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Ohio's Medicaid program provides a package of medical services that includes preventive care, community mental health/alcohol and drug addiction treatment and home care for people with serious disabilities, as well as doctor visits, hospitalization, nursing home care, and many other services.
Some services are limited by dollar amount, number of visits per year, or setting in which they can be provided. With some exceptions, all services are available as medically necessary to everyone enrolled in Medicaid statewide.
Medicare premium assistance program
Individuals with low incomes who are eligible for Medicare can receive help with all or part of their Medicare Part B premiums, co-payments and/or other deductibles. Different levels of assistance are available depending on income.
Medicare Prescription Drug Benefit and how it works with Medicaid
Dual eligibles (people with Medicare and Medicaid benefits) will no longer receive their drug coverage through Medicaid. They will receive drug coverage from Medicare, which may be different from what is included on the Ohio Medicaid drug formulary. However, Medicaid will still pay for other medically necessary services (e.g., doctor visits, hospital care, dental, vision etc..) for those who are dually eligible.
Dual eligibles will be automatically enrolled in the Medicare Prescription Drug Benefit and will need to select a PDP to get their prescription coverage, or one will be selected for them. In addition, they will only be responsible for paying co-payments that can range from $1-$5 per prescription. Copayments will be waived for dually eligible beneficiaries who reside in long-term care institutions or who are enrolled in Medicaid’s Program of All-Inclusive Care (PACE).
To learn more about the Medicare Prescription Drug Benefit call: 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov .
Extra help with drug costs
Extra help is available to provide people with limited income and resources assistance with premiums, deductibles and co-pays under the Medicare Prescription Drug Benefit through the Social Security Administration (SSA). An application must be completed and filed with SSA. Beneficiaries can apply on-line www.socialsecurity.gov for this extra help. In addition, applications can be obtained at local social security offices and at the county departments of job and family services.
Additional information on Medicaid
Medicaid was passed as part of the Social Security Act of 1965 and began in Ohio in 1968. Each state operates its own distinct program within guidelines established per the Social Security Act. The federal government plays a very active oversight role through the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services
November is the Open Enrollment Month for all Medicaid clients in southeast Ohio, including Athens County. November is the only month of the year that Athens County residents can switch between the different managed care plans providing Medicaid coverage.
How do consumers receive Medicaid services?
Medicaid provides primary and acute care services through a fee-for-service system or, for consumers in some areas, managed care plans. (Managed care plans, or HMOs, are required for those with Healthy Start/Healthy Families Medicaid.)
Both delivery systems provide all medically necessary primary care, specialty and emergency care and preventive services.
Ohio Medicaid also provides both home health care and facility-based services for those consumers requiring a long-term care benefit package.
Home care services allow consumers to remain in their homes and communities. Long-term care services are also available for consumers needing care in nursing homes and facilities for persons with mental retardation. Alternatives to institutional care are offered through Home and Community Based Services Waivers.
Additional information can be obtained from the Ohio Senior Health Insurance Information Program (OSHIIP) website or by calling 1-800-686-1578.