Medicaid and Medicare

Ohio Medicaid and Medicare together

You can have Ohio Medicaid and Medicare at the same time. Medicare pays first, and Medicaid pays after it for costs and services it covers, including long-term care. Since August 1, 2026, most Ohioans 21 and older with Medicare Parts A, B and D and full Medicaid get their Medicaid through Next Generation MyCare Ohio in all 88 counties, and can choose the same plan for Medicare.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 13, 2026

Quick answers

Can I have Ohio Medicaid and Medicare at the same time?: Yes. People with both are called dual eligibles. Medicare pays first; Ohio Medicaid pays after Medicare for what it covers and may pay your Medicare premiums and cost sharing.
What is MyCare Ohio?: Ohio's managed care program for people 21 and older with Medicare Parts A, B and D and full Medicaid. Since August 1, 2026, Next Generation MyCare Ohio runs in all 88 counties. Joining for Medicaid is required; using the same plan for Medicare is your choice.
Who runs PASSPORT?: The Ohio Department of Medicaid funds it and the Ohio Department of Aging runs it day to day through local PASSPORT administrative agencies, most of them area agencies on aging. It serves people 60 and older who need a nursing-home level of care and want care at home.
Where is PACE available in Ohio?: The Ohio Department of Aging lists PACE in Cuyahoga, Lorain, Summit, Franklin, Hamilton, Ashtabula, Trumbull, Mahoning and Montgomery counties, with Lucas County planned for 2027.
How do I apply for Ohio Medicaid if I have Medicare?: Apply online at benefits.ohio.gov or through your county Department of Job and Family Services. Questions about plans go to the Ohio Medicaid Consumer Hotline, 1-800-324-8680.

What does it mean to have both?

People who have Medicare and Ohio Medicaid are called dual eligibles. There are two kinds:

Full-benefit dual eligibles have full Ohio Medicaid. Medicaid pays after Medicare and also covers services Medicare doesn't, such as long-term nursing home care and home care through a waiver.
Partial-benefit dual eligibles get only a Medicare Savings Program, which Ohio calls the Medicare Premium Assistance Program. It pays Medicare premiums and, for QMB, Medicare cost sharing. See Medicare Savings Programs in Ohio.

Either way, you keep Medicare and it pays first. You also get Extra Help with Part D drug costs automatically (42 CFR 423.773(c)).

Who qualifies for Ohio Medicaid with Medicare?

Ohio reviews people who are 65 or older, blind or disabled under its aged, blind and disabled (ABD) Medicaid rules. The Ohio Department of Medicaid's 2026 eligibility table sets the ABD income standard at the federal SSI benefit rate, and OAC 5160:1-3-05.1 sets a limit on countable resources. Your home is generally not counted while you live in it or intend to return (OAC 5160:1-3-05.13).

If you need long-term care, different income rules apply. Ohio uses a special income level of 300% of the SSI benefit rate (OAC 5160:1-6-03.1). If your income is above it, you can still qualify by putting income into a qualified income trust (OAC 5160:1-6-03.2).

Next Generation MyCare Ohio

Ohio Medicaid serves most dual eligibles through managed care. Next Generation MyCare Ohio began January 1, 2026, in the 29 original MyCare counties and reached all 88 counties on August 1, 2026 (OAC 5160-58-02). You are enrolled if you are 21 or older and have Medicare Parts A, B and D and full Medicaid, unless you are in PACE, on a developmental disabilities waiver or in an ICF-IID, or have other health coverage.

Medicaid side: required. If you don't pick a plan, Ohio Medicaid assigns one.
Medicare side: your choice. You can get Medicare from the same MyCare plan, which makes it one plan for both, or keep Original Medicare or another Medicare plan.

Details, county dates and how to change: MyCare Ohio guide and MyCare vs. Original Medicare and Medicaid.

Medicare Advantage plans for dual eligibles

A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan only for people with Medicare and Medicaid. In Ohio, the MyCare plans' Medicare side is a fully integrated D-SNP (FIDE SNP). For 2027, CMS plan data shows that every D-SNP in Ohio belongs to one of the four MyCare organizations; separate coordination-only D-SNPs are open only to people with Medicare Savings Program help and not full Medicaid. More in D-SNPs in Ohio.

Long-term care: nursing homes, waivers and PACE

Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. It doesn't pay for long-term custodial care. Ohio Medicaid can, in several ways:

Option	Who it's for	Rule
Nursing facility care	People who meet Medicaid's financial rules and need a nursing-facility level of care	OAC Chapter 5160:1-6
PASSPORT waiver	Age 60+ at enrollment, nursing-facility level of care, care at home	OAC 5160-31-03
Assisted Living waiver	Age 21+, nursing-facility level of care, living in a licensed residential care facility, able to pay room and board	OAC 5160-33-03
Ohio Home Care waiver	Under 60, nursing-facility level of care, care at home	OAC 5160-46-02
MyCare Ohio Waiver	MyCare members who need waiver services (replaces PASSPORT, Assisted Living and Ohio Home Care for them)	ODM MyCare FAQ
PACE	Age 55+, nursing-facility level of care, living in a PACE county	42 CFR Part 460

The Ohio Department of Aging lists PACE in Cuyahoga, Lorain, Summit, Franklin, Hamilton, Ashtabula, Trumbull, Mahoning and Montgomery counties (Montgomery opened November 1, 2026), with Lucas County planned for 2027. PACE members aren't enrolled in MyCare Ohio. See PASSPORT and other Ohio waivers and Does Ohio Medicaid pay for nursing home care?

When you ask Medicaid to pay for long-term care, Ohio looks back 60 months at gifts and transfers for less than fair market value (OAC 5160:1-6-06). An improper transfer leads to a restricted coverage period when Medicaid won't pay for that care.

Estate recovery

After death, the Ohio Attorney General seeks repayment for Ohio Medicaid from the estates of people who were 55 or older or permanently institutionalized (OAC 5160:1-2-07; ORC 5162.21). Ohio's definition of estate reaches non-probate assets too, such as jointly owned property and living trusts. Recovery waits until a surviving spouse has died and can't happen while there is a surviving child under 21 or a blind or disabled child. Medicare Premium Assistance Program benefits paid since January 1, 2010, are not recovered. More in Does Ohio Medicaid take your house after death?

How to apply

Make sure you have Medicare. If you have never had Part A or Part B, the county will ask you to sign up through Social Security first (1-800-772-1213, TTY 1-800-325-0778).
Apply for Medicaid. Apply online at benefits.ohio.gov or at your county Department of Job and Family Services. The same application can be used for the Medicare Premium Assistance Program.
Ask about long-term care if you need it. For PASSPORT or other home care, call 1-866-243-5678 to reach your area agency on aging, which starts with a phone screening.
Answer every letter and renewal. Missing a renewal is a common way to lose coverage you still qualify for.
Review your Medicare choices. Decide whether to use your MyCare plan for Medicare too. The Ohio Medicaid Consumer Hotline (1-800-324-8680) handles MyCare plan choices; 1-800-MEDICARE handles Medicare plan changes.

Where to get help

Ohio Medicaid Consumer Hotline: 1-800-324-8680 (Mon–Fri 7 a.m.–8 p.m., Sat 8 a.m.–5 p.m.), ohiomh.com.
Ohio Department of Aging: 1-800-266-4346; area agency on aging connect line 1-866-243-5678.
State Long-Term Care Ombudsman (nursing home and home care problems): 1-800-282-1206.
1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or Medicare.gov.
To review Medicare plan options from the companies they work with, you can request a call from a licensed insurance agent.

All Ohio agency numbers are on Ohio Medicare contacts.

Sources

Every question in this guide

Frequently asked questions

How do I apply for Ohio Medicaid if I'm on Medicare?

Apply at benefits.ohio.gov or at your county Department of Job and Family Services. Ohio reviews people 65 or older, blind or disabled under its aged, blind and disabled rules, which count both income and resources. If you need long-term care, say so on the application so the county also checks the long-term care rules.

What is the Medicaid look-back period in Ohio?

Five years. Under OAC 5160:1-6-06, when you ask Ohio Medicaid to pay for nursing home care or a home and community-based waiver, the county reviews gifts and other transfers for less than fair market value made in the 60 months before your baseline date. An improper transfer leads to a period when Medicaid won't pay for long-term care.

What is PACE in Ohio?

PACE (Program of All-Inclusive Care for the Elderly) covers all Medicare and Medicaid care through one local team for people 55 and older who need a nursing-home level of care and live in a PACE service area. The Ohio Department of Aging lists PACE in nine counties, with Lucas County planned for 2027. PACE members aren't enrolled in MyCare Ohio.

Does Medicaid replace Medicare when I have both?

No. You keep Medicare, and it pays first. Medicaid fills in after Medicare, and covers some services Medicare doesn't, such as long-term nursing home care and home and community-based waiver services.

Do I get Extra Help automatically with Ohio Medicaid?

Yes. Under 42 CFR 423.773(c), people with full Medicaid or a Medicare Savings Program are treated as eligible for Extra Help with Part D costs without a separate application to Social Security.

Medicare in your Ohio county

Plans, local agents and help, county by county: Franklin · Cuyahoga · Hamilton · Summit · Montgomery · Lucas · Butler · Stark · Lorain · Warren · Delaware · Lake · Mahoning · Clermont · Trumbull · Licking · Medina · Greene · Fairfield · Portage · All 88 counties →

Licensed insurance agents for Ohio

These independent insurance agents are licensed in Ohio and work with Benefits Life, the publisher of this site. When they enroll you in a plan, the agent and Benefits Life may be paid by the insurance company. Learn more.