Helping you age better

Last month, we discussed what the Next Generation MyCare plan is and how it came to be in the State of Ohio. This Fully Integrated, Dually Eligible, Special Needs Plan or “FIDE-SNP”, is currently rolling out in counties across the state and will eventually be available in all 88 counties in Ohio. But what does this really mean for people who have both Medicare and Medicaid plans?

For Medicaid, the State of Ohio has awarded contracts for Next Generation MyCare to four Managed Care Plans including Anthem, Buckeye, CareSource, and Molina. Dually eligible individuals can select one of the Plans for their Medicaid coverage. Since Medicaid is issued at the State level, Ohio can use its data to assign patients to a Plan based on which one contracts with medical providers that the individual currently uses. Once that has occurred, a letter will be sent giving the individual 60 days to change that selection if they prefer a different Plan. If action is not taken to change the selected Plan within that timeframe, the individual will be enrolled on the first day of the month after the 60 days have passed. For example, if an individual is assigned a Plan in June, they would have through August to make a different selection. If they do not select differently during that time, on September 1st, they will be active in the assigned Plan. We expect individuals within the ten counties of our Area Agency on Aging District 7 (AAA7) to begin receiving these letters in June 2026.

For Medicare, individuals maintain the right to choose any available Medicare option. This includes choosing a MyCare Medicare Plan associated with their MyCare Medicaid Plan, another Medicare Advantage Plan available in their area, or Traditional Medicare. Individuals may choose to enroll in a MyCare Medicare Plan at any time. Individuals who select a Medicare Advantage Plan or Traditional Medicare may make changes to their Medicare option during the Annual Medicare Open Enrollment Period each year (October 1st – December 15th) or during Medicare Advantage Plan Open Enrollment (January 1st to March 31st) each year. If the person chooses to enroll in an Anthem, Buckeye, CareSource, or Molina MyCare Medicare Plan, they will automatically be enrolled in the coordinating MyCare Medicaid Managed Care Plan. As a reminder, consumers will always choose their Medicare Plan as this cannot happen through any action but voluntary enrollment by an individual.

Many individuals receiving services at home through a Medicaid Waiver program, like the PASSPORT Program through our Agency, will be transitioning to a MyCare Plan. There are some points of interest that these individuals should be aware of. Just like any other health insurance, providers will need to be contracted or “in-network” for each Plan to continue to provide services. The State has provided a 180-day grace period for PASSPORT consumers that will not require providers to be contracted with the new Plans to receive payment in order to ensure a smooth transition for the consumer; however, after 180 days, any provider (Doctor, Physical Therapist, Hospital, Home Health Agency, etc.) must be contracted with the Plan to continue services. This is a key component when selecting a Plan that is right for you. For more information on how to select the best Plan for your needs, we have links on our website’s home page to assist (www.aaa7.org). You can also call the Ohio Medicaid Consumer Hotline at 800-324-8680.

As always, the Area Agency on Aging District 7 is here as a resource for the community. Check our website at www.aaa.org for further information or call/email us with any questions – 1-800-582-7277 or [email protected].