Check Eligibility

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.

Quick Tips: Member Consent

• When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
• 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.
• The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf.
• Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization Formso that all providers involved in their care can effectively coordinate their care.