What Is The Best Medicaid Plan In Ohio


Health Insurance Rate Changes In Ohio

Changes coming to Ohio Medicaid will require participants to actively pick a plan each year

Health insurance rates, deductibles and out-of-pocket maximums are determined annually by health care providers then submitted for approval to state and federal regulators.

In 2022, the cost of health insurance rose by an average of 8% across all metal tiers. The cost of Bronze plans increased by the largest amount: 16% or $55 per month compared to 2021.

Metal tier

Premiums are for a 40-year-old adult.

Buckeye Health Plan Rated Best Medicaid Health Plan For Quality Performance


The Ohio Department of Medicaid awarded Buckeye Health Plan the highest quality rating among all Ohio managed care plans with 20 stars across the five categories on its 2018 Managed Care Plans Report Card published today. Buckeye earned the top, five-star rating for Keeping Kids Healthy and Doctors Communication and Service. Buckeye is Ohios second largest managed care plan serving nearly 325,000 Medicaid members statewide.

Ohio Medicaid 2018 Managed Care Plans Report Card

Performance Areas

Ratings on the states report card and P4P program are based primarily on performance as measured by the National Committee for Quality Assurance , which rates and compares health plans in Ohio and across the country. NCQA is a private non-profit organization dedicated to improving healthcare quality through annual performance measurements from annual Healthcare Effectiveness Data and Information Set reviews, and annual Consumer Assessment of Healthcare Providers and Systems surveys.

Being tops in quality is great for our members, Hill said. Our goal is to continue to improve and to elevate care for all Medicaid members, not just the members who choose Buckeye. This is one more way that we are living our mission of transforming the health of our communities, one person at a time.

Examples of Buckeye programs that create better patient outcomes and decrease cost include:

Average Cost Of Health Insurance By Family Size In Ohio

The cost of health insurance is based on each person covered, and the number of people on the policy will directly impact your premiums.

Children ages 14 and younger are typically covered at a flat rate, meaning the cost of coverage won’t likely increase until they’re older.

A couple in Ohio would pay double the monthly rate for the same Silver health plan than a single person would, or $981 on average, assuming both people are 40 years old. However, adding a child under the age of 15 would only increase the monthly health insurance rate by an average of $293, meaning a family of three would pay $1,274 for a health plan.

Family size

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How Ohio Grades Medicaid Managed Care Plans

The 2019 Ohio Department of Medicaid Managed Care Plans Report Card is a comparison of each plans performance across five reporting categories.

  • Getting Care
  • Living with Illness
  • Womens Health
  • The report card serves as a side-by-side comparison of plan performance for consumers specifically addressing areas of interest to consumers in an easy to read, user-friendly format.

    Information used for this report is collected from the managed care plans and their members and was reviewed for accuracy by independent organizations. Additionally, 2019 HEDIS® and 2019 CAHPS® data is used for this report. The yearly report cards create transparency for people choosing a Medicaid managed care plan.

    Medicaid: Managed Care Plans

    Medicaid works in Ohio
    What is a managed care plan?

    A managed care plan is a health insurance company the Ohio Department of Medicaid pays to provide health care services to some people. In Ohio, most people who have Medicaid must join a managed care plan to receive their health care. Ohios five managed care plans are: Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage and United Healthcare. If you have a managed care plan, you should receive a managed care card in the mail.

    Some people in Ohio are in a special managed care program called MyCare Ohio, which is supposed to coordinate both Medicare and Medicaid benefits. The MyCare Ohio plans include: Aetna, Buckeye, CareSource, Molina and United Healthcare. This factsheet does not discuss MyCare Ohio plans.

    What services do managed care plans provide?

    Managed care plans must provide the same services as traditional Medicaid. However, a managed care plan may have different rules for deciding whether you can get a service. They might also make you get approval ahead of time before you can get a service. Some managed care plans offer optional benefits that are not included in traditional Medicaid. When you enroll in a managed care plan, you should receive a member booklet with information about the benefits. Your doctor or other medical provider should also be able to help you find out these limits and how to request authorization for your medical services.

    How do I enroll in and choose a managed care plan?

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    Sticking To The Same Plan

    New and current Medicaid participants will receive a notice asking them to actively choose a plan. From early March to June, one can choose to remain in the same plan or select a different one.

    That’s different from before when individuals were automatically put back in the same plan. The change is to nudge people into knowing about their own health plan, and in turn, health outcomes would be improved.

    “There were people on the program who didn’t even realize some of those simple things about transportation being available to your doctor, or that your management people can help coordinate your care,” Ohio Medicaid Director Maureen Corcoran previously said.

    But there was criticism that Medicaid recipients, who tend to be difficult to reach and in disadvantaged communities, are less likely to actively enroll. Advocates feared those who didn’t make a choice would find themselves assigned to completely different plans, to their surprise.

    New adjustments to the plan could erase those concerns. According to Corcoran, the top factors when assigning someone would be ensuring physicians and other providers remain mostly constant and all members of a family receive the same coverage.

    As a result, nobody currently on Medicaid will be assigned to a different health plan, she emphasized at least when the new system begins.

    Hospital & Doctor Insurance

    Health ProtectorGuard fixed indemnity insurance,2 underwritten by Golden Rule Insurance Company, can supplement your major medical plan by paying cash for eligible, covered medical services, like a doctor visit, a trip to urgent care or a surgical procedure.

    • No deductibles or copays to pay first
    • Benefits paid regardless of other insurance
    • Money to pay costs not covered by major medical plans, like a deductible

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    Ohio Department Of Insurance

    The Ohio Department of Insurance is responsible for regulating insurance policies sold within the state. It advocates on behalf of residents to help ensure everyone has access to fair coverage. The department also provides a directory of Ohio State Insurance Information Program coordinators who can connect you with agencies and information about Medicare and the Medicare Savings Program.

    Contact information: Website | 644-2658

    Each Year States Develop Mco Capitation Rates That Must Be Actuarially Sound And May Include Risk Mitigation Strategies

    Ohio’s Medicaid work requirement approved by Trump now overturned by Biden

    States pay Medicaid managed care organizations a set per member per month payment for the Medicaid services specified in their contracts. Under federal law, payments to Medicaid MCOs must be actuarially sound. Actuarial soundness means that the capitation rates are projected to provide for all reasonable, appropriate, and attainable costs that are required under the terms of the contract and for the operation of the managed care plan for the time period and the population covered under the terms of the contract. Unlike fee-for-service , capitation provides upfront fixed payments to plans for expected utilization of covered services, administrative costs, and profit. Plan rates are usually set for a 12-month rating period and must be reviewed and approved by CMS each year. States may use a variety of mechanisms to adjust plan risk, incentivize plan performance, and ensure payments are not too high or too low, including risk sharing arrangements, risk and acuity adjustments, medical loss ratios , or incentive and withhold arrangements.

    Figure 2: CMS has provided guidance to states to address MCO payment issues in response to the COVID-19 pandemic

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    About Humana Healthy Horizons In Ohio

    Nationally, we serve Medicaid members through:

    • Medicaid Managed Care

    Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. . Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.

    Medical Plans

    Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. Administered by Humana Insurance Company.

    Go365® is not an insurance product. Not available with all Humana health plans.

    Individual Dental and Vision Plans

    Group Dental and Vision Plans

    Life Insurance Plans

    Choosing Your Managed Care Organization

    Most people are automatically selected for Medicaid managed care coverage. Shortly after you enroll in Medicaid, you will get a letter asking you to choose a Medicaid MCO. Visit the websites below for each to learn more and find one that is right for you. If you dont choose a plan, we will choose one for you. You can change plans up to 90 days from your date of initial enrollment, or during our annual open enrollment period.

    A helpful way to enroll in managed care is online through the Medicaid MCO Member Service Website. With help from the MCO Member Service, you can compare plans additional benefits and view plans provider networks. You may want to consider: what services you might need, which health plan is accepted by the doctors you use, which plan was found to meet the highest quality for your health care needs, and which extra benefits are most beneficial to you.

    Once you are enrolled with an MCO, you will get a new card in the mail. MCOs send one permanent card when you enroll. Keep this card for as long as you are on the plan. If you need to replace your managed care ID card, please contact your MCO, or use their online member portal. The plan will also send you information on your doctors, health services, and the scope of coverage from your plan.

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    The Humana Healthy Horizons In Ohio Difference

    Everyone should have a health ally. Were here to help you work toward your best health.

    Humana Healthy Horizons in Ohio provides healthcare services to eligible Ohio residents, including:

    • Individuals who meet income requirements
    • Individuals who are pregnant
    • Older adults
    • Individuals with disabilities

    With Humana Healthy Horizons in Ohio, you get high-quality medical, behavioral health, and pharmacy coverage, and more, including access to:

    • Go365 for Humana Healthy Horizons, a program that rewards you for completing healthy activities
    • Health coaches and programs
    • Specialized care management programs

    We do our best to give our members what they need plus things they didnt even know they needed. We call that human care.

    Map of Ohio counties covered by Humana Medicaid

    Region 1 counties include: Adams, Allen, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Crawford, Darke, Defiance, Fulton, Greene, Hamilton, Hancock, Hardin, Henry, Highland, Logan, Lucas, Marion, Mercer, Miami, Montgomery, Ottawa, Paulding, Preble, Putnam, Sandusky, Seneca, Shelby, Van Wert, Warren, Williams, Wood, Wyandot

    Region 2 counties include:Ashland, Ashtabula, Carroll, Columbiana, Coshocton, Cuyahoga, Erie, Holmes, Geauga, Harrison, Huron, Jefferson, Knox, Lake, Lorain, Mahoning, Medina, Portage, Richland, Stark, Summit, Trumbull, Tuscarawas, Wayne

    Humana Healthy Horizons in Ohio

    Big Step Forward For Ohio Medicaid But More To Come

    Ohio and the ACAs Medicaid expansion

    On April 9, Ohio Department of Medicaid Director Maureen Corcoran made a long-awaited announcement revealing the names of the Medicaid managed-care insurance companies that would get to share in a 20 billion dollar, five-year contract to provide health care services for 3 million Ohioans.

    Director Corcoran said repeatedly that she wanted to focus on people and not just the business of managed care.

    The announcement had been delayed likely because of a lawsuit that Ohio Attorney General David Yost had filed against Centene accusing the company of a conspiracy to wrongfully and unlawfully obtain tens of millions of dollars in Medicaid payments. Its not clear how this situation will resolve itself, but it seems likely that Centene has a strong incentive to settle this case.

    The announcement of the winning plans was the culmination of a process that began a little more than two years ago. In fact, Governor Mike DeWine signaled early that he wanted to re-procure Ohios Medicaid managed-care contracts. Director Corcoran said repeatedly that she wanted to focus on people and not just the business of managed care.

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    A Number Of Large Health Insurance Companies Have A Significant Stake In The Medicaid Managed Care Market

    States contracted with a total of 290 Medicaid MCOs as of July 2018.9 MCOs represent a mix of private for-profit, private non-profit, and government plans. As of July 2018, a total of 17 firms operated Medicaid MCOs in two or more states , and these firms accounted for nearly 62% of enrollment in 2018 . Of the 17 parent firms, eight are publicly traded, for-profit firms while the remaining nine are non-profit companies.11 Six firms UnitedHealth Group, Centene, Anthem, Molina, Aetna, and WellCare have MCOs in 10 or more states and accounted for over 47% of all Medicaid MCO enrollment .12 All six are publicly traded companies ranked in the Fortune 500.13

    Figure 8: Six firms have a wide geographic reach in Medicaid, each with MCOs in 10 or more of the 39 MCO states

    Figure 9: In the 39 MCO states, six Fortune 500 firms have almost half of the Medicaid MCO market

    Health Hospital And Preventative

    Most preventative healthcare services do not have a copay, including wellness visits, family planning/pregnancy care, physical therapy, inpatient and outpatient hospital visits, medical equipment, x-rays, immunizations, and other exams and screenings. If you visit the emergency room with a medical necessity, you will not face a copay. However, if you visit the emergency room and it is determined that your medical need is not an emergency, you may face a $3 copay.

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    Ohio Medicaid Handbook Insert

    • PDF 16.67KB – Last Updated: 11/12/2020

    Use the documents below to learn more about each important health topic.

    UnitedHealthcare OMWTM is an interactive website that helps you get ready for real life. It’s easy and fun, and has important information all on one secure site.

    Money: Set up a budget and learn about taxes.Housing: Understand and compare housing options.Work: Create a resume and learn interview tips.

    And more!

    Fraud, Waste and Abuse

    Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness.

    Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits.

    Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources.

    Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.

    What is provider fraud, waste and abuse?

    • Billing for services not rendered
    • Upcoding
    • Soliciting, offering or receiving kickbacks
    • Improper or sloppy billing practices
    • Failure to maintain adequate records
    • Routine waiver of coinsurance and deductible

    What is member fraud, waste and abuse?

    • Anonymous fraud, waste and abuse hotline:

    Clinical Health Guidelines

    Perinatal Care

    Ohio Dental And Vision Plans

    Legal Changes Possible For Ohio Medicaid Expansion

    Dental and vision insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions.3 They offer coverage for the dental and vision services many medical insurance plans dont include.

    From Cincinnati to Cleveland, Columbus to Toledo, explore these Ohio health insurance options and more that may be available now.

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    Eligibility & Enrollment Total Points: 3333

    • Children Medicaid Eligibility Level: Full Weight Note: This metric is expressed as a percentage of the Federal Poverty Level.
    • Pregnant Women Medicaid Eligibility Level: Full Weight Note: This metric is expressed as a percentage of the Federal Poverty Level.
    • Adults Medicaid Eligibility Level : Full Weight Note: This metric is expressed as a percentage of the Federal Poverty Level.
    • Total Medicaid Enrollment per Low-income Population: Double Weight

    Unitedhealthcare Connected For Mycare Ohio

    UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

    Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

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