MyCare Ohio allows individuals to opt-out of Medicare coverage from the plan managing their MyCare Ohio benefits. Individuals may choose to have CareSource MyCare Ohio either:
- Provide their Medicare benefits, or
- Opt out of the Medicare portion of the program and stay with their current Medicare Advantage plan or traditional Medicare
Providers need to confirm the MyCare Ohio member’s option for Medicare coverage.
If a member chooses a different plan for their Medicare benefits, CareSource will only manage Medicaid benefits and will only reimburse claims for Medicaid services. Claims for Medicare must be submitted to the plan managing the member’s Medicare benefits.
Therefore, we recommend that you check member eligibility each and every time a member presents for services, as member eligibility can fluctuate. Changes in health status such as certain medical conditions may also cause changes in plan eligibility and coverage status.
Providers may use our secure Provider Portal to check member eligibility. Click “Member Eligibility” on the left, which is the first tab. Or, call our Provider Services department at 1-800-488-0134.
Member ID Card
When members select CareSource MyCare Ohio to provide both their Medicare and Medicaid benefits, they will have a single ID card replacing both their state Medicaid and their Medicare card. These members will require only one card for both plans.
However, when members do not select CareSource to provide Medicare benefits, they will continue to use the card for their selected Medicare plan.
Members are asked to present an ID card each time services are accessed. If you are not familiar with the person seeking care and cannot verify the person as a member of our health plan, please ask to see photo identification.
A detailed view and explanation of the member ID card is available in the Member ID Card Flier.
When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI). SHI is a subset of protected health information (PHI) which may require consent from the individual in order to be shared with others.
When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, mental health or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.
Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization Form so that all providers involved in their care can effectively coordinate their care. This form is located on the member Forms page.
The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. This designated representative can be a relative, a friend, a physician, an attorney or some other person that the member specifies.