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UnitedHealthcare Connected® for MyCare Ohio
This plan is for adults who need extra support and care. You may qualify based on income and health needs. The plan offers members a customized care plan and a single point of contact for all Medicare and Medicaid services. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. You get many services to help with daily activities that other MyCare Ohio plans don’t offer. View the benefits below to see all that it offers.
More information on eligibility and enrollment can be found on www.ohiomh.com, or by calling the Medicaid Hotline at 1-800-324-8680, TTY 1-800-292-3572. The Hotline operates from 7 a.m. to 8 p.m.m local time, Monday through Friday and 8 a.m. to 5 p.m., local time, on Saturday.
Columbiana, Cuyahoga, Geauga, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, and Wayne.
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Benefits & Features
Adult Day Care
Companionship is important. Adult day care provides care and companionship for seniors who who qualify for extra help during the day.
Caregivers also benefit, knowing their loved one is well cared for and safe during the day.
If your need for long‑term care has been determined by Ohio Medicaid, Adult day care can provide:
- Social connections and friendship.
Asthma and COPD Care
Individual care to help control asthma and other lung diseases.
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 help you:
- Manage flare-ups.
- Reduce symptoms.
- Help you stay active.
Members get a 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.
Our plan includes visits for chiropractic care. Whether chiropractor services are your primary or alternative treatment method, you're covered.
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.
Regular exams help keep teeth and gums strong and healthy. Beginning April 30, 2015, oral exams are covered once per year for members over age 21.
Equipment and Supplies
Our plan covers some medical equipment ordered by a member's doctor or case manager. This can include supplies like:
- Hospital beds
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.
- Therapeutic shoes and inserts for members with diabetes.
Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect your hearing.
Our plan covers:
- Exams, therapy and tests.
- Hearing aids, batteries, and accessories.
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 may cover:
- An in-home medical visit.
- Medical equipment like hospital beds, walkers or wheelchairs.
- A home health aide, nursing services or a private nurse.
- Physical, occupational, and speech therapy.
- Help with personal care or housekeeping.
- Home infusion therapy.
This plan pays for most expenses related to a hospital stay, so you can rest and heal.
Our plan covers these services and more:
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Language and Interpretation
You and your doctor need to understand each other. We can explain information in English or in your primary language. If you are visually or hearing impaired, special help can be provided.
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 services may include:
- Needed equipment and supplies.
- Home support services.
- Health education and training.
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 Services Representative
Every member of the health plan gets a personal Members Services representative. This person can help you get the most of your benefits. They can:
- Welcome you to the plan and help you understand your benefits.
- Arrange for extra support services.
- Complete a health risk assessment.
- Help you access community services.
Mental Health and Substance Use Disorder Treatment 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:
Medical questions and situations come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.
Our nurses will:
- Listen to symptoms.
- Help with self-care.
- Advise you about getting care at a doctor visit or an urgent care center.
- Help you know when to go to the emergency room.
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.
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.
Therapy can help you recover from a serious injury or illness, or simply reach your full potential. Members receive needed:
- Occupational therapy.
- Physical therapy.
- Respiratory therapy.
- Speech therapy.
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.
Eye exams are covered once every two years.
Beginning April 30, 2015, eye exams are covered once every two years for members age 21-59. No extra allowance for contact lenses. Contact lenses are covered only if medically necessary.
UnitedHealthcare Connected® for MyCare Ohio
2022 Annual Notice of Changes
2022 Medicaid Handbooks
2022 Medicare/Medicaid Handbooks
2022 Provider/Pharmacy Directories
OH Northeast Cuyahoga County
OH East Central - Portage, Stark, Summit, and Wayne Counties
OH - Northeast-Central - Columbiana, Mahoning, and Trumbull Counties
OH Northeast - Geauga, Lake, Lorain, and Medina Counties
2022 Summary of Benefits
2022 Waiver Services Handbooks
Influenza is a serious illness that can be easily prevented by a simple shot.
- The best time to get a flu shot is before flu season starts. Talk to your doctor about what is right for you. You may want to write down when you get your shot, and plan to get it at the same time each year.
- When you get your flu shot, it is covered by the terms of your plan. For help scheduling an appointment, call the toll-free number on the back of your member ID card. Health coaches are available daily from 8 a.m. – 8 p.m. to help you.
Don't have time to see the doctor for a flu shot? View a list of locations where you can get a flu shot.
Member Advisory Council and Connected Advisors
UnitedHealthcare Care Managers for Member's Unique Needs
Every UnitedHealthcare MyCare Ohio member receives a personal representative. These Care Managers are licensed professionals providing education and coordination of UnitedHealthcare Connected® for MyCare Ohio (Medicare Medicaid Plan) benefits, tailored for each member's unique needs.
Click here to watch a video on how these Care Managers are helping current members.
UnitedHealthcare Member Advisory Council and "Connected Advisors"
UnitedHealthcare Member Advisory Council and "Connected Advisors" is an advisory council to ensure that UnitedHealthcare actively engages consumers, families, advocacy groups, and other key stakeholders as partners in the program design and delivery system.
Who is involved?
- Any members, or a member's representative, are eligible to participate.
- There are no term limits for participation.
- Representatives from member stakeholder or advocacy organizations.
- Representation reflects the diversity of the member population including: race, ethnicity, religion, sexual orientation, gender, disability (physical or mental), age, parental status, or genetic information.
They will advise and guide the UnitedHealthcare Community Plan of Ohio on:
- Clinical design and delivery
- Strategies to support members in the community
- Abuse and neglect initiatives
- Promote member-centric culture
- Provide input regarding research and best practices
How is it organized?
- One statewide council
- Three local groups of "Connected Advisors" with representation in the Northeast (Cuyahoga, Geauga, Lake, Lorain, and Medina counties); Northeast Central (Columbiana, Mahoning, and Trumbull counties); and East Central (Portage, Stark, Summit, and Wayne counties) MyCare Ohio regions.
What will they do?
- Participate in quarterly conference calls
- Receive electronic or printed newsletter(s).
- Attend three in-person, regional meetings held annually (UnitedHealthcare will provide a travel stipend at the request of a member. The amount of the stipend will follow the guidelines of the appropriate state governing rules and guidelines).
- There is no cost for participation.
- Decisions of the Member Council and Connected Advisors will be made by simple majority vote of members present.
- One member will be appointed/elected to participate in UnitedHealthcare's National Peer Ambassador program. The goal of a peer ambassador program is to elevate and empower members through meaningful dialogue, information exchange, and inclusion in the development of best practices, innovations, and delivery/design in promotion of a member-centered culture. The Community and National Peer Ambassadors connect virtually (via conference or web-based technology) to share experiences and insights regarding opportunities to better the quality of life and experience of the populations we serve. We leverage recommendations and insights shared by the Ambassadors to support improved outcomes and experiences in the promotion of a member-centered culture. The Ambassadors do not receive compensation for service in the ambassador role.
To learn more about UnitedHealthcare's Member Advisory Council and "Connected Advisors," or get involved, get information at www.myuhc.com/communityplan or call Member Services at 1-877-542-9236 (TTY 711).
Fraud, Waste and Abuse
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 (billing for more expensive services or procedures than were actually provided or performed)
- 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?
- Loaning or using another person's insurance card
- Forging or selling prescription drugs
- Providing false information when applying for program benefits
UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:
- Anonymous fraud, waste and abuse hotline: 1-877-766-3844
Clinical Health Guidelines
Clinical Care Guidelines
American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care
Preventive Services Guideline
Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)
Agency for Healthcare Research and Quality
For a description of the UnitedHealthcare practice guidelines, please write to:
UnitedHealthcare Community Plan Quality Improvement
5900 Parkwood Place
Dublin, OH 43016
Coronary Artery Disease
UnitedHealthcare Connected® for MyCare Ohio H2531-001-000
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