Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Last updated: June 10, 2024
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
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Last updated on June 10,2024
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Table of Contents
Purpose ...................................................................................................................................................................................................................3
How can you choose a health plan? ........................................................................................................................................................................3
Definitions ...............................................................................................................................................................................................................3
Health benefits all plans must offer ........................................................................................................................................................................4
Value-added services ..............................................................................................................................................................................................5
Dental services ............................................................................................................................................................................................................. 5
Vision care .................................................................................................................................................................................................................... 6
Transportation .............................................................................................................................................................................................................. 7
Health and wellness programs ................................................................................................................................................................................... 10
Incentives to strengthen health and well-being .......................................................................................................................................................... 13
Prenatal and postpartum health incentives ................................................................................................................................................................ 17
Application or online services ..................................................................................................................................................................................... 19
Telehealth ................................................................................................................................................................................................................... 21
24-hour medical advice line ........................................................................................................................................................................................ 21
Appendix ............................................................................................................................................................................................................... 22
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
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Purpose
The purpose of Ohio Medicaid’s Managed Care Organizations (MCO) Health Plan Comparison is to help you select the health plan best suited to your needs. The
Health Plan Comparison provides insights into the benefits all MCOs must offer. It also lists value-added services unique to each MCO. As you consider your
choice, take advantage of this guide and other resources available to you through the Ohio Medicaid Consumer Hotline.
The benefits detailed in this document are subject to change throughout the year. We encourage you to check with Ohio Medicaid’s MCOs to locate the most
recent information. You can find additional information in the appendix.
How can you choose a health plan?
Visit the Ohio Medicaid Consumer Hotline Portal at https://members.ohiomh.com where you can login and make a plan selection.
Call the Ohio Medicaid Consumer Hotline at (800) 324-8680. Representatives are available 7 a.m. to 8 p.m. Monday through Friday and 8 a.m. to 5 p.m.
on Saturdays. They can provide interpreters and answer your questions about how to select an MCO.
Definitions
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): EPSDT services, also known in Ohio as Healthchek, is a comprehensive Medicaid benefit
package for individuals younger than age 21. Under EPSDT, the service limitations described in this document may be exceeded based on medical necessity
with prior authorization. See Appendix for additional information.
Value-Added Services: Services provided by the MCOs that are in addition to the required health services that all plans must offer. These services are not
available in the Medicaid Fee-For-Service program.
Health and Wellness Program: Programs targeted at care for specific populations (babies, children, etc.) or for management of a chronic illness (asthma,
diabetes, etc.).
Incentives to Strengthen Health and Well-Being: A reward for participation in and completion of specific services or activities specified by the MCO to promote
the health and well-being of members.
Application or Online Services: Ability to engage with an MCO in ways other than over the phone, such as: online member portal to view claims, enroll in
incentives, print ID card, etc.
Nurse Advice Line: 24/7 advice line staffed with experienced staff of registered nurses who can assist members with triage care (deciding whether self-care,
doctor care, or emergency care is appropriate), understanding a medical condition or recent diagnosis, preparing questions for an upcoming medical
appointment, learning more about medications, and more.
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Health Plan Comparison
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Health benefits all plans must offer
•
Inpatient hospital services.
•
Outpatient hospital services (including those provided by rural health clinics and federally
qualified health centers).
•
Physician services.
•
Laboratory and x-ray services.
•
Screening, diagnosis, and treatment services for children under 21 years old, under
Healthchek, Ohio's Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Program.
•
Immunizations.
•
Contraceptive services and counseling.
•
Home health and private duty nursing services.
•
Podiatry services.
•
Chiropractic services.
•
Blood glucometers and blood glucose test strips.
•
Behavioral health services, including treatment for mental health and substance use
disorders (see appendix for more information).
•
Physical, occupational, developmental, and speech therapy services.
•
Nurse-midwife, certified family nurse practitioner, and certified pediatric nurse
practitioner services.
•
Durable medical equipment and medical supplies.
•
Nursing facility services.
•
Respite services for eligible children receiving Supplemental Security Income (SSI).
•
Hospice care.
•
Telehealth.
•
Coverage for mom and baby for 12 months following delivery.
•
Dental services, including:
o
For members 21 and older - one cleaning per calendar year.
o
For members under 21 years old – one cleaning every six months and, in extreme
cases with prior authorization, braces.
o
For pregnant members – two cleanings per calendar year.
o
Dentures, fillings, extractions, crowns, medical and surgical dental services, and
root canals (based on medical necessity).
•
Vision care services, including:
o
For members under 21 years old – one exam and eyeglasses every 12 months.
o
For members 21 to 59 years old - one exam and eyeglasses every 24 months.
o
For members over 60 years old – one exam and eyeglasses every 12 months.
•
Transportation services, including:
o
Necessary transportation by ambulance or wheelchair van, without regard to
distance.
o
Necessary transportation by standard vehicle (e.g., taxicab, sedan) when the
nearest network provider is located at least 30 miles away.
o
For OhioRISE members, necessary transportation by standard vehicle, without
regard to distance.
o
If the member exhausts the value-added transportation benefit, the health plan
works with the member to transition them to their county non-emergency medical
transportation (NEMT), if possible.
•
Prescription drugs (see appendix for more information).
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Value-added services
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These services are provided in addition to the dental services described on page three
Dental services
•
No co-pays for dental
services
•
For members 21 years
and older - one
additional dental
cleaning and exam per
calendar year (some
restrictions and
limitations apply)
•
For pregnant members -
one additional dental
cleaning per calendar
year
•
No co-pays for dental
services
•
For members 21 years
and older - one
additional dental
cleaning per calendar
year
•
No co-pays for dental
services
•
For members 21 years
and older - one
additional cleaning and
exam per calendar year
•
Eligible Special Needs
members receive one
practice office visit
annually, to become
accustomed to dental
cleanings and
treatment
•
$25 Preventive Dental
Care Incentive (one per
year) through
MyHealth Pays
•
For member
households with
children up to 14 years
- quarterly toothpaste
provision (four per
year)
•
No co-pays for dental
services
•
One additional teeth
cleaning and exam per
year
•
Mobile dental unit for
rural communities
•
For members up to 20
years old – fluoride
varnish
•
For members up to 20
years old – nitrous
oxide
services
•
For members 21 years
and older - one
additional dental
cleaning per calendar
year
•
SmileMD mobile
anesthesiology
services for children
and adults
•
No co-pays for dental
services
•
Interactive dental
mobile app to guide
members on oral
health and wellness
•
For members 21 years
and older - one
additional dental
cleaning per calendar
year
•
For pregnant members
- two additional
cleanings per calendar
year (up to three per
calendar year during
pregnancy)
•
For children needing
surgical dental
procedures – mobile
anesthesiology
services available
•
Members with
periodontal disease
who have obtained
scaling and root
planning – may receive
up to two periodontal
maintenance services
once per 12 months up
to 24 months
•
No co-pays for dental
services
•
Two exams and
cleanings per calendar
year
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Value-added services
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These services are provided in addition to the vision services described on page three
Vision care
•
For members 21 to 50
years - one additional
eye exam per calendar
year for diagnosed with
diabetes
•
No co-pays for vision
services
•
For members up to 21
years - $100 towards
purchase and fitting
for contact lens or
eyeglasses per
calendar year
•
For members 21 to 59
years - $100 towards
purchase and fitting
for contact lens or
eyeglasses per
calendar year
•
No co-pays for adults
on exams or eyewear
•
For members up to 20
years and 60 years and
older - $50 for contact
lenses and $50 for
contact lens fitting per
calendar year
•
For members 21 to 59
years – $50 for contact
lens and $50 for
contact lens fitting
every two calendar
years
•
For members up to 21
years - $100 toward
contacts and lens
fitting per year
•
For members 21 to 59
years - $100 toward
contacts and lens
fitting every two years
•
For members with
diabetic diagnosis –
special screenings
services
•
One eye exam every
12 months
•
For members 21 to 59
years - up to $200 for
one pair of eyeglasses
(frames and lenses) or
contact lenses per
calendar year (both
eyeglasses and contact
lenses cannot be
obtained in the same
calendar year)
•
No co-pays for vision
services
•
“Ten plus Ten” frame
option lets you waive
the standard frame
selection and opt for
any frame
•
For members 18 years
and under - one set of
frames and lenses
once per year, or up to
$150 toward contact
lenses per calendar
year
•
For members 21 years
and older - one eye
exam and replacement
frames and lenses
every 12 months
•
No co-pays for vision
services
•
$150 toward the
purchase and fitting of
contact lenses per
calendar year
•
One eye exam every 12
months
•
$25 benefit towards
eye glass frames &
lenses once every 12
months (you may
choose contact lenses
instead of glasses)
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Value-added services
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These services are provided in addition to the transportation services described on page three
Transportation
•
Up to 30 round trip or
60 one-way rides
qualifying non-medical
trips, such as county
caseworker meetings
to
manage your eligibility
and WIC
appointments,
less than 30
miles away
from a member’s
home
per calendar year
•
Unlimited additional
trips for
chemotherapy,
radiation, dialysis, or
prenatal and
postpartum
appointments
•
Unlimited trips for
medical services for
members who utilize a
wheelchair
•
Bus passes available
for
members who prefer
mass transit
•
Up to 30 round trip or
60 one-way trips to
provider
appointments, grocery
stores, food banks,
county caseworker
meetings to manage
your eligibility,
pregnancy classes,
WIC appointments,
and more less than 30
miles from a
member’s home
•
Uber gift card for
eligible members to
help with
transportation needs
•
Up to 15 round trip or
30 one-way trips that
are less than 30 miles
from the member’s
house per calendar
year to medical,
behavioral health, SUD
or dental
appointments, and
county caseworker
meetings to manage
your eligibility, rides
home from the
hospital or emergency
room, or to a
pharmacy after a
doctor’s office visit
•
Unlimited trips for
pregnancy and
prenatal; twelve
weeks limited trips for
post-partum visits less
than 30 miles; WIC
appointments; NICU;
children (younger than
age one) well visits;
and trips for parents
to visit their child in a
residential or inpatient
behavioral health
facility
•
Up to 30 round trip or
60 one-way trips that
are less than 30 miles
from the member’s
home for eligible non-
medical trips, such as
county caseworker
meetings to manage
your eligibility and
WIC. Benefits also
include non-medical
appointments, food
banks, and grocery
store
•
Unlimited trips are
available for critical
care including dialysis,
chemo/radiation,
wound care, prenatal,
and substance use
disorder (SUD)
•
Up to five round trips
or 10 one-way trips
for food
•
Sick visit trips
available same day
•
Paid mileage may be
offered for
appointments
•
Up to 15 round trip or
30 one-way trips that
are less than 30 miles
from the member’s
home for qualifying
non-medical trips,
such as county
caseworker meetings
to manage your
eligibility and WIC
•
Unlimited trips for
dialysis, radiation,
chemotherapy,
diabetes
management, organ
transplant care, and
wound care
•
Unlimited additional
trips for prenatal and
postpartum doctors’
appointments,
available up to 12
months postpartum
•
Additional trips
available for:
o
Members receiving
care for a
behavioral
health/substance
use disorder
•
Up to 15 round trips
or 30 one-way
provider trips that are
less than 30 miles
from the member’s
home. Benefits also
include non-medical
trips to the grocery
store, food bank,
county caseworker
meetings to manage
your eligibility and
WIC
•
Unlimited trips for
pregnant women,
children under one
year old, and
members who use a
wheelchair
•
Members can choose
services through Uber
or Lyft
•
Mileage
reimbursement to
cover any approved
trip if the member
drives themselves or
gets a ride from a
friend
•
Free bus passes
•
Up to 15 round trip or
30 one-way trips to
and from your PCP,
WIC, pharmacy, or
other participating
healthcare or
behavioral health care
providers, and county
caseworker meetings
to manage your
eligibility
•
Unlimited trips for
pregnancy, prenatal,
post-partum, WIC
appointments,
Neonatal Intensive
Care Unit (NICU) and
well visits for children
younger than one year
•
Mileage
reimbursement is
available for
transportation to
provider visits
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Health Plan Comparison
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Transportation
•
Mileage
reimbursement is
available for one-way
trips that are less than
30 miles from the
member’s house;
longer trips require
prior authorization
from the plan
•
Up to five round trip
or 10 one-way for food
resource
transportation (food
bank, food pantry and
grocery store for curb
side pick-up)
•
Additional
transportation may be
available for members
enrolled in Buckeye
case management
programs
•
Trips to Housing
Authority and job
interviews – up to two
round trips each per
year
•
Bus passes are
available for
appointments
(quantity limits
defined by county
specific rules)
•
Bus passes may be
available to get to
appointments and
•
Lyft may be available
when another type of
ride is not an option
•
Unlimited rides for
hospital discharge,
wheelchair van,
parents to visit their
child in the Neonatal
Intensive Care Unit
(NICU), chronic
conditions, and more
•
Trips for sick visits
available same day
•
Mileage
reimbursement and
public transportation
options
o
Parents to visit their
child in the
Neonatal
Intensive Care Unit
(NICU), residential,
or behavioral health
facility
•
Easy ride scheduling
and trip tracking with
the transportation
app
•
Unlimited trips
allowed for dialysis,
radiation treatment,
chemotherapy, and
transportation from
hospital to home.
(These trips do not
count toward the
annual trip maximum)
•
Transportation for
food resources – to a
food bank, food
pantry and grocery
store for curb side
pick-up (this counts
toward the trip
maximum of 15 round
trip or 30 one-way
trips)
•
Additional trips
allowed for critical
care trip types
including dialysis,
chemo/radiation,
wound care,
pregnancy, substance
abuse. (This does not
count toward the trip
maximum of 15 round
trips or 30 one-way)
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Transportation
•
Lyft is available when
another
transportation
provider is unable to
fulfil a transportation
request
•
All trips/benefits
above are for 30 miles
or less one-way; any
trips greater require
prior authorization
from Buckeye
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Value-added services
These services are provided in addition to the other health and wellness services described on page three.
Health and wellness programs
•
Access to a housing
coordinator to identify
local resources for
safe and stable
housing
•
Food as medicine
• For members with
diabetes – two
meal per day for
12 weeks; must
enroll in
nutritional
counselling (once
per year max)
• For pregnant
members – two
meals a day for
up to 14 days;
may include up to
four family
members; must
have
documented food
insecurity; may
be used up to
two times in a 12-
month period
•
Housing and
Employment
Navigator
to help with your
needs
•
Up to $100 towards
childcare for eligible
members who enroll
in
an employment
support program
•
Post discharge meals:
home-delivered,
medically tailored
meals to eligible
members
•
Eligible members will
be able to receive a
no-cost laptop to help
with employment and
educational pursuits
•
Anthem will provide
up to 24 hours of
virtual tutoring
services in all subjects
including language
arts, math, science,
social services, and
foreign languages
•
Smoking Cessation
program
•
For members 13 to 18
years - this is Quitting
Vaping Cessation
program
•
10 healthy, home-
delivered meals
following acute
inpatient hospital or
nursing facility stay
for eligible members
with a chronic
condition
•
Education supports:
o
GED Testing
o
SAT and ACT prep
support
o
College Application
Reimbursement (up
to $100 for
members who do
not quality for
application fee
waivers)
•
Buckeye Works -
employment support
to connect members
with employment
opportunities and
career paths
•
For members 14 years
and older - receive
help through
CareSource Life
Services®. A certified
life coach can provide
support with:
o
Finding full-time
employment
opportunities, job
application
assistance,
interview
preparation
coaching, and post-
employment
supports
(JobConnect™)
o
Food assistance
o
Transportation
assistance (including
pre- and post-
employment
supports)
o
Housing resources
and support
o
Education and
training, and
budgeting assistance
•
For members 18
years and older - up
to $500 toward
housing related
expenses such as
utility bills, eviction
diversion, trailer
park/lot rent, or
moving expenses via
a licensed moving
company
•
For members 14
years and older up to
$50 per quarter (up
to four times a year)
reimbursement for
childcare expenses
for caretakers who
are seeking
employment
•
Housing navigator to
support members in
unstable housing,
identification of
housing options, and
assistance with
housing applications
•
Molina Help Finder
program to help find
services close to
members including
food assistance and
more
•
Access to up to 56
home-delivered,
nutritionally tailored
meals over four
weeks when
members transition
between settings or
experience a
significant change in
condition
•
Up to six months of
Weight Watchers®
Online at no cost
•
Housing Navigator to
provide support by
assessing the
housing needs and
preferences of
members with
unstable housing,
identifying qualifying
housing options, and
assisting with the
housing application
process
•
For pregnant
members - meals
delivered post
discharge from
hospital for up to 14
days
•
Findhelp program to
help you find services
that are close to you.
Find food assistance,
help paying bills, and
other resources
•
Diabetes self-
management
education
•
Dr. Chat – Connect to
a doctor via a mobile
app
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Health and wellness programs
o
For members post-
discharge – one
meal per day up to
14 days with
documented food
insecurity
•
For members 18 to 64
years - WW®* (Weight
Watchers)
membership at no cost
for six months
•
Coaching and
vouchers to take a
high school
equivalency exam at
no cost
•
Up to $75 per child for
school uniforms
•
Access to a virtual
physical health
appointment with
access to a provider in
15 minutes in most
cases
•
Rapid Response
Outreach Team to
help members get
needed supplies,
community supports
schedule
appointments, and
more
•
Cover the cost of
employment
certifications for
eligible members who
are interested in
obtaining them
•
Eligible members will
receive access to
Substance Use
Disorder Recovery
Support Program, a
mobile platform that
provides daily
motivations, check-
ins,
peer support,
counselor messaging,
care plan reminders,
goals, journals, high-
risk location alerts,
and
content to support
ongoing recovery
•
Eligible members will
receive access to
Emotional Well-being
Resources, a web and
mobile online
community designed
to help members cope
with emotional health
issues such
depression,
anxiety, stress,
insomnia, and
managing drugs or
alcohol
•
Buckeye Healthy
Homes - for eligible
families with Buckeye
Children with chronic
asthma to receive
home materials and
supplies to improve
air quality and reduce
asthma triggers (up to
maximum annual plan
funding level)
•
Buckeye Front Steps –
food insecurity home
delivered meals
program and post
discharge meals
•
Buckeye Mobile
Market and Clinic –
Mobile market and
clinic to bring fresh
fruits, vegetables, and
health care services
directly to local
communities (up to
maximum annual plan
funding level)
•
Buckeye Community
Connect to find
financial assistance,
food pantries, medical
care, and more
o
Resources to
support goals are
available on case-by-
case basis
•
Up to $500 per family
for social
determinants
of health related, non-
covered services
related to
transportation,
accessibility
equipment,
medications, housing,
utility, employment,
and food access, based
on individual
circumstances.
•
WW (formerly Weight
Watchers) - up to 12
weeks of digital WW
free for members with
a diagnosis of high
blood pressure,
diabetes, or obesity
(body mass index > 30)
•
Kids wellness
programs
that focus on
childhood obesity
•
Healthy Body Healthy
Me™ Program for
adult
obesity
•
14 refrigerated
home-delivered
meals following
discharge from an
inpatient or
residential facility
(Limited to four
discharges per year)
•
For members 16
years and older – GED
test preparation
assistance
•
For members 12
years and older – a
Weight Management
program and a
Tobacco Cessation
program
•
For members 18
years and older - one
employment physical
exam per year
•
Access to the
HumanaBeginnings
TM
program that advises
expectant mothers
on how to best care
for themselves during
pregnancy as well as
provides support and
guidance from
experienced
maternity-registered
nurses
•
Molina Kids’ Corner
to get children
excited about fitness
and healthy habits
and get them
involved in their own
healthcare
•
Mpowered by You
tools to keep you on
track
•
Molina Member
Works job coaching
and support program
•
Diabetes support
though no-cost
glucometers,
delivered to your
door
•
Access to Psych Hub,
which is a library of
mental health
educational videos,
and screening
assessment tools
•
Molina keeps seniors
connected during
social distancing via
Supporting Social
Connection Program
•
Diabetes education
classes to help build
healthy habits
•
Live and Work Well
member resource for
well-being. Tool for
behavioral health,
Employee Assistance
Program, work-life, or
wellness benefits
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Health and wellness programs
to
•
Health education
materials and
interactive tools
•
Peer-to-peer services
to educate members
on effective
preventative care and
health system
navigation while
providing the
motivation and
support to act on
knowledge
•
Ohio Council for
Home Care and
Hospices’ Home
Health Aid Training
Programing. This
training will be at no
cost to the individual
and completion of the
training meets CMS
and PASSPORT
requirements for
Home Health aid
training and
education
•
Tobacco cessation
services, including
tobacco and vaping
counselling and FDA-
approved medications
•
Eligible members will
receive $100 to
purchase over the
counter products
online or in-store
•
Access to 24/7 virtual
•
physical and
behavioral health
care services
provided by board-
certified
practitioners,
psychiatrists, or
therapists, Caregiver
assistance, including
counseling and
caregiving support
services; up to three
sessions annually
•
Legal and financial
consultation,
including 30 minutes
and 25% discount for
retainers and access
to do-it-yourself
document
preparation
•
Amazon Prime for
three months at no
cost, to get everyday
items and health
essentials delivered
free to your door
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Value-added services
These services are provided in addition to the other incentives to strengthen health and well-being described on page three.
Incentives to strengthen health and well-being
•
CARE Card - Earn
rewards on a
reloadable gift card by
doing things that help
you stay healthy
including:
o
$20 reward for
completing each
well child visit
newborn to 15
months
o
$30 reward per
calendar year for
completing well
child visit 16 to 30
months
o
$30 reward per
calendar year for
completing well
child visit three to
11 years
o
$50 reward per
calendar year for
completing well
child visit 12 to 21
years
•
The Anthem Healthy
Rewards member
incentive program -
provides up to $245 in
screenings:
o
$20 reward for
annual health risk
screening
o
$10 reward for
annual diabetic
exam
o
$10 reward for
diabetic retinal
exam
o
$10 reward for
diabetic A1c
screening
o
$10 reward per
quarter for diabetic
medication
management and
adherence
o
$10 reward for
diabetic members
on approved
medication
o
$10 reward per six
months for asthma
management exam
o
$10 reward for child
lead screening
•
My Health Pays
Program - earn
rewards by completing
the following healthy
activities:
o
For members one
to 11 years - $75
reward for an
annual well care
visit
o
For members 12
years and older -
$50 reward for an
annual well care
visit
o
$100 reward for
annual
comprehensive
diabetes care -
must
complete all the
following once in
the calendar year:
HbA1c test, kidney
screening and
retinopathy
screening (dilated
eye exam)
•
For members
newborn17 years old
receive rewards in
CareSource MyKids
Incentives:
o
For 18 months to 17
years - $20 reward
for routine dental
exam ($10 reward
per exam)
o
For 18 to 30 months
-
$30 reward for well
child visit
o
For three to 17 years
-
$50 reward for well
child visit
o
For four to six years
-
$20 reward for
well
child vaccines
(Tdap,
IPV, MMR, and
Varicella -given as a
series)
o
For 11 to 17 years -
$15 reward for well
child vaccination
(Tdap)
o
For 11 to 14 years -
$30 reward for well
child vaccination
(HPV two shot
series)
vaccination
•
$25 reward for
chlamydia screening
•
For female members
40 years and older -
$50 reward for breast
cancer screening
•
For female members
21 years and older -
$50 reward for
cervical cancer
screening
•
For members 45
years and older - $25
reward for colorectal
cancer screening
•
For members five
years and older - $25
reward for COVID-19
vaccination
•
$25 reward for
downloading
Humana’s mobile
Go365 application
and completing the
registration
•
$50 gift card for
members who
successfully complete
their GED or high
school equivalency
test, plus job
coaching
•
Up to $100 in
rewards per year for
attending Molina’s
Member Advisory
Council Meetings
•
Members newborn to
15 months receive up
to $100 reward for
well-child visits
•
Members three to 17
years receive $10
reward for completing
one well-care visit each
year
•
Members 18 to 21
years receive $20
reward for
completing one well-
care visit each year
•
Healthy First Steps
Rewards for going to
prenatal, postpartum,
and well childcare
visits; receive $20 gift
card for signing up and
earn up to eight
rewards
•
Discount and rewards
on health and wellness
items and receive
monetary incentives
for completing health
and wellness activities
or membership events
including:
o
$50 reward for
breast cancer
screenings
o
$50 reward for
cervical cancer
screenings
o
$25 reward
comprehensive
diabetes care - eye
exam
o
$25 reward
comprehensive
diabetes care -
blood sugar control
(A1c test)
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
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Incentives to strengthen health and well-being
o
For female
members 21 to 64
years - $50 reward
for completing a
cervical cancer
screening
o
$25 reward for
each Member
and Family
Advisory
meeting
attended
o
$50 reward for
each Quality
Advisory
Board Meeting
attended
o
$20 reward for
breast cancer
screening
o
$20 reward for
cervical cancer
screening
o
$10 reward for
chlamydia screening
o
$10 reward for
childhood and
adolescent wellness
visit
o
$20 reward for
smoking cessation
initiation and $20
reward for
completion
o
$25 reward for
annual dental visit
o
$20 reward for
seven-day follow-up
after behavioral
health discharge
o
$10 reward for
metabolic testing
for members using
antipsychotic
medication
o
For members six
months and older -
$25 reward for
getting an annual
flu vaccine
o
For female
members 50 to 74
years - $75 reward
for an annual breast
cancer screening
o
For female
members 21 to 64
years - $75 reward
for an annual
cervical cancer
screening
o
For members
newborn to two
years - $25 reward
for child
immunizations
o
For members
newborn to two
years - $25 reward
for lead screening
o
For 9 to 17 years -
$30 for well child
vaccination (HPV
three shot series)
o
For 11 to 17 years -
$10 reward for well
child vaccines
(meningococcal)
o
For 18 months to 17
years - $25 reward
for yearly flu shot
o
For 18 months to 17
years - $10 reward
for ADHD follow-up
visits within 30 days
of initial prescription
(only if diagnosis is
applicable)
o
For 18 months to 17
years - $20 reward
for ADHD follow-up
visits within 10
months (ADHD
diagnosis required)
o
For 18 to 72 months
- $10 for lead
screening
o
MyHealth Rewards for
adults:
o
$50 reward for yearly
physical exam
o
For members 20 and
older - $10 reward
for cholesterol exam
o
$25 reward for follow
up after high
intensity care
for substance
use disorder
o
$25 reward for
follow up after
hospitalization for
mental illness
o
For members nine
to 13 years – Up to
$50 reward for HPV
vaccine
o
For members 19
years and older -
$10 reward for
watching the level
of care video
o
For all pregnant
members - $25
reward for
notification of
pregnancy
o
$25 reward for
Health Risk
Assessment
o
For members 21
years & older: $25
reward for diabetic
retinal eye exam
and $25 reward for
diabetes (HbA1c)
screening
o
Female members
ages 50-74 receive
$50 reward for
completing a
breast cancer
screening
o
Female members
ages 21-64 receive
a $50 reward
completing a
cervical cancer
screening
o
Members ages 18-64
who complete a
follow up visit 7
calendar days of
discharge after
hospitalization for
mental health
treatment receive a
$20 reward.
o
Members 18 years
and older who were
treated with an
antidepressant
medication and
remain on the
medication for 6
months receive a
$20 reward
o
$25 reward kidney
disease check
o
$25 reward
chlamydia screening
o
$50 reward child
immunization status
(had all required)
o
$50 reward
immunizations for
adolescents
o
$25 reward lead
screening for
children
o
$25 reward well
child visits
o
$25 reward Member
Advisory Council
meeting attendance
o
$280 reward
completion of
tobacco cessation
program
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 15
Last updated on June 10, 2024
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Incentives to strengthen health and well-being
o
$50 reward for new
members who
complete their
health risk
assessment within
90 days of
enrollment
o
For members 22
years and older -
$40 reward per
calendar year for
completing annual
well visit
o
Buckeye Fan Club –
box fans for eligible
members with
respiratory
conditions such as
Chronic obstructive
pulmonary disease
(COPD),
emphysema,
asthma, and/or
chronic heart
failure
to improve
respiratory status
especially during
the summer
months
o
$75 reward for
diabetes screening
bundle (HbA1c,
retinal screening,
micro albumin)
o
$40 reward for
routine dental exam
($20 reward per
exam)
o
$20 reward for
routine eye exam
o
$25 reward for
yearly flu shot
o
$10 reward for Tdap
vaccine
o
For females 5 years
and older - $20
reward for bone
density screening
o
For females 18 to 24
years - $25 reward
for chlamydia
screening
o
For 18 to 26 years -
$30 reward for HPV
vaccines (three shot
series)
o
For females 21 to 64
years - $40 reward
for pap smear
o
For females 40 to 74
years - $25 reward
for mammogram
kidney screening
o
$25 reward for
wellness visit
•
For members 12
years and older:
o
$25 reward for
enrollment in
tobacco cessation
program
o
$25 reward for
completion of
tobacco cessation
program
o
$10 reward for
enrollment in
weight
management
program
o
$20 reward for
completion of
weight
management
program
•
For members up to
15 months old – up
to $90 reward for
well child visits
•
For members 16 to
30 months – up to
$30 reward for well
child visits
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 16
Last updated on June 10, 2024
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Incentives to strengthen health and well-being
•
For members 45 to 64
- colorectal screen
options:
o
$100 reward
colonoscopy (once
every 10 years)
o
$75 reward flexible
sigmoidoscopy
(once
every five years)
o
$75 reward
computed
tomography (CT)
colonography (once
every five years)
o
$50 reward fecal
immunochemical
test (FIT) test (DNA
test once every
three years)
o
$25 reward fecal
occult blood test
(yearly)
years and older – up
to $50 reward for
well child visits
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 17
Last updated on June 10, 2024
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Value-added services
These services are provided in addition to the other prenatal and postpartum health incentives described on page three
Prenatal and postpartum health incentives
•
Members get access
to the pregnancy care
program Bright Start®
to help schedule
appointments,
connect to community
resources, and
additional programs
•
$50 per visit for
completing a
postpartum
appointment within
seven to 84 days of
delivery
•
$25 for each
completed prenatal
visit (up to seven
visits)
•
Keys to Your Care® -
an interactive
maternity texting
program that provides
prenatal education,
coaching, and
reminders for
appointments
•
Electric breast pump
per pregnancy
•
Up to $220 for
prenatal, postpartum,
and well child visits:
o
$10 for prenatal
visits
o
$10 for ongoing
prenatal care (per
visit up to four)
o
$10 for
postpartum visit
incentive
o
$20 for bonus new
mom reward (if
mom completes
first prenatal visit,
ongoing prenatal
visits, and the
postpartum visit
they earn an extra
$20)
o
$10 for well-baby/
well child incentive
(per visit, up to
eight)
•
Healthy Baby Program:
o
$75 for completing
a Notification of
Pregnancy form
within the first
trimester or $25 for
completing a
Notification of
Pregnancy form
within the second
trimester
o
$100 for
completing
six infant well care
visits by 15 months
old
o
$75 for postpartum
visits between
seven to 84 days
after delivery
o
Up to $50
($25/visit) for
completing two
infant well care
visits by 30 months
(ages 16 to 30
months)
•
Two meals per day up
to 14 days with
documented food
insecurity to support
postpartum nutrition
•
For members age up
to 18 months old -
$415 for Babies First®
rewards:
o
$75 for first prenatal
visit
o
$50 for fifth and
twelfth prenatal
visits
o
$60 for postpartum
visits completed
between seven to 84
days after delivery
o
For members
newborn to 17
months - Up to $130
for seven well-baby
visits
o
For members 12 to
17 months old - Up
to $50 for lead
screening
•
Members participating
in the
HumanaBeginnings
TM
program may receive
one convertible car
seat or portable crib
per pregnancy, per
child
•
Up to $105 in rewards
per pregnancy for
pregnant members
who complete
prenatal visits ($15
per visit for seven
visits)
•
$50 in rewards for
postpartum members
who complete one
postpartum visit seven
to 84 days after
delivery per
pregnancy
•
For members who
are pregnant – up to
$250 in gift cards for
timely prenatal,
postpartum, and
well child visits
o
$50 for going to
your first prenatal
visit in your first
trimester
o
$100 for going to
your postpartum
visit seven to 84
days after your
baby is born.
o
$100 in gift cards
for completing all
six well child visits
before the baby
turns 15 months
old
•
Wellhop for mom and
baby to connect with
a community of moms
•
Healthy First Steps to
get extra support and
rewards to keep you
and your baby healthy
•
$20 gift card for
postpartum and well
child visits
•
Text4Baby to get
helpful tips and links
to free health and
wellness items for you
and your baby
•
$50 gift card for
prenatal visits
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 18
Last updated on June 10, 2024
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Prenatal and postpartum health incentives
•
Portable crib and safe
sleep education
through Cribs for Kids
•
Bright Start®
Beginnings Bundle to
provide essential
items for a new baby,
including items to
support a safe sleep
environment and
postpartum support.
•
Up to $750 towards
housing-related
expenses in
emergency situations
for pregnant members
o
$20 for bonus well
child rewards (if
child completes all
eight well child
visits between
birth to 30 months
and needed
immunizations by
age two, they earn
an extra $20)
•
Up to two baby
essential items from
customized catalogue
for eligible members
•
Prenatal, postpartum,
and well-baby
education for all
pregnant members
•
Up to $75 worth of
free diapers shipped
to their home
•
Up to $30 of baby
food for eligible
members
•
Community Baby
Showers offered in
each region, providing
diaper bags and other
grand prize donations
along with education
and support
•
Assistance for new
or expectant
mothers to get a
breast pump
•
Immediate access to
24/7 infant feeding
assistance, 24/7
nurse advice, and
healthy tips with
Pacify appText4Baby
to get helpful tips
and links to free
health and wellness
items for you and
your baby
•
Community baby
showers in each
region, providing
new parents kits and
raffles for baby care
essentials
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 19
Last updated on June 10, 2024
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Value-added services
These services are provided in addition to the other application or online services described on page three
Application or online services
•
Member portal and
mobile apps to help
monitor members’
health including care
and medicines
•
Mobile gaming
application to
support health
education and link
to member benefits
•
Member portal and
mobile apps to help
monitor your health
including care and
medicines
•
CHESS Health -
implement the
eRecovery, eTherapy,
and eIntervention
solutions to support
the treatment and
recovery of Ohio
Medicaid members
with or at-risk of
developing substance
use disorder
•
Community Resource
Tool to assist in
finding referrals to
community services
and programs
•
Sydney - member
portal and app that
provides access to ID
card, reminders,
rewards, and more
•
Member portal and
mobile apps to help
monitor your health
including care and
medicines
•
Secure Member Portal
to access copies of
member ID card and
check rewards
•
Wellframe Care App -
Members in Care
Management
•
Find A Provider (online
search tool)
•
myStrength –
confidential online
cognitive behavioral
therapy program.
•
On-demand crisis
texting support
through Crisis Text
Line, a national
organization providing
professional and
confidential, 24/7
texting support to
members in crisis
•
Member portal and
mobile apps to help
monitor your health
including care and
medicines
•
CareSource Mobile
App to view your
digital member ID
card, access your
account, find a
doctor, and more
•
MyHealth Online Tool
•
MyStrength
sm
Online
Mental Health
•
Text4Baby
•
MyResources tool
that helps you find
free or low-cost
programs and
support
for food, shelter,
school, work, and
more
•
My CareSource®
member portal
account to choose
your primary care
provider, request a
new member ID card,
and more
•
CareSource’s Amazon
Alexa Skill
•
Member portal and
mobile apps to help
monitor your health
including care and
medicines
•
Go365 for Humana
Healthy Horizons
rewards program
•
For pregnant
members and
members with a child
up to one year -
unlimited access to a
smartphone
application that
provides 24/7 on-
demand assistance
•
WellSky for accessing
networks for social
service and
community-based
organizations,
including access to
food, jobs, housing,
and childcare
•
Member portal and
mobile apps to help
manage your health
including care and
medicines
•
Housing &
Community
Assistance Through
Molina Help Finder to
gain access to
services and supports
near you
•
Molina Mobile App -
access your ID card,
online risk
assessments, health
reminders, health
records, mobile chat,
and more
•
Text4Baby to get
helpful tips and links
to free health and
wellness items for
you and your baby
•
Dental mobile app for
oral health tips and
finding dental
providers
•
Transportation Trip
Management mobile
app
•
Member portal and
mobile apps to help
monitor your health
including care and
medicines
•
Text4Baby
UnitedHealthcare® app
- download the
UnitedHealthcare app
for free on the App
Store® and Google Play
•
Dr. Chat mobile app -
connect to a doctor
wherever you are
•
Live and Work Well -
find articles, self-care
tools, caring providers,
and other mental
health and substance
use disorder resources
•
OnMyWay - provides
members with a
resource to help make
the move to
independent living
•
Findhelp – social
services search engine
that helps you find
referrals to programs
and services
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 20
Last updated on June 10, 2024
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Application or online services
•
Krames Health Library-
members receive free
access to our
comprehensive online
Health Library
•
KidsHealth, web based
pediatric educational
content, including
health videos and
literature, related to
the development
from
before birth through
the teen years,
content available to
parents and children
•
24/7 infant feeding
assistance with Pacify
app
•
Myuhc.com/Communit
yPlan member portal
to
help monitor your
health including care
and medicines
•
UnitedHealthcare
mobile app to help
monitor your health,
including care and
medicines
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 21
Last updated on June 10, 2024
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Value-added services
These services are provided in addition to the other telehealth services described on page three
Telehealth
•
Access to a board-
certified medical
provider via
telemedicine platform
•
Telehealth services
available when
medically necessary
•
Telehealth services
available
•
Telehealth provides
24/7 non-emergency
healthcare advice
from
board certified
doctors
and behavioral health
therapists
•
Doctor on Demand
provides members
24/7 virtual care
services from board-
certified providers,
psychiatrists, or
therapists
•
24/7 virtual urgent
care and behavioral
health support
through Teledoc
•
Telehealth provider to
speak to a medical and
behavioral health
professional
Value-added services
24-hour medical advice line
•
1-833-625-6446
•
844-430-0341 (TTY
•
1-866-246-4358 (TTY:
•
1-866-206-0554 (TTY:
•
866-376-4827 (TTY:
•
888-275-8750
•
1-800-542-8630, TTY:
711)
711)
1-800-750-0750 or
711)
(English)
1-800-855-2880
711)
•
866-648-3537
(Spanish)
•
866-735-2929 (TTY)
Ohio Medicaid’s Managed Care Organizations
Health Plan Comparison
Page | 22
Last updated on June 10, 2024
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Appendix
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): EPSDT services, also known in Ohio as Healthchek, is a comprehensive benefit package for
individuals younger than age 21 who are covered by Ohio Medicaid, including those covered by Medicaid Managed Care Organizations. The purpose of EPSDT is
to discover and treat health problems early and provide further diagnoses and treatments if necessary to ensure younger individuals have the best health and
development possible. Under EPSDT, service limitations described in this document may be exceeded based on medical necessity with prior authorization.
Transportation Services: Transportation services are paid for by the of Ohio Medicaid’s Managed Care Organizations and County Department of Job and Family
Services Non-Emergency Transportation (NET).
Pharmacy Benefits: The Single Pharmacy Benefit Manager (SPBM) vendor, Gainwell Technologies, is responsible for all pharmacy services with the exception of
in-office physician administered drugs. The Managed Care Organizations are responsible for in-office physician administered drugs. To learn more information
about your pharmacy benefits, please visit https://spbm.medicaid.ohio.gov/
.
Behavioral Health Services: The OhioRISE program helps meet the needs of children and youth with complex behavioral health and multi-system needs. Learn
more at https://managedcare.medicaid.ohio.gov/managed-care/ohiorise.
Selection of your managed care organization does not affect your OhioRISE eligibility
or enrollment.
Ohio Medicaid’s Managed Care Organizations
• AmeriHealth Caritas Ohio, Inc.
• Anthem Blue Cross and Blue Shield
• Buckeye Community Health Plan
• CareSource Ohio, Inc.
• Humana Healthy Horizons in Ohio
• Molina Healthcare of Ohio, Inc.
• UnitedHealthcare Community Plan of Ohio, Inc.
This edition of the Health Plan Comparison reflects benefits provided by the managed care plans as of November 14, 2023. If you have any questions about the
benefits that are available from each plan, please reach out directly to the managed care plan you’re interested in.