Your Benefits
As an AmeriHealth Caritas Ohio member, you will receive all medically necessary Medicaid-covered services at no cost to you. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition.
Your health benefits can help you stay as healthy as possible if you:
- Are pregnant.
- Are sick or injured.
- Are having difficulty with substances or have behavioral health needs.
- Need assistance with tasks like eating, bathing, dressing or other activities of daily living.
- Need help getting to and from your primary care provider’s (PCP’s) office.
- Need medicine.
You can get some services without getting a referral from your PCP. These include primary care, emergency care, women’s health services, family planning services, children’s screening services, services provided at local health departments, school-based services, and some behavioral health services. You do not need a PCP referral for any specialty services.
Use the links below to learn more about what is included in your plan:
- Medical benefits
Get information on primary care, maternity care, hospital care, home health services, vision care, and more. - Behavioral health benefits
Review our services for members with mental health and substance use disorders. - Pharmacy and prescription benefits
Learn about your pharmacy and prescription benefits. - Transportation
Need a ride to and from your next checkup? We can help. - Health programs
We provide extra support and programs to help you manage your health. - Rewards and extra benefits
In addition to the covered services required by Ohio Department of Medicaid, AmeriHealth Caritas Ohio offers extra benefits to help you. - CARE Card rewards program
You can earn rewards by doing things that help you stay healthy. - Prior authorization
Some services or items need approval from AmeriHealth Caritas Ohio before you can get the service. - Criteria for medical necessity
The following criteria are used for determinations related to medical necessity - Take a health risk assessment
Take a short quiz about your health. Get your wellness score, learn tips to be healthier, and earn $15.
Plan member copays
Members are not required to pay a fee (copay) at the time you get healthcare services from a provider.
If you have any questions about Ohio Department of Medicaid copays, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
If you get a bill
If you get a bill for a treatment or service you do not think you should pay for, do not ignore it. Call Member Services at 1-833-764-7700 (TTY 1-833-889-6446) right away. We can help you understand why you may have gotten a bill. If you are not responsible for payment, AmeriHealth Caritas Ohio will contact the provider and help fix the problem for you.
If you are not satisfied with our decision about your care, you can file an appeal. Read our appeals section for more information.
Once the appeals process is exhausted, you have the right to ask for a fair hearing if you think you are being asked to pay for something Medicaid or AmeriHealth Caritas Ohio should cover. A fair hearing allows you or your representative to make your case before an administrative law judge. Visit our Fair Hearings section for more information.
If you have any questions, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
Still have questions?
Get in touch if you need more information about any of your AmeriHealth Caritas Ohio benefits. Call AmeriHealth Caritas Ohio Member Services, 24 hours a day, seven days a week, at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.