Dual-Eligible Medicare and Medicaid in Ohio: 2026 Guide

Who counts as dual-eligible

"Dual-eligible" means you qualify for both Medicare (the federal program for people 65+, or under 65 with certain disabilities or End-Stage Renal Disease) and Medicaid (the federal-state program for low-income individuals and families, administered in Ohio by the Ohio Department of Medicaid).

There are two main flavors:

• Full dual-eligible — qualifies for both Medicare and full Ohio Medicaid benefits. Medicaid pays Part A and Part B premiums, deductibles, coinsurance, and provides additional long-term care services, transportation, behavioral health, and other benefits Medicare doesn't cover.
• Partial dual-eligible — qualifies for Medicare and a Medicare Savings Program (QMB, SLMB, or QI), but not full Medicaid. The MSP pays your Part B premium and sometimes additional cost-sharing, but you don't get full Medicaid benefits like long-term care or expanded dental/vision.

Roughly 300,000 to 350,000 Ohioans are dual-eligible at any given time — a population that includes seniors with limited retirement income, people with disabilities receiving SSI, and nursing facility residents whose income is below Medicaid limits.

Medicare Savings Programs (MSPs)

Medicare Savings Programs are federally defined but state-administered. Ohio Medicaid runs Ohio's MSPs, and eligibility is based on income and asset limits updated annually. Three programs cover most low-income Medicare beneficiaries:

If you qualify for QMB, providers cannot bill you beyond what Medicare and Medicaid together pay — a protection that's often overlooked when beneficiaries receive surprise bills. Show your QMB card any time you receive a Medicare-covered service.

OSHIIP (Ohio Senior Health Insurance Information Program) can help you apply for an MSP — call 1-800-686-1578.

Extra Help for Part D

The federal Extra Help program (also called the Low-Income Subsidy or LIS) reduces what you pay for Medicare Part D drug coverage. If you have full Medicaid, you're automatically enrolled in Extra Help — you don't need to apply separately. If you have an MSP, you're also automatically enrolled. If you have Medicare but neither Medicaid nor an MSP, you can apply directly through Social Security.

Extra Help can reduce monthly Part D premiums to $0 (in some cases), eliminate the deductible, and cap your prescription copays at a few dollars or less per medication. For someone with significant prescription costs, the savings can run into thousands of dollars per year. SSA estimates that hundreds of thousands of eligible Americans nationwide haven't applied — meaning many Ohio beneficiaries are leaving money on the table.

Next Generation MyCare Ohio (launched Jan 1, 2026)

For Ohioans who qualify as full dual-eligible, the most important 2026 development is the launch of Next Generation MyCare Ohio. The program replaces Ohio's earlier 29-county Medicare-Medicaid Plan (MMP) demonstration — which had been running since 2014 — with a permanent Fully Integrated Dual-Eligible Special Needs Plan (FIDE-SNP) model.

What that means in plain English: instead of holding a Medicare card plus a separate Medicaid card and dealing with two sets of rules, providers, and billing systems, you can enroll in a single integrated plan that handles both Medicare and Medicaid benefits with unified care coordination, transportation, behavioral health, long-term services and supports, dental, vision, hearing, and prescription drugs.

Four managed care organizations were selected by the Ohio Department of Medicaid to operate Next Generation MyCare plans:

• Anthem Blue Cross and Blue Shield
• Buckeye Health Plan
• CareSource
• Molina HealthCare of Ohio

Coordination-only Dual-Eligible Special Needs Plans (CO-DSNPs) are no longer permitted in Ohio. Plans that previously operated under that structure had to either transition to a FIDE-SNP, exit Ohio, or move members to other coverage.

See the full Next Generation MyCare Ohio guide for plan details, the statewide rollout schedule, and what current MyCare members should expect.

PASSPORT waiver and HCBS

For dual-eligibles who need long-term services and supports but want to stay in their own homes rather than enter a nursing facility, Ohio's PASSPORT waiver provides Home and Community-Based Services (HCBS) under Medicaid. PASSPORT funds in-home care, personal care attendants, home-delivered meals, adult day services, transportation, and home modifications.

Eligibility for PASSPORT requires:

• Age 60 or older.
• Medicaid eligibility (income and assets meet HCBS limits — sometimes higher than regular Medicaid).
• A level of care assessment confirming you'd otherwise need nursing facility-level care.
• Residence in a setting that supports HCBS (your home, family member's home, or assisted living).

PASSPORT is administered through Ohio's twelve Area Agencies on Aging. To start the application, call your local AAA or the Ohio Department of Aging at 1-866-243-5678. For Ohioans under 60 with disabilities, similar HCBS services are available through other Medicaid waivers (Ohio Home Care, Individual Options, Level One). For dual-eligibles enrolled in Next Generation MyCare Ohio, PASSPORT and other HCBS benefits are coordinated through the MCO.

Original Medicare + traditional Medicaid (without MyCare)

Not every dual-eligible Ohioan is required to enroll in Next Generation MyCare. You can still:

• Keep Original Medicare (Parts A and B) + a stand-alone Part D plan, with Ohio Medicaid as a secondary payer for cost-sharing and additional benefits. This is the traditional dual-eligible structure and remains available throughout Ohio.
• Enroll in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) — but only a FIDE-SNP, since CO-DSNPs are no longer permitted. In practice, the available FIDE-SNPs in Ohio are the four Next Generation MyCare plans listed above.

The trade-off: keeping Original Medicare gives you maximum provider freedom, but you'll deal with separate Medicare and Medicaid systems. Enrolling in Next Generation MyCare gives you integrated care coordination and additional benefits, at the cost of a managed care network.

How to apply

Three paths depending on what you need:

1. Ohio Medicaid application — through Ohio Benefits at benefits.ohio.gov or by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (Mon–Fri 7am–8pm, Sat 8am–5pm).
2. Medicare Savings Programs (MSP) — applied for through Ohio Medicaid via the same Ohio Benefits portal. OSHIIP counselors can help you prepare the application.
3. Extra Help / Low-Income Subsidy — applied for through Social Security at SSA.gov/extrahelp or by calling 1-800-772-1213.

If you're already enrolled in Medicaid and you become Medicare-eligible (or vice versa), Ohio's eligibility systems should identify your dual status automatically and trigger MSP and Extra Help enrollment. But the systems aren't perfect — if you're not seeing premium reductions or LIS on your Part D, call OSHIIP to investigate.