UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) How To Enroll

There are three ways to enroll: Online, paper application, Customer Service

Who Is Eligible to Enroll in a MyCare Ohio Plan?

You are eligible for membership in our MyCare Ohio plan as long as you:

• Live in our service area; and
• Have Medicare Parts A, B and D; and
• Have full Medicaid coverage; and
• Are 18 years of age or older at time of enrollment.

You are not eligible to enroll in a MyCare Ohio plan if you:

• Do not have full Medicaid benefits and Medicare Parts A, B and D;
• Are younger than age 18;
• Are enrolled in PACE (Program for All-Inclusive Care for the Elderly);
• Have any private medical insurance, including retiree benefits, other than a Medicare Advantage plan; or
• Have intellectual or other developmental disabilities and receive services through a waiver; or
• Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID)

If you believe that you meet any of the above criteria and should not be enrolled, please contact Member Services at 1-877-542-9236 (TTY 711), TTY users should call Ohio Relay at 7-1-1, or on the managed care enrollment center (MCEC) website at www.ohiomh.com.

Applicants can ask an authorized representative to apply on their behalf using the forms below:

• Medicare Authorized Representative Form
• Medicare Form to Share Information
• OHIO Authorized Representative Form
• HIPAA Authorization Form

To file an Appeal or Grievance, please visit the FAQ section.