Medicaid member materials and benefits
Coverage from head to toe
Your Medicaid plan gives you access to services like adult day health care, durable medical equipment, home care and occupational therapy. There are special benefits and programs designed to help you live a healthier, more independent life. This coverage includes preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for added help.
You need to review the information in this section closely. It helps you understand what’s covered by your plan, what’s not and how you can find the right care when you need it.
Stay in-network and save
You must receive services covered by the health plan, from facilities and/or providers in the Aetna Better Health of Ohio network. The only time you can use providers that are not in the Aetna Better Health of Ohio provider network is for:
• emergency services
• federally qualified health centers/rural health clinics
• an out-of-panel provider that Aetna Better Health of Ohio has approved you to see during or after your transition of care time period.
We provide services in only certain counties in Ohio. When you are out of our service area, you are only covered for emergency services. If you are out of the service area and need non-emergency services, call your PCP or Member Services.
Out-of-network and emergency care
Except in certain cases, like emergencies, you cannot visit a care provider outside of our network. “In network” providers are listed in our directory. These care providers have agreed to charge less for many services. If you do not use in-network providers, you may be responsible for these charges.
If you have questions about this, call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, 7 days a week. The call is free. You also can use the Find a Provider tool.
How do I know if it’s an emergency?
For more information about emergency care, please review your Member Handbook. You can also call your PCP or our 24/7 Nurse Advice Line at 1-855-364-0974 (TTY: 711).
Your benefit summary will help you understand how your health plan works. It provides details about the kind of care you can get, what services are covered, and much more.
Your mental health is important
Behavioral health benefits cover services to help you improve your mental health. For example, if you suffer from mental illness, alcohol or drug addiction, you may need therapy or medicine. Your Aetna Better Health of Ohio covers many kinds of services for mental health.
As a member of Aetna Better Health of Ohio, you will have your own care manager as part of our care management program. Your care manager can help you find the right care and services. Your care manager will contact you soon after you are enrolled with Aetna Better Health of Ohio.
A care manager will work with you, your doctors and other providers to make sure you receive the right care and services, with your needs in mind. The goal is to build a treatment plan just for you to help you live a healthier life. Your care manager will meet with you by phone or where you live as often as needed.
A care manager can help guide you if you have had any of these or other issues:
- You are having to go to the ER a lot
- You are having trouble getting things your doctor has ordered
- Your doctor just told you that you have a disease like CHF (congestive heart failure) or diabetes but you would like to get more information about a disease or treatment
- You need services to help you at home and need help getting long term services and support
- Your doctor wants you to see a specialist, but you don't know what to do
If you want to discuss your health care needs and questions with your case manager, call Member Services to ask to speak to your care manager. Your care manager is there for you!
Extra support to care for you
Our disease management programs are designed just for members with chronic (ongoing) conditions. This may include things like asthma, diabetes, lung disease or a heart issue.
What is a disease management program?
These programs provide education and outreach to you based on your medical needs. The goal is to help you be healthier and get quality care. If you choose to be part of our program, we work with the doctor to create a plan for your care. This plan will include goals that will help you and your doctor track your results. We will also provide education to you about how to stay well.
We have disease management programs for:
- Chronic Obstructive Pulmonary Disorder (COPD)
- Congestive Heart Failure (CHF)
When you sign up for one of our disease management programs, we give you all the help we can. We will also connect you with other resources to help you manage your condition.
If you want to know more about our disease management programs, talk to your care manager or call the 24-hour Care Management line at 1-855-364-0974 (TTY: 711).
*NEW* Acupuncture and Respite Services
Two new Medicaid benefits have been added to the list of covered services.
- Acupuncture - Coverage is limited to pain management of migraine headaches and lower back pain.
- Respite Services - For Supplemental Security Income (SSI) members under the age of 21, as approved by CMS within the applicable 1915(b) waiver and as described in the OAC rule 5160-26-03.
Please call Member Services at 1-855-364-0974 (TTY: 711) 24 hours a day, 7 days a week if you have any questions.
An additional Oral Exam, Cleaning, Fluoride Treatment and X-Rays per year for members 21 and older. This lets you get these services every 6 months instead of once per year. To access these services go to a dentist in the Aetna Better Health of Ohio network and show your Aetna Better Health of Ohio ID card. If you have questions or need help finding a dentist call Member Services