Navigating Mycare Ohio Insurance Changes: A Step-By-Step Guide

MyCare Ohio is a managed care program for Ohio residents who receive both Medicaid and Medicare benefits. The program is jointly run by the Ohio Department of Medicaid and the federal government to provide better healthcare for those who qualify for both Medicare and Medicaid. MyCare Ohio offers a range of benefits, including no copays or premiums, transportation services, and a large network of providers.

If you want to change your MyCare Ohio insurance, there are a few options available to you. Firstly, you can change your membership by choosing to get your Medicare services separately while remaining in the plan for your Medicaid services. Alternatively, you can end your membership by choosing a different MyCare Ohio plan. This can be done by calling the Ohio Medicaid Hotline or by enrolling through the Ohio Medicaid Consumer Hotline Portal. It is important to note that there are certain requirements that must be met to change your plan, such as being a member of your current plan for three months or less, or having ongoing problems finding the care you need.

Changing to a different MyCare Ohio plan

MyCare Ohio is a managed care program designed for Ohio residents who receive both Medicaid and Medicare benefits. The program offers a team approach to coordinating care needs, including medical and behavioral health, and long-term care services.

If you are already enrolled in a MyCare Ohio plan and would like to switch to a different plan, you must meet one of the following requirements:

• You have been a member of your current plan for three months or less.
• You attempted to get help from your Managed Care Plan (MCP) but continue to have issues finding the care you need.

If you meet either of these requirements, you can complete a change request. If you do not meet these requirements but still wish to change your plan, you may do so during the open enrollment period each November.

To initiate a change to your MyCare Ohio plan, you can utilize the following methods:

• Visit the Ohio Medicaid Consumer Hotline Portal at ohiomh.com and select "I Would Like to Change My Plan." Follow the prompts to check your eligibility and apply for a new plan.
• Contact the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 1-800-292-3572) and inform them that you want to change your plan. They will guide you through the process.
• Enroll by mail. Download the appropriate enrollment form, fill it out, and mail it to 505 South High Street Columbus, OH 43215.
• Speak to a customer service representative by calling the number provided and requesting assistance with enrolling in a different plan over the telephone.

It is important to remember that if you choose to switch to a different MyCare Ohio plan, your membership in the previous plan will end on the last day of the month in which you make the request or the following month, depending on when you submit your request. Your new coverage under the different MyCare Ohio plan will begin on the first day of the subsequent month.

Ending your membership

If you want to end your membership with MyCare Ohio, you have certain rights and responsibilities. You can ask to change or end your membership at any time.

You can change your membership in the MyCare Ohio plan by choosing to get your Medicare services separately (you will stay in the plan for your Medicaid services). If you choose to change your membership in this way, you will keep getting Medicare services through the MyCare Ohio plan until the last day of the month that you make the request. Your new Medicare coverage will begin the first day of the next month.

You can also end your membership by choosing a different MyCare Ohio plan. If you ask to switch to a different plan before the last five days of a month, your membership in the original plan will end on the last day of that same month, and your new coverage will begin the first day of the next month. If you make the request during the last five days of a month, your membership will end on the last day of the following month, and your new coverage will begin on the first day of the month after that.

To end your membership in MyCare Ohio and join a different plan, or to end your membership altogether, you can call the Ohio Medicaid Hotline at 1-800-324-8680, Monday through Friday from 7 a.m. to 8 p.m., and Saturday from 8 a.m. to 5 p.m. TTY users should call the Ohio Relay Service at 7-1-1. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

If you do not want to enroll in a different MyCare Ohio plan, you will return to getting your Medicare and Medicaid services separately. Your Medicaid services will still be provided by MyCare Ohio.

Getting Medicare services separately

MyCare Ohio is a program jointly run by the Ohio Department of Medicaid and the federal government to provide better health care for people who have both Medicare and Medicaid. If you want to change your membership in MyCare Ohio, you can choose to get your Medicare services separately (while staying in the plan for your Medicaid services).

Eligibility

To be eligible for MyCare Ohio, you must be 18 or older, live in one of the 29 demonstration counties, and have full Medicaid and Medicare Parts A, B, and D. MyCare Ohio is currently only available in 29 counties, and not all plans are available in each of these counties.

Enrollment

If you are eligible for MyCare Ohio, you can choose to receive your benefits in one of two ways: Dual-Benefits or Medicaid-Only Benefits. With Dual-Benefits, you receive both Medicare and Medicaid benefits through a MyCare Ohio plan. With Medicaid-Only Benefits, you receive Medicaid-covered services through a MyCare Ohio plan, while your Medicare benefits are provided through traditional Medicare or a private insurance company.

Changing your plan

If you are already enrolled in a MyCare Ohio plan and would like to change to a different plan, you must meet one of the following requirements:

• You have been a member of your current plan for three months or less
• You tried to get help from your MCP, but continue to have problems finding the care you need

If you meet one of these requirements, complete the change request. If you do not meet either of these requirements but still want to change your plan, you may do so during open enrollment each November.

Timing of changes

If you choose to get your Medicare services separately, your new Medicare coverage will begin the first day of the month following your request. For example, if you make a request on January 18th to not have Medicare through your plan, your new Medicare coverage will begin on February 1st.

Contact information

To join a different MyCare Ohio plan or end your membership, you can call the Ohio Medicaid Hotline at 1-800-324-8680, Monday through Friday from 7 a.m. to 8 p.m., and Saturday from 8 a.m. to 5 p.m. TTY users should call the Ohio Relay Service at 7-1-1. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

Enrolling in a plan

To enrol in a MyCare Ohio plan, you must meet the following eligibility criteria:

• You are 18 years of age or older.
• You live in one of the 29 demonstration counties.
• You currently have full Medicaid and Medicare Parts A, B, and D.

If you meet the above criteria, you can enrol in a MyCare Ohio plan by:

• Calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 1-800-292-3572) and selecting MyCare Ohio.
• Visiting the website www.ohiomh.com and selecting MyCare Ohio.
• Logging into the Ohio Medicaid Consumer Hotline Portal and following the steps to select a plan online.
• Mailing the appropriate enrollment form to 505 South High Street Columbus, OH 43215.
• Calling and speaking to a customer service representative who will help you enrol over the telephone.

If you are already enrolled in a plan and would like to change to a different MyCare Ohio plan, you must meet one of the following requirements:

• You have been a member of your current plan for three months or less.
• You tried to get help from your MCP, but you continue to have problems finding the care you need.

If you believe you meet one of these requirements, complete the change request. If you do not meet one of the above requirements and still want to change your plan, you may change your plan during open enrollment each November.

When selecting a plan, be sure to choose a primary care physician for each person in your family, or the plan will choose one for you.

Renewing your benefits

To renew your MyCare Ohio benefits, you must renew your Medicaid benefits once every 12 months. You will receive a reminder notice from both CareSource and the State. If you receive a termination notice, you must reapply. You have 90 days to complete your renewal from the end date of your Medicaid. If you miss this deadline, your healthcare benefits will end, and you will receive a letter of termination.

To renew your benefits, you can visit your local Job and Family Services (JFS) office or call the Ohio Medicaid Consumer Hotline at 1-800-324-8680. The hotline is open Monday to Friday, 7 am to 8 pm, and Saturday, 8 am to 5 pm.

You can also renew your benefits online by logging in to the member portal on the Ohio Benefits website. Here, you can check your eligibility and apply for a range of benefits.

It is important to keep your information up to date with the Ohio Department of Medicaid. You can do this by calling 1-800-324-8680, logging in to the online portal at benefits.ohio.gov, or contacting a caseworker with the County Department of Job and Family Service.

If you receive a packet in the mail asking you to renew or requesting more information about your Medicaid coverage, respond right away. If you do not respond, you risk losing your coverage, even if you are eligible for Medicaid.

Frequently asked questions