Medicare-Medicaid Plan by Buckeye Health Plan
The Medicare-Medicaid Plan (MMP) is a joint effort between the Ohio Department of Medicaid (ODM) and the Centers for Medicare and Medicaid Services (CMS). Buckeye Health Plan – MyCare Ohio (Buckeye) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. The goal of this program is to improve the experience in accessing quality, coordinated care.
What is MyCare Ohio?
MyCare Ohio is a new managed care program that will coordinate physical, behavioral, and long-term care services for individuals age 18 and older, who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults, and individuals who receive behavioral health services.
As a member of Buckeye Health Plan – MyCare Ohio, you will still be able to get all medically-necessary Medicaid and Medicare-covered services including Healthcheck (EPSDT) services. Here are some of the benefits you will receive at no additional cost by enrolling with a MyCare Ohio plan for your Medicare and Medicaid services:
- A MyCare Ohio health plan to serve as your single point of contact for all of your Medicare and Medicaid services.
- A single ID card to carry with you for all of your Medicare and Medicaid Services
- Access to a Nurse Advice line available 24 hours a day, 7 days a week that will offer immediate assistance with your questions and concerns.
- A care team, which will include you, your family, your doctor(s), your MyCare Ohio health plan and anyone else you choose to help you make decisions about your health care.
Does everyone who has both Medicaid and Medicare have to enroll in a MyCare Ohio plan?
No. You do not have to enroll in a plan if you:
- Do not have full Medicaid benefits and Medicare Parts A and B;
- Are younger than age 18;
- Receive PACE;
- Have a spenddown;
- Have any private medical insurance, including retiree benefits, other than a Medicare Advantage plan; or
- Do not live in one of the these counties: 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, or Wood
If you meet one of the exclusions above, call the Medicaid Consumer Hotline at 1-800-324-8680 or visit www.ohiomh.com. (Please note: By clicking on this link you will be leaving the Buckeye website.) Otherwise, you must choose a plan.
Buckeye Health Plan is located in the following counties of Ohio:
- Clark, Cuyahoga, Fulton, Geauga, Greene, Lake, Lorain, Lucas, Medina, Montgomery, Ottawa, and Wood.
You can get this information for free in other languages. Call Member Service at 1-866-549-8289. TTY users call 711 (Ohio State Relay). Hours are from 8 a.m. to 8 p.m., seven days a week. The call is free.
Usted puede obtener esta información de forma gratuita en otros idiomas. Llame a Servicio al Cliente al 1-866-549-8289. Usuarios de TTY deben llamar al 711 (Relé de estado de Ohio). El horario de atención es de 8 AM a 8 PM, siete días a la semana. La llamada es gratuita.
Last Updated: 09/30/2015
Buckeye Health Plan – MyCare Ohio (Buckeye) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. The program combines services from both Medicare and Ohio Medicaid programs. Persons who meet the rules to join MMP can get benefits from one single health plan—MMP.
For more information about joining a MyCare Ohio plan, click here.
MyCare Ohio Medicaid Benefits
Those who meet the rules to join in our plan for Ohio Medicaid, they will get the following benefits from our health plan:
- Inpatient hospital, rehabilitation, and nursing facility stays. Home health, DME, physician services, routine vision, dental, and hearing services. Some members get services through managed care plans or fee-for-service Ohio Medicaid.
- Regular traditional Ohio Medicaid also covers behavioral health services from the Ohio Department of Mental Health and Addiction Services. Members can get these benefits through fee-for-service Ohio Medicaid; our Medicare-Medicaid Plan will offer these benefits in addition to traditional Ohio Medicaid covered services. Behavioral health services include one-on-one or group meetings, crisis intervention, intensive outpatient and inpatient mental health services, partial hospitalization, and community psychiatric supportive treatment.
- Waiver programs. Waiver programs offer limited coverage, but are targeted to eligible individuals for:
- Adaptive/assistive devices
- Adult day health care
- Emergency response systems
- Home-delivered meals
- Home modifications
- Nursing facility care
- Nursing services
- Personal care assistance services and/or skilled therapy services
- Respite care
- Supplemental transportation
These waivers provide members on Ohio Medicaid with certain services that allow them to get long-term care outside of a hospital or nursing facility. Those who meet the rules to join have been understood as having a physical or emotional need or skilled level of care. Without the services available through the waiver benefit, these individuals are at risk for hospital or long-term nursing home placement.
MyCare Ohio will include all of the services that are covered in the following home and community-based Medicaid waivers: PASSPORT, Choices, Assisted Living, Ohio Home Care, Transitions Carve-out. If you are getting services in one of these waivers at the time you joined in MyCare Ohio, you can continue to get those same services by your same providers for a specified time.
Finally, Ohio Medicaid covers drugs for all recipients except those who are able to join in Medicare Part D; Part D-eligible recipients can only get Ohio Medicaid coverage for medications that are not covered by Medicare Part D.
MyCare Ohio Medicare Benefits
For Buckeye members who joined in our plan for Medicare, they will get the following benefits from our health plan:
- Part A (Hospital Insurance) covers inpatient hospital stays of two nights or more, with a half room, food, and tests. There is also coverage for a skilled nursing home, hospice, and home health if certain conditions are met.
- Part B (Medical Insurance) covers defined services and items not covered by Part A, generally on an outpatient basis. Part B covers doctor services, home health, preventive services, x-rays, lab and diagnostic services, DME, vaccinations, chemotherapy, and more.
- Part C (Medicare Advantage Plans) allows a person to select a private managed care organization, such as Buckeye, to take care of their healthcare benefits instead of the traditional fee-for-service plan provided by Medicare. Part C includes Parts A, B, D, and extra benefits.
- Buckeye covers $70 a quarter for over-the-counter items from our mail order pharmacy. Members can have items such as vitamins, antacids, first aid supplies, oral care items, and pain relievers sent free to their home.
- Part D covers Medicare-covered drugs for Medicare recipients.
For more information on any of these benefits we provide, please call Buckeye Member Services at 1-866-549-8289. Hours are from 8 a.m. to 8 p.m., Monday through Friday. On weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.
Last Updated: 10/01/2016