Medicaid and Medicare for Mental Health Services in Ohio

Medicare and Medicaid

Georgetown Behavioral Hospital gladly works with patients to simplify the confusion in paying for rehab. We accept many different health insurances including Medicare and Medicaid. Learn more about the difference between Medicare and Medicaid for mental health coverage and whether Medicare or Medicaid is the right option for you. 

Medicare vs Medicaid

Medicare and Medicaid

Medicare and Medicaid are two different government health insurance programs that offer assistance in covering medical and mental health services costs for U.S. citizens. In short, the main differences between Medicare and Medicaid are as follows:

  • Medicare: Medicare is a national, federally run program that is based on age qualifications. If you are a U.S. citizen and over 65 years old, or under 65 with a disability, you are likely covered by Medicare. Medicare is not based on income, so it does not matter how much money you make. 
  • Medicaid: Medicaid is a state-run program that is based on income qualifications. In other words, if you don’t make very much money, the state will provide health insurance if you qualify. 

It is possible to qualify for both Medicare and Medicaid, referred to as dual eligibility. If you qualify for dual eligibility in Ohio, you may be able to find assistance in scheduling mental health services under the MyCare Ohio program, depending on what county you live in. However, if you have only Medicare or Medicaid, there are a few differences in coverage benefits.   

Medicaid vs Medicare for behavioral health

Medicare in Ohio

Medicare is available to those 65 and older or to those with disabilities. Because Medicare is a federal program, it does not matter which state you reside in. Ultimately, there are a few different parts to Medicare insurance:

  • Part A: Hospital Insurance
    Medicare Part A covers all or part of inpatient hospital stays or other residential services, such as nursing facilities or hospices. Inpatient medicare rehab coverage or inpatient mental health services would also be covered under Part A. Your specific costs and copays will depend on your specific plan.
  • Part B: Medical Insurance
    Medicare Part B covers outpatient services, including outpatient rehab and mental health services. 
  • Part C: Medicare Advantage (Private Insurance)
    Medicare Part C, also called Medicare Advantage, are Medicare programs offered through private health insurance companies. Part C usually offers additional services to those offered under Parts A and B but also requires additional monthly payments. 
  • Part D: Prescription Drug Coverage
    Medicare Part D covers prescription medications. This is usually an optional part of Medicare that may cost more to include.

Traditionally, Medicare-covered 80% of the costs of services provided by approved mental health providers. However, the exact cost of behavioral health services through Medicare in Ohio will depend on the type of plan you have (i.e., Parts A and B only or additional coverage through C and D) and whether or not you see an in-network provider. If possible, it is ideal to discuss your behavioral health benefits with the mental health hospital chosen prior to treatment so that there is an understanding of potential costs involved. 

Medicare Eligibility in Ohio

Medicare eligibility in Ohio is the same as it is throughout the rest of the country. In general, you must be 65 or older (or have a disability), be a U.S. citizen, and be able to receive Social Security or Railroad Retirement Board benefits. If deemed eligible, Medicare will assist in medical services as well as mental health services and substance abuse treatment.

Ohio Medicaid

Ohio Medicaid

Medicaid in Ohio is the state program that provides health insurance coverage to those who have a low income. There are a few other ways to qualify for Medicaid. For example, pregnant women, the elderly, and the disabled could be covered by Medicaid insurance. In general, Medicaid does cover some or all substance abuse treatment or mental health services to those who qualify.

Ohio Medicaid Eligibility

To qualify for Medicaid in Ohio, you must:

  • Be a U.S. citizen
  • Have a Social Security number
  • Make a low income
  • Maintain residence in Ohio

In addition, if you fall into one of the following categories you may also be eligible for Ohio Medicaid:

  • Disabled (or living with a disabled family member)
  • Elderly
  • Blind
  • Pregnant
  • Parent

Ohio Medicaid eligibility can be a little confusing. Because of this, Ohio residents are encouraged to apply to the Medicare program even if they are unsure if about their qualifications.

Ohio Medicaid Income Guidelines

To meet the requirements for Ohio Medicaid on the status of income, you or your household must make less than a certain amount of money each year. For example, consider the following examples of household sizes and maximum annual income requirements:

  • One-person household: $17,131 
  • Two-person household: $23,169 
  • Three-person household: $29,207
  • Four-person household: $35,245

Medicaid is also associated with the Children’s Health Insurance Program (CHIP), the program that covers the children of low-income families. Keep in mind that because Medicaid is state-run, income requirements and other eligibility will vary between states.

Examples of Behavioral Services Covered by Ohio Medicaid

Mental Health Services

Ohio Medicaid many mental health services and substance abuse treatments. Often, these services do not require any copay if they are provided within network. 

Mental Health Services:

  • Tests, Screenings, and Assessments
  • Crisis Intervention
  • Counseling (Individual or Group)
  • Medications
  • Partial Hospitalization Programs
  • Inpatient Programs

Substance Abuse Treatment:

  • Drug or Alcohol Detox
  • Inpatient Substance Abuse Treatment
  • Outpatient Substance Abuse Treatment
  • Partial Hospitalization Programs
  • Screenings
  • Opioid Addiction Management

In order to receive assistance, it is important that you verify that the treatment provider accepts Ohio Medicaid. In addition, the actual number of treatment hours for behavioral services that are covered per year will depend on your specific plan and Medicaid Managed Care Organization.

Apply for Medicaid in Ohio

If you qualify under Ohio Medicaid eligibility then you can apply for Medicaid in Ohio in a few different ways. There are numerous Ohio Medicaid programs, so it would be helpful to establish which one you are interested in before applying. Once you’re read you can choose to apply online, in person, by mail, or by phone

Paying for Rehab with Insurance in Ohio

Georgetown Behavioral Hospital accepts many insurances, including Medicare and Medicaid, and our team will be happy to assist you in sorting out your benefits. In order to provide you with the most accurate estimate based on your specific plan coverage and prospective services, please contact our admissions specialists at 937-483-4930 and one of our admissions representatives will be happy to assist you. At Georgetown Behavioral Hospital we can start your recovery today. 

FAQs Regarding Medicare and Medicaid

Medicare and Medicaid are both government programs designed to assist in providing health insurance. The main differences are as follows:

  • Medicare is a national, federally run program that is based on age qualifications. If you are over 65 years old, or under 65 with a disability, you are covered by Medicare regardless of how much money you make. 
  • Medicaid is a state-run program that is based on income qualifications. In other words, if you have a low income, the state will provide health insurance.

Medicaid is a state program that provides health insurance to those with a low income. Since Medicaid is state-run, eligibility will vary by state.

Medicare is a federal program that provides assistance with health insurance based on age qualifications. If you are over 65 years old (or under 65 with a disability) and a U.S. citizen, you are likely covered by Medicare regardless of how much money you make. 

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