioans who receive both Medicaid and Medicare benefits |
| What is CHIP? | The Children's Health Insurance Program provides medical and dental care for uninsured children and teens up to age 19 |
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What You'll Learn
Medicaid eligibility
Medicaid is a health care program for low-income individuals and families. It provides free or low-cost medical benefits to eligible people. In Ohio, persons who are found eligible for SSI are automatically approved for Medicaid. In addition to nursing home care and care services in assisted living facilities, Ohio Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.
There are three categories of Medicaid long-term care programs for which Ohio seniors may be eligible:
- Institutional/Nursing Home Medicaid: An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
- Medicaid Waivers/Home and Community-Based Services (HCBS): Not an entitlement; there are a limited number of participants and waitlists may exist. Intended to delay and prevent nursing home admissions, services are provided at home, adult day care, or in assisted living.
- MyCare Ohio: This is the managed care program for Ohioans who receive both Medicaid and Medicare benefits.
In Ohio, eligibility for Medicaid depends on income and assets, which are counted differently depending on whether one or both spouses are applying. For a single Nursing Home Medicaid applicant in 2025, the criteria are:
- Income under $2,901 per month
- Assets under $2,000
- Require a nursing home level of care
However, it is important to note that not meeting all of the criteria does not mean someone is ineligible or cannot become eligible for Medicaid. Eligibility criteria also change annually and vary depending on marital status. Additionally, Ohio offers alternative pathways towards eligibility.
To apply for Medicaid in Ohio, you can use the Ohio Benefits website to check your eligibility and apply for benefits. You can also call the Ohio Medicaid Consumer Hotline at (800) 324-8680 or the federally-run insurance marketplace at 1-800-318-2596. Enrollment in Medicaid is year-round, so eligible individuals can apply at any time.
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MyCare Ohio
The program offers all the benefits of traditional Medicare and Medicaid programs, including long-term care services in the community, in nursing facilities, and for behavioural health. It also provides wellness, prevention, coordination, and community-based services.
The plans available are Aetna Better Health of Ohio, Buckeye Health Plan, CareSource, Molina HealthCare, and United Healthcare Community Plan. To enrol in a MyCare Ohio plan, eligible individuals can contact the Ohio Medicaid Consumer Hotline at 800-324-8680. If an eligible person does not choose a plan, the Ohio Department of Medicaid will select one for them.
Starting in January 2026, the Next Generation MyCare plans will support Ohioans who are eligible for both Medicaid and Medicare in the 29 counties where MyCare Ohio is currently available.
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OhioRISE
To be eligible for OhioRISE, one must be eligible for Ohio Medicaid (either managed care or fee-for-service), not be enrolled in a MyCare Ohio plan, and require significant behavioral health treatment using the Ohio Child and Adolescent Needs and Strengths (CANS) assessment or have a recent inpatient hospital stay for a behavioral health reason.
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Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women. Each state has its own CHIP program and works closely with its state Medicaid program. Each state program has its own rules about who qualifies for CHIP.
In Ohio, CHIP was implemented in 1998, initially covering children up to the age of 19 with a household income of up to 150% of the poverty line. This upper threshold was later increased to 200% of the poverty line. CHIP covers medical and dental care for uninsured children and teens up to age 19.
If your income is too high to qualify for Medicaid, your child may still qualify for CHIP. CHIP qualifications are different in every state, and in most cases, they depend on income. The costs are different in each state, but you won't have to pay more than 5% of your family's income for the year. Routine "well child" doctor and dental visits are free under CHIP.
You can apply for CHIP at any time of the year by creating an account with the Health Insurance Marketplace and filling out an application. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
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Medicare Savings Programs
Ohio's Medicaid program provides free or low-cost medical benefits to eligible individuals and families. The program is designed for people with low incomes and limited resources, and it covers a broad range of medical services.
- Qualified Medicare Beneficiary (QMB): This program is for individuals with income less than 100% of the Federal Poverty Level (FPL) and resources under a certain limit. For 2025, the resource limit is $9,660 for singles and $14,470 for married couples. QMB covers Medicare Part A (if applicable) and Part B premiums, deductibles, copayments, and coinsurance.
- Specified Low-Income Medicare Beneficiary (SLMB): This program helps individuals with incomes up to 120% of the FPL pay for their Medicare Part B premiums.
- Qualifying Individual (QI): The QI program is for individuals who do not qualify for any other Medicaid coverage or benefits but still need help with Medicare costs. Priority is given to those who received QI benefits the previous year.
- Qualified Disabled and Working Individuals (QDWI): This program assists people with disabilities who are working and have incomes up to 200% of the FPL. QDWI covers Medicare Part A premiums.
To apply for Medicare Savings Programs in Ohio, you can start by visiting the HealthCare.gov website or calling their call center at 1-800-318-2596. You can also contact your county Department of Job and Family Services office or the Ohio Medicaid Consumer Hotline at (800) 324-8680. Additionally, you can create an account with the Health Insurance Marketplace and fill out an application to see if you qualify for Medicaid or MSPs.
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Frequently asked questions
To be eligible for Medicaid coverage in Ohio, individuals must be US citizens or meet Medicaid citizenship requirements and fall into one of the four eligibility categories: Covered Families and Children (CFC), Group VIII, Aged, Blind and Disabled (ABD). CFC includes pregnant women, infants, and children. Group VIII includes individuals at or below 138% of the federal poverty line, including childless adults. ABD includes individuals with disabilities.
You can apply for Medicaid benefits in Ohio through the Ohio Benefits website, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680, or by visiting your local Department of Job and Family Services (JFS) office.
Medicaid is a state-funded program that provides health insurance for people with low incomes. Medicare is a federal program that provides health insurance for people over 65 or with certain disabilities. Many Medicare beneficiaries in Ohio receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare.
