Benefits

Ohio Medicaid helps with medical costs for certain people with limited incomes and resources. Ohio Medicaid pays for Medicare premiums for certain people, and pays for Medicare deductibles, coinsurance and copayments. Consumers have no premiums or medical copays on Buckeye.

Ohio Medicaid covers long-term care services such as home and community-based “waiver” services and assisted living services and long-term nursing home care. It also covers dental and vision services. Because you chose or were assigned to only get Ohio Medicaid-covered services from our plan, Medicare will be the primary payer for most services.

You can choose to get both your Medicare and Ohio Medicaid benefits through Buckeye so all of your services can be coordinated.  Visit our Enrollment Information page for more information on how you can make this choice.

2018 Summary of Benefits

2018 Resumen de Beneficios

As a Buckeye member, you will continue to get all medically-necessary Ohio Medicaid-covered services at no cost to you.

MyCare Ohio Benefits

For Buckeye members enrolled in our Medicare plan, they will get the benefits below from our health plan. Member copays will be covered by Ohio Medicaid. For Buckeye members enrolled in our Ohio Medicaid plan, they will get the benefits below from our health plan. Medical services do not have any copays or cost sharing.

Ambulance/ambulette transportation*

Ambulance covered, $0 copay

Covered, $0 copay

Assisted living services (waiver services**)

Not covered

Covered, $0 copay

Certified nurse midwife services

Covered, $0 copay

Covered, $0 copay

Certified nurse practitioner services

Covered, $0 copay

Covered, $0 copay

Chiropractic (back) services

Covered, $0 copay

Covered, $0 copay

Dental services - surgery of the jaw or related structures, setting fractures of the jaw or facial bones, extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease, or services that would be covered when provided by a physician*

Covered, $0 copay

Covered, $0 copay

Dental services - all others

Not covered

Covered, $0 copay

Diagnostic services (x-ray, lab)

Covered, $0 copay

Covered, $0 copay

Durable medical equipment/supplies*

Covered, $0 copay

Covered, $0 copay

Emergency services

Covered, $0 copay

Covered, $0 copay

Family planning services and supplies

Covered, $0 copay

Covered, $0 copay

Federally Qualified Health Center or Rural Health Clinic services

Covered, $0 copay

Covered, $0 copay

Home health and private duty nursing services*

Covered, $0 copay

Covered, $0 copay

Home health and private duty nursing services (waiver services*)

Not covered

Covered, $0 copay

Hospice care (care for terminally ill, e.g., cancer paitients)*

Covered, $0 copay

Covered, $0 copay

 

Through Original Medicare

 

Inpaitient hospital services*

Covered, $0 copay

Covered, $0 copay

Medical supplies*

Covered, $0 copay

Covered, $0 copay

Mental health and substance abuse services*

Covered, $0 copay

Covered, $0 copay

Nursing facility and long-term care services and supports*

Covered, $0 copay

Covered, $0 copay

Nursing facility and long-term care services and supports (waiver services*)

Not covered

Covered, $0 copay

Obstetrical (maternity care - prenatal and postpartum including at rist pregnancy services) and gynecological services

Covered, $0 copay

Covered, $0 copay

Outpatient hospital services*

Covered, $0 copay

Covered, $0 copay

Physical and occupational therapy*

Covered, $0 copay

Covered, $0 copay

Physical exam required for employment or for participation in job training programs if the exam is not provided free of charge by another source

Not covered

Covered, $0 copay

Podiatry (foot) services

Covered, $0 copay

Covered, $0 copay

Prescription drugs

Visit our Prescription Drug (Part D) page for more information

Visit our Prescription Drug (Part D) page for more information

Preventative mammogram (breast) and cervical cancer (pap smear) exams

Covered, $0 copay

Covered, $0 copay

Primary care provider services

Covered, $0 copay

Covered, $0 copay

Renal dialysis (kidney disease)

Covered, $0 copay

Covered, $0 copay

Screening and counseling for obesity

Covered, $0 copay

Covered, $0 copay

Shots (immunizations)

Covered, $0 copay

Covered, $0 copay

Specialist services

Covered, $0 copay

Covered, $0 copay

Speech and hearing services, including hearing aids*

Covered, $0 copay

Covered, $0 copay

Therapy services (physical, occupational and speech)*

Covered, $0 copay

Covered, $0 copay

Vision services - outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye; glaucoma screenings for people at high risk of glaucoma, and one pair of eye glassses or contact lenses after each cataract surgery*

Covered, $0 copay

Covered, $0 copay

Vision services, all other

Not covered

Covered, $0 copay

Waiver services**

Not covered

Covered, $0 copay

Well-child (Healthchek) exams for children under the age of 21

Covered, $0 copay

Covered, $0 copay

Yearly well adult exams

Covered, $0 copay

Covered, $0 copay

Prior Authorization
*These services require prior authorization by the health plan – that means we need certain information from you, your provider, or waiver services coordinator to approve the service. If we do not approve a service, we will send you information on how you can appeal our decision and your right to a state hearing. Contact your Care Manager or Member Services for more information.

Note: Most services received from a provider who is not part of our network require prior authorization from Buckeye. Contact your Care Manager or Member Services for more information.

Waiver Benefits

**Consumers must meet the rules for enrollment into the waiver program within MyCare Ohio. Once consumers meet these rules and are approved to be in the waiver program by their waiver services coordinator and health plan care manager, they will be able to get waiver services on their care plan arranged by their waiver services coordinator.

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 are enrolled in MyCare Ohio, you can continue to get those same services by your same providers for a specified time.

Transportation

Buckeye covers all medically-necessary Medicare and Ohio Medicaid covered transportation services.

To arrange transportation, contact Buckeye at the numbers below.

Type of Transportation Who to Contact
Medicaid Waiver-Covered Transportation Contact your Waiver Services Coordinator or Care Manager. For assistance, contact the 24-Hour NA Line at 1-866-549-8289, Option #3.
Non-Emergency Ambulance and Ambulette (Wheelchair Van) Transportation 1-866-531-0615. Please call at least 48 hours in advance of your scheduled trip.

Please contact Member Services at 1-866-549-8289 if you have any problems with transportation or need any assistance.

Healthchek – EPSDT

Keeping children healthy and growing the way they should is important. A big part of this is seeing the doctor regularly for Healthchek screenings—even when your child is not sick—in order to make sure your child stays healthy. Healthchek screenings help find problems or possible problems early, before they become serious. If a problem is found, Healthchek includes medically necessary follow-up care and referrals. Healthchek screenings are provided from birth to under 21 years of age. These services are covered as part of your Ohio Medicaid Care Coordination Plan.

Click on the link below for more information about Healthchek.

EPSDT Website
(Note: Most services received from a provider who is not part of our network require prior authorization from Buckeye. Contact your Care Manager or Member Services for more information.)

Or call Medicare at 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048. Calls to this number are free, 24 hours a day, 7 days a week.

 

Last Updated: 09/30/2017
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