2. July 2026
What Is Ohio's Next Generation MyCare Program and Who Can Benefit?
Managing both Medicare and Medicaid can sometimes feel overwhelming, especially when you're coordinating multiple health plans, provider networks, and healthcare services. To make healthcare simpler and more coordinated, the Ohio Department of Medicaid introduced the Next Generation MyCare Program, an updated program designed specifically for Ohioans who qualify for both Medicare and Medicaid.
By bringing benefits together under one coordinated plan, the program aims to improve the member experience while helping individuals receive the care they need more efficiently. If you or a loved one is eligible for both Medicare and Medicaid, understanding how the Next Generation MyCare Program works can help you make informed healthcare decisions.
What Is the Next Generation MyCare Program?
The Next Generation MyCare Program is Ohio's updated managed care program for individuals who qualify for both Medicare and Medicaid, often referred to as "dual-eligible" beneficiaries. The program combines Medicare and Medicaid benefits into one coordinated health plan, making it easier for members to access healthcare services and navigate their coverage.
The Ohio Department of Medicaid designed the program to provide more personalized care, improve health outcomes, strengthen care coordination, and simplify communication between members, providers, and health plans. Instead of managing separate systems for Medicare and Medicaid, eligible members can receive many of their healthcare services through one integrated plan.
Who Is Eligible for the Program?
The Next Generation MyCare Program is intended for Ohio residents who meet specific eligibility requirements. In general, individuals may qualify if they:
- Are age 21 or older.
- Are enrolled in both Medicare (Parts A, B, and D) and full Ohio Medicaid.
- Live in a county where the program is available.
Some individuals enrolled in programs such as PACE (Program of All-Inclusive Care for the Elderly) or certain developmental disabilities waivers may not be eligible for enrollment in Next Generation MyCare. Because eligibility depends on individual circumstances, it's important to review your specific situation before enrolling.
How the Program Makes Healthcare Simpler
One of the biggest advantages of the Next Generation MyCare Program is care coordination. Instead of working with separate organizations for Medicare and Medicaid services, members can receive coordinated care through one health plan.
This approach helps streamline communication, reduce confusion, and improve collaboration among primary care providers, specialists, hospitals, behavioral health professionals, and long-term care providers. Members also receive support from care coordinators and Ohio's Area Agencies on Aging, helping them navigate healthcare services more effectively.
For individuals with complex medical needs, having one coordinated care team can simplify healthcare management and improve continuity of care.
Benefits Members May Receive
In addition to covering all Medicare and Medicaid benefits, many Next Generation MyCare plans offer extra services designed to support members' health and independence.
Depending on the selected health plan, benefits may include transportation assistance, dental, vision, hearing services, behavioral health support, long-term services and supports, wellness programs, and care coordination. Some plans also provide healthy living rewards or other supplemental benefits beyond standard Medicare and Medicaid coverage.
Because benefits vary by plan, reviewing available options during enrollment can help members choose coverage that best fits their healthcare needs.
What Ohio Members Should Know Before Enrolling
Enrollment in the Next Generation MyCare Program occurs in phases across Ohio. Eligible individuals will receive information from the Ohio Department of Medicaid when the program becomes available in their county.
Before selecting a plan, members should compare provider networks, prescription drug coverage, supplemental benefits, care coordination services, and any additional programs offered by participating health plans.
If you're already enrolled in Medicare and Medicaid, reviewing your available options carefully can help ensure your healthcare providers, medications, and preferred services are included in your selected plan.
Conclusion
Ohio's Next Generation MyCare Program is designed to make healthcare simpler for individuals who qualify for both Medicare and Medicaid. By integrating benefits into one coordinated plan, the program helps improve communication, streamline care, and provide additional support for members with complex healthcare needs.
If you believe you may qualify, learning about your options before enrollment can help you choose a plan that supports your health, independence, and long-term well-being.
Discover Your Medicare and Medicaid Options
If you qualify for both Medicare and Medicaid, understanding your coverage choices can help you get the most from your healthcare benefits. Schedule a consultation to discuss your options with a knowledgeable professional.
For more educational resources on Medicare, Medicaid, and health insurance, visit Belle Vida Insurance.