UnitedHealthcare Community Plan

Medicaid

Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. Members can choose a primary care doctor from our network. Plus get access to a 24/7 nurse advice hotline, health education materials and extras that other plans don't offer. View the benefits below to see all that it offers.

More information on eligibility and enrollment can be found on the Ohio Medicaid website, or by calling the Medicaid Hotline at 1-800-324-8680, TTY users should call Ohio Relay at 7-1-1.

 

This plan is available in all counties.

Benefits & Features

Well and Sick Care

Get the care you need to get better if you are injured or sick — or to reach your full potential. Benefits include:

  • NurseLineSM. Speak with a registered nurse 24/7.
  • No Copays. You pay nothing for your care or services.
  • Medicines. Fill your prescriptions, including over the counter drugs at local pharmacies.
  • Therapy Services. Physical or other therapy to recover and heal.
  • Chiropractor Services. We provide up to 15 chiropractic visit per year.
  • Well Visits. Annual checkups can help keep you healthy.
  • Urgent Care. Convenient care for a sudden illness or injury.

Nothing is more important than the health and well-being of a mother and her child. That's why our plan benefits include:

  • Choice of Doctors and Birthing Center. Find a doctor and hospital you trust in our network.
  • Prenatal Visits. Care for you before your baby is born.
  • Baby Blocks™ Earn rewards for keeping you and your baby healthy.
  • Text4baby. Get helpful tips and links to free health and wellness items for you and your baby.
  • Healthy First Steps®. Extra support to help you and your baby stay healthy.

If you have asthma, diabetes or another chronic condition, you can depend on us. Our plan makes sure you get the care, support and services you need. Benefits include:

  • Mental Health and Substance Abuse Services. With prior approval counseling and other treatments are covered.
  • Care Management. Personal support from an experienced professional.
  • Asthma Care. Exams, testing and supplies are covered for asthma and other lung diseases.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Obesity Care. We cover screenings and counseling for obesity.

We help members keep their vision, smile and hearing at their best. Benefits include:

  • Vision. Covers exams, glasses or $150 toward contact lenses.
  • Dental. We pay for cleanings, checkups and some dental work.
  • Hearing. Tests, checkups and with prior approval hearing aids are provided.

You get the medical care and equipment needed to live safely at home. Benefits include:

  • Equipment and Supplies. With prior approval, in-home medical and safety equipment are covered.
  • Nurse Visits. Medical care to help with a safe recovery at home.
  • Respite Care. In-home help to give caregivers taking care of children under age 21 a rest.
  • Care Coordinator. Someone to get you the services you need after surgery or illness.
  • Home Health Care. With prior approval, medical and personal care in your home, if needed.

Sometimes members need a little extra help using their health plan. For those times, they can rely on:

  • Transportation. We pay for up to 30 one way or 15 round trip rides to medical visits or the pharmacy.
  • Language Help. Connect to a translator through Member Services.
  • Members Matter. Someone to help you get the most from your plan.
  • Quitting Tobacco. Coaches and supplies to help quit using tobacco.
  • My Advocate. We help members connect to community services.
  • Healthy Rewards. Earn up to $100 in credits for completing healthy activities.

Asthma and COPD Care

Individual care to help control asthma or COPD symptoms.

Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:

  • Manage flare-ups.
  • Reduce symptoms.
  • Help you stay active.

Care Management

Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:

  • Work with you to develop a plan of care that meets your individual needs.
  • Coordinate with family members, caregivers and health care providers.
  • Help get additional services or support you may need.

Chiropractor Services

Our plan includes visits for chiropractic care.

  • Members of all ages can get up to 15 visits per year.
  • Members under 21 may get additional visits with prior authorization.

Choice of Doctor

From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.

You get a primary care physician (PCP), who is your main doctor. If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

Choice of Birth Center

Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds of hospitals across Ohio.

We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.

Dental Care

Checkups and cleanings are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.

Employment Physicals

Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.

Equipment and Supplies

The health and safety of our members at home are important.

Our plan covers medical equipment ordered by a member's doctor or care manager. This can include supplies like:

  • Hospital beds.
  • Oxygen tanks.
  • Wheelchairs or walkers.
For some of these services prior approval is required. Please check your member handbook for these details.

Foot Care

We provide the exams and treatments needed to help keep your feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

  • Routine foot exams.
  • Tips about foot care and choosing the right shoes.
  • Information about nerve damage warning signs.

Hearing Care

Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect your hearing.

We cover:

  • Exams, therapy and tests.
  • With prior approval, hearing aids and batteries.

Healthify

Sometimes a person's health and safety needs require the assistance from community support programs.

Here's where UnitedHealthcare's Healthify program can easily help. By calling 1-800-895-2017 our members can learn about and sign up for money-saving programs like: food, legal assistance, housing, utility discounts, free cell phone service; adult and child day care; and other social service programs.

Healthy First Steps®

You may receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy.

We can help:

  • Find a doctor for both mother and baby.
  • Learn resources for nutrition, fitness and safety.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

Earn great gifts for you or your child by doing things like:

  • Completing well-child exams.
  • Getting lab tests.
  • Recording the family's health activities.

Home Health Care

If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing.

With approval, our plan covers:

  • An in-home medical visit.
  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.
  • Help with personal care or housekeeping.

Hospitalization

This plan pays for all medically necessary expenses related to a hospital stay. This way you can rest and heal.

Our plan covers:

  • Nursing care.
  • Room and board.
  • Supplies and equipment.
  • Treatment and therapies.
  • Diagnostic tests and exams.

And after leaving the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.

Our plan includes:

  • Dialysis.
  • Medications.
  • Health education and support.
  • Organ transplant if needed.

Lab and X-rays

Knowing what's wrong and finding it early can make all the difference. With prior approval, our plan covers:

  • Labs and testing.
  • X-rays, scans and other imaging.

We'll help you get the information needed to improve your health or be at your best.

Language Help

You can receive information in your preferred language. Just ask. We also have people at our service centers who speak more than one language. Chances are, we have someone who speaks your language.

Medicines

Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.

Member Matters Representative

Meet your personal health plan assistant. Our job is to help you get the most of your benefits. We can help you:

  • Schedule doctor, dental and vision appointments.
  • Arrange for extra support services.
  • Complete a health risk assessment.
  • Stay in touch with you.

Mental Health and Substance Abuse Services

Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:

  • Therapy
  • Counseling
  • Medications
For some of these services prior approval is required. Please contact Member Services to learn more.

No Copays

With our plan there are no copayments for covered services.

Members get:

  • Care from highly skilled and compassionate doctors.
  • Treatments at respected hospitals and clinics.
  • Home medical equipment and supplies to help them be their best.

NurseLine℠

Medical questions and situations come at inconvenient times. For questions about health, call a nurse 24/7.

Our NurseLine nurses will:

  • Listen to the symptoms.
  • Provide guidance on self-care.
  • Advise the member about getting care at a doctor visit or an urgent care center.
  • Help know when to go to the emergency room.

Obesity Care

Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan includes:

  • Screening for obesity.
  • Counseling for obesity.

Prenatal Visits

A pregnancy is an incredible journey. It's a journey the new mother wants to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

  • Make sure both mother and baby are healthy.
  • Explain what to expect at each stage of the pregnancy.
  • Answer any questions.

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

With prior approval, our plan covers short stays in a rehabilitation center where you can heal. Included are:

  • Nursing home services.
  • 24-hour nursing care.
  • Help with activities of daily living.
  • Physical, occupational and speech therapy.
Call Member Services for information on available providers.

Respite Care

Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members with coaching while they quit. We support our members while they quit, with coaches and supplies. The only thing they won't get from us is a lecture.

Therapy Services

Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.

With prior approvals, our plan covers visits for:

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.
  • In-home therapy.

Transportation

Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Rides are available to:

That includes trips to:

  • Dental and vision appointments.
  • Pharmacies.
  • Women, infants and children (WIC) visits.
  • Job and Family Services offices for benefits redetermination.

UnitedHealthcare OMW™

UnitedHealthcare On My WayTM is an engaging, interactive program that informs Ohio youth and helps prepare them for many real-world situations that lie ahead. UnitedHealthcare OMW™ teaches the practical skills of managing bank accounts, securing housing, creating a resume, finding job training and applying for college. It is a reliable, go-to resource they can use throughout their journey toward independent living.

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

  • Urgent care centers.
  • Federally qualified health centers.
  • Other walk-in clinics.

Vision Care

You'll get the care, eyeglasses and treatment that let you see life more clearly.

Benefits include:

  • Annual eye exams.
  • Glasses and $150 toward contact lenses.

You also can chose from an expanded selection of frames.

This benefit is offered by Block Vision.

Well Visits

Well visits with your doctor can help keep you and your family healthy. These visits can catch health problems early, so they can be treated.

Preventive services include:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mammograms.

There are no copayments for preventive care.

Member Resources

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UnitedHealthcare Community Plan