Next Generation My Care: It’s here…now what? 

By Jamie Herrmann
Executive Director 
AAA7

As of Aug. 1, Next Generation MyCare is now statewide and impacts all Ohioans who are dually eligible, meaning they have both Medicare and Medicaid coverage.

The new structure allows for health insurance claims to be processed for both Medicare and Medicaid lines of business by one plan for more efficient claims processing and eliminates the confusion of which plan pays first in a dual coverage situation. 

By pairing a Medicare Advantage plan with a Medicaid Managed Care plan, the individual benefits from a more efficient process and coordination of benefits.

For Medicaid, the State of Ohio has awarded contracts for Next Generation MyCare to four Managed Care Plans including: Anthem, Buckeye, CareSource, and Molina. Dually eligible individuals can select one of the plans for their Medicaid coverage. Since Medicaid is issued at the State level, Ohio used its data to assign individuals to a Medicaid plan based on which one had the most contracts with medical providers that the individual currently uses. When the auto assignment occurs, individuals receive a letter in the mail from the Ohio Department of Medicaid letting them know what plan has been selected. 

Individuals have 60 days to change that selection if they prefer a different plan. 

The first round of these Medicaid auto assignment letters has gone out from the State. Individuals who have received them can make a change at any time over the next 60 days. If no action is taken, they will transition on Sept. 1. A second round of auto assignment letters are expected for our area in August with a start date of Oct. 1.  

As a reminder, no one can be auto enrolled for Medicare plans. That is still an action that requires the individual to select. This includes choosing a MyCare Medicare plan associated with their MyCare Medicaid plan, another Medicare Advantage plan available in their area, or Traditional Medicare. Individuals will not be auto assigned into a Medicare plan. Individuals may choose to enroll into a MyCare Medicare plan at any time. 

Changes to other (non-MyCare) Medicare Advantage Plans or Traditional Medicare is an option during the Annual Medicare Open Enrollment Period each year (October 15th – December 7th) or during Medicare Advantage Plan Open Enrollment (January 1st to March 31st). If the person chooses to enroll in an Anthem, Buckeye, CareSource, or Molina MyCare Medicare plan, they will automatically be enrolled in the coordinating MyCare Medicaid Managed Care plan.   

As we work our way through this transition, it is important to remember the system is new to all of us: individual consumers, providers, hospitals, and Area Agencies on Aging (AAA) alike. In addition to the Area Agency on Aging District 7 (AAA7), there are many resources available to help you navigate these changes. AAA7 continues to be a trusted partner in the region, and we are here to help you every step of the way. For more information, you can contact the Ohio Medicaid Consumer Hotline at 800-324-8680 or visit www.ohiomh.com. 

Representatives are available Monday through Friday from 7:00 am – 8:00 pm and Saturdays from 8:00 am – 5:00 pm.