Help me chose a managed care plane for medicaid
July 4, 2014 4:20 PM   Subscribe

I received an acceptance letter for medicaid, and they want me to chose a managed care plan (MCP) in my region. There are 5 choices, how do I know the difference and which one is right for me? Which one is best?

The five choices I have for Managed Care Pan (MCP) are: Buckeye Community Health Plan ------------ Caresource ------------ Molina Healthcare of Ohio INC www.molinahealthcarecom ------ Paramount Advantage ------- United Healthcare Cmmunity Plan of Ohio I am an older lady and I have no idea how to chose one, and they said if I don't chose by July 18 then they will chose for me.
posted by kikithekat to Health & Fitness (11 answers total) 2 users marked this as a favorite
I would start by looking at the clinics that are within each of their provider networks - look for both primary care and any specialties that are relevant to you, and see whether they're convenient for you to get to, and maybe also whether they have evening/Saturday hours if that's important for your schedule. You could also ask friends for doctor recommendations and choose a plan where the clinic where the most-recommended doctor is in-network.
posted by lakeroon at 4:53 PM on July 4, 2014

Have you read anything about these plans? Are there overviews to download and read? Or brochures? If there stuff like that available, I recommend you download them all and either print them out or view them side by side on your computer, to compare them.

Here are some things I considered when I was choosing my individual insurance plan last fall:

Am I on any medications?
Are those medications covered by this plan?
Do I see any doctors or specialists regularly?
Do those people accept this plan?
Is the hospital nearest me on this plan?

Do you have a senior services where you live? If so, you could call and ask to make an appointment with someone to talk about how the Medicaid plans might work for you and they might also have a volunteer who can help you find out if medications, treatments, and providers and / or facilities that you use regularly are covered by the plan.

If you have a regular provider, you could call the office and ask if they know if one of those plans will cover all the stuff you usually need. They may know this off the tops of their heads (the bookkeeper at my dentist's office usually knows this stuff). If they don't, they maybe able to offer you some ideas on what to ask about so you can call each plan and ask.
posted by AllieTessKipp at 4:55 PM on July 4, 2014 [1 favorite]

Also if there's any particular service that's important to you, see whether it's covered under some and not others. Similarly, some drugs are on the formularies of some plans and not others, or may be in a different cost bracket, so if there's an expensive drug you know you'll be taking, check that.
posted by lakeroon at 4:57 PM on July 4, 2014

When I enrolled in Medicaid this year in a different state, the coverage was the same regardless of which plan I chose. I think that is the norm, but I'm not certain. There were slight differences in which providers were in network between plans. Also, some companies have better customer service than others or have extra wellness programs. Other than those factors, it might not make any difference which plan you choose.
posted by Comet Bug at 5:26 PM on July 4, 2014

In addition to the suggestions above, this ranking of Medicaid plans could be useful:
NCQA Rankings
posted by Francolin at 5:35 PM on July 4, 2014

Hey, I just did this! And I had a psychiatrist I was already working with, so that helped on two fronts--I knew I needed someone who covered him, and I was also able to talk to the lady in the front office who deals with a lot of billing, and her advice was that they seem to have a lot of trouble dealing with CareSource, but the others are all pretty equivalent. Look at the doctor lists to see who's covered in your area. The benefits are pretty much the same. I ended up on Buckeye, for whatever that's worth, but I don't know if they're better in Akron than Columbus.
posted by Sequence at 6:07 PM on July 4, 2014

My primary care doctor told me which one he preferred and that was the one that I chose.
posted by myselfasme at 6:50 PM on July 4, 2014

Every state is different. And I don't live in your state but I've helped people transition here. Medicaid actual benefits havent changed just how it is paid out and your network may be smaller. Or bigger. My suggestion is to ask any major doctors in your life which plans they take. Some plans may still be fee for service and not HMO meaning you can see doctors out of network who take medicaid but not your chosen plan but what that is called in your state and if it is available may vary. Call the plan and ask directly about specialist referrals to find out. It is being phased out of this area in approximately 3 years.
Also some companies here are offering small perks like no perscription or doctor Co pays which may save you a little money. But it really depends on your state and funding and laws.
There should be some services to help you through the process but they will be strangers and training will vary. Here the helpline for enrollment and problems is hit or miss. Some people will tell you can't do something and the advice we got was to hang up and call back to someone more competent. I've spent hours upon hours in training on how this is suppose to work.

Here there is tons of information online you can wade through. But most people just call their doctor and ask. Here after your plan had been chosen you have up to 90 days to change it.

Of course your milage will vary greatly. Good luck.
posted by AlexiaSky at 7:00 PM on July 4, 2014

The Ohio Medicaid agency doesn't make it easy to find, but they do publicly release the results of surveys of Medicaid members about how happy they are with their health care plan. That seems like a decent enough way to try to figure out which plan you might also be happy with. The latest is from 2010 (which is a bit out of date but not too bad), and you can find it here.

The relevant bits for you are on pages D-23 through D-26. If I had to choose one of those plans and didn't have any constraint like my personal doctor only accepting a certain plan, I'd be inclined to go with Paramount, which had the top score among people surveyed on their overall rating of their health plan. It also got the top score for overall rating of all health care (which is not only how well you like your plan, but the doctors and everything else too). Wellcare and CareSource seem to be liked decently well by people on Medicaid who sign up for their plan as well. I'd definitely stay away from Amerigroup (which looks like it's not even an option in your area), which scored pretty badly across the board, and I'd probably avoid Molina as well.
posted by iminurmefi at 7:33 PM on July 4, 2014

Completely personal opinion based on my experience but: I live in Northeast Ohio and have had really good experiences dealing with United Healthcare. They answer the phone promptly when I call to ask questions, they have a good 24-hour nurse care line and pre-authorization for testing/medications/procedures is usually a very well-documented process (i.e. even if the first decision is a denial, there are many avenues for adding further info from doctors/specialists for reconsideration). Good luck!
posted by Merinda at 9:12 PM on July 4, 2014

Like Merinda, I'm in NE Ohio and I chose United (I think they had slightly better dental benefits than which ever other one I was considering). They have been mostly great. The only thing I ran into is a problem with one of my meds. FDA say up to 120 mg but someone put it into their system as a max of 60 mg and nobody wants to try and fix it. I had no problems getting into see specialists and my only preauth drug was covered the first month without the auth and the process was painless (I sat there while the doc called, unfortunately it's the drug that their systems is screwed up). I like that their vision coverage includes actual MDs so I was able to get a full, dilated eye exam. Interestingly enough, you don't even need a referral to see a specialist.

They did ask me which hospital I preferred (which here is CCF or UH basically) and then assigned my PCP based on that.

The only negative thing I have to say is that the PCP they assigned me is completely useless. The Rheumatologist I saw wanted to know why I was there and I told her the PCP refused to write scrips for my pain meds. She was upset that he "turfed" me. He did the same with my psych meds (which I was going to see a psych for anyways, but he wouldn't even refill them until I could see her) and my HBC. I'm planning on ditching him and complaining to United about him, but I haven't found the energy to do so.
posted by kathrynm at 9:15 AM on July 5, 2014

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