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. For additional information, please visit the Enrollment Information section.
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 | Not covered | Covered, $0 copay |
Federally Qualified Health Center or Rural Health Clinic services | Covered, $0 copay | Covered, $0 copay |
| Fitness membership | Covered, $0 copay | Not covered |
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 patients) | Covered, $0 copay | Covered, $0 copay |
| Through Original Medicare |
|
Inpatient hospital services* | Covered, $0 copay | Covered, $0 copay |
Medical supplies* | Covered, $0 copay | Covered, $0 copay |
Mental health and substance use disorder treatment 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 risk 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 | ||
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 glasses 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 | Not covered | 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 get by a provider who is not part of our network require prior authorization by 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, and 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; (TTY: 711) . |
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 (TTY: 711) 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.
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.