The Devil and Mrs. Jones, Part 6: Mrs. Jones discovers MyCare

Written by Chris Stieben. Posted in Taking Care of Your Life

Mrs. Jones received a postcard with information about “MyCare Ohio” and did not understand what this was all about, so she called the Ombudsman for more information.

Mrs. Jones found out that MyCare Ohio is a demonstration project with the Centers for Medicaid and Medicare Services (CMS) and Ohio Medicaid to provide a managed care program to people who have both Medicare and Medicaid.

There were a few things that Mrs. Jones had to make a decision about when it came to MyCare. First, she had the option of choosing Aetna or Buckeye in the Northwest Ohio region.

Highlights of either plan can be found on the “Aetna Better Health” or “Buckeye Community Health Plan” website. Additional benefits of enrollment can include care management to coordinate your care, coverage of all eligible Medicare and Medicaid health services, and several value-adds that provide extra benefits, such as transportation and prescription benefits.

Mrs. Jones learned from the Ombudsman that approximately 6,500 people in the Northwest Ohio area have a MyCare Ohio plan.

With the information provided by the Ombudsman, Mrs. Jones also learned of the flexibility of the MyCare Ohio program. She had the option of being “opt-out” or “opt-in.” Opt-out would mean that her Medicare would remain traditional Medicare and her benefits through Medicare and Medicaid would be handled separately. She decided the best plan for her would be to opt-in, which means that she will have the managed care plan (through Buckeye or Aetna) handle both her Medicare and Medicaid benefits.

With the help of her tech-savvy grandkids, she was able to go to the plan website to access benefit information and create a log-in to manage her own care and services.

If you have questions regarding eligibility or enrollment, or you have concerns about your coverage, you can reach out to the Long-Term-Care-Ombudsman Office for assistance. You can reach us by phone at 419-259-2891 or visit our Facebook by searching “ABLE: Ombudsman” and follow our page for up-to-date information.

Next month, we will follow Mrs. Jones as the assisted living opens up for visits and we will discuss the obstacles (and solutions) to the next phase of visitation guidance for long-term-care facilities.

Chris Stieben is Director of the ABLE Long-Term-Care-Ombudsman Program, which can be reached at 419-259-2891 (http://ombudsman.ablelaw.org).