CareSource Of Ohio is a leading nonprofit health insurance company that offers private and Medicare plans. Instantly compare plans and rates from this Dayton-based carrier. Ohio medical plans provided include Marketplace coverage to persons under age 65, Medicare Advantage plans to Seniors, and Medicaid benefits to low-income households. Generally, prices are extremely competitive when compared to other carriers. Additional states where plans can be purchased include Indiana, Kentucky, Georgia, and West Virginia. Life Services helps low-income families with job opportunities, coaching, and additional resources. Plans are affordable and simple, and are available to all Buckeye State residents.
PPO and HMO options are offered, and a comprehensive outreach program has been created to increase access to opioid addiction treatment. Pharmacy lock-ins have helped reduce the number of unneeded prescriptions. An integrated medication assisted program is also offered to plan members. Holistic treatment along with clinical, physical, and mental treatment help keep customers healthy. A managed care business model has become very popular, and shared by other organizations across the U.S. The company nickname is “Health Care With Heart.”
“Care4U” is the company model that promotes good health, wellness, and support to members. Health risk assessment, wellness, behavioral health, women’s and children’s health, care management, disease management, and tobacco cessation forms the core of treatment. For Seniors, a formulary drug list is available to view. Additional states plans are available are Arkansas, Georgia, Indiana, Kentucky, and west Virginia.
Under Age-65 Marketplace Plans
Individuals and families can apply for 2024 coverage regardless of household income. Although a federal subsidy is available, unsubsidized coverage is also offered. When purchased during Open Enrollment, or with and SEP (Special Enrollment Period) exemption, pre-existing conditions are covered. An “Advance Premium Tax Credit” (APTC) is offered on all non-catastrophic plans. Eligibility and amount of the credit is generally based on your previous year’s modified adjusted gross income. 2024 subsidies are higher than any previous year.
The Ohio service area consists of the following counties: Adams, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Mercer, Miami, Monroe, Marion, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wyandot, and Wood.
The network of physicians, specialists, hospitals, and other medical facilities is very extensive. The online provider link allows consumers to locate in-network options that can reduce out-of-pocket costs. Dental and vision benefits can be added along with the “Active&Fit” program. Note: CareSource was the initial carrier in the Marketplace to receive its application (nine years ago).
Marketplace Prescription Drug Coverage
Prescription drugs are partially administered by “RxInnovations” which works with Express Scripts to limit costs. Policyholders can search for nearby participating pharmacies, and review the cost of all medications. A printed formulary is provided to simplify the drug comparison process. A “Find The Pharmacy” link will also help locate pharmacies. Prior authorization may be required with specific drugs. The Formulary will list all drugs requiring prior authorization. If the request is not granted, an appeal can be made.
When ordering or picking up a drug, an ID card and prescription will be needed. It is possible that a cheaper alternative generic drug may have to be used before the drug is approved. Copays, coinsurance, or a deductible may impact your out-of-pocket expenses. Limits may apply to certain medicines and some drugs may require an alternative drug be used first. Opioid drugs have special requirements, including no current therapy with benzodiazepines, and no more than 90 days of therapy in the last 365 days. An extended-release opioid will require prior authorization.
CareSource Marketplace Drug Formulary offers providers and policyholders guidance regarding which prescriptions to utilize. Free online tools provide information about the specific drugs and amounts that are covered. Six tiers of drugs are available with different cost levels. Most large pharmacies accept CareSource, but it is always advisable to verify first. A “Find A Pharmacy” tool helps locate area pharmacies.
Accredo Specialty Pharmacy provides special-tier drugs prescribed by your doctor or specialist. Specific attention and preparation is often needed with the administration and prescribing of these drugs. The cost is also generally substantially higher than most other generic and preferred generic drugs. Accredo can assist in filling the prescription and arranging delivery to your home or place of work. Trained healthcare professionals are also available for consultation and recommendation.
Bronze
CareSource Marketplace Bronze First – $7,500 deductible with $9,450 maximum out-of-pocket expenses and 50% coinsurance. No cost for Telemedicine Partners. $50 and $100 office visit copays. Urgent Care and ER visits are subject to copays ($80 and 50% coinsurance) and deductible. $25 generic drug copay. X-rays are subject to coinsurance and the policy deductible. Lab tests are also subject to coinsurance and the policy deductible.
CareSource Marketplace Bronze First Dental, Vision, And Fitness – Similar to previous plan with basic dental, vision, and fitness benefits included.
Silver
CareSource Marketplace Low Premium Silver – $6,500 deductible with $9,100 maximum out-of-pocket expenses and 50% coinsurance. $30 and $70 office visit copays with $50 Urgent Care copay. The hospital stay copay is $500 and is subject to the deductible. Generic and preferred brand drugs are subject to $3 and $75 copays ($7.50 and $187.50 for 90-day mail-order). X-rays are subject to a $200 copay and the policy deductible. Blood work is subject to a $40 copay. MRIs have a $250 copay and must meet the policy deductible. Children’s dental checkups are covered (two per year). Children’s eye exams and eyewear are also covered up to policy limits.
CareSource Marketplace Low Premium Silver Dental, Vision, And Fitness – Similar to previous plan with basic dental, vision, and fitness benefits included.
CareSource Marketplace Silver – $5,900 deductible with $9,100 maximum out-of-pocket expenses and 40% coinsurance. $40 and $80 office visit copays with $60 Urgent Care copay. Generic and preferred brand drugs are subject to $20 and $40 copays ($50 and $100 for 90-day mail-order). X-rays, diagnostic tests (blood work and x-rays) and imaging are subject to 40% coinsurance and the policy deductible. . Children’s dental checkups are covered (two per year). Children’s eye exams and eyewear are also covered up to policy limits.
CareSource Marketplace Silver Dental, Vision, And Fitness – Similar to previous plan with basic dental, vision, and fitness benefits included.
CareSource Marketplace Core Silver – $6,000 deductible with $8,900 maximum out-of-pocket expenses and 40% coinsurance. $30 and $70 office visit copays with $60 Urgent Care copay. The hospital stay copay is $500 and is subject to the deductible. Generic and preferred brand drugs are subject to $3 and $70 copays ($7.50 and $175 for 90-day mail-order). X-rays are subject to a $200 copay and the policy deductible. Blood work is subject to a $50 copay. MRIs have a $250 copay and must meet the policy deductible. Children’s dental checkups are covered (two per year). Children’s eye exams and eyewear are also covered up to policy limits.
CareSource Marketplace Core Silver, Dental, Vision, And Fitness – Similar to previous plan with basic dental, vision, and fitness benefits included.
CareSource Marketplace Diabetes Silver – $3,400 deductible with $9,450 maximum out-of-pocket expenses and 50% coinsurance. $35 and $80 office visit copays with $70 Urgent Care copay. The hospital stay copay is $600 and is subject to the deductible. Generic and preferred brand drugs are subject to $3 and $100 copays ($7.50 and $250 for 90-day mail-order). X-rays are subject to a $250 copay and the policy deductible. Blood work is subject to a $75 copay. MRIs have a $300 copay and must meet the policy deductible. Children’s dental checkups are covered (two per year). Children’s eye exams and eyewear are also covered up to policy limits.
CareSource Marketplace Core Silver, Dental, Vision, And Fitness – Similar to previous plan with basic dental, vision, and fitness benefits included.
Gold
CareSource Marketplace Gold – $1,500 deductible with $8,700 maximum out-of-pocket expenses and 25% coinsurance. $30 and $60 office visit copays with $45 Urgent Care copay. ER visits are subject to coinsurance and the deductible. Generic drugs subject to $15 copay ($37.50 for 90-day mail-order). Preferred brand drug copays are $30 and $75. Non-preferred brand drug copay is $60 ($150 copay).
CareSource Marketplace Gold Dental, Vision, And Fitness– Similar to previous plan with basic dental, vision, and fitness benefits included.
CareSource Marketplace Core Gold – $2,000 deductible with $7,000 maximum out-of-pocket expenses and 25% coinsurance. $20 and $60 office visit copays with $40 Urgent Care copay. ER visits are subject to coinsurance and the deductible. Generic drugs subject to $10 copay ($25 for 90-day mail-order). Preferred brand drug copays are $50 and $125. Lab copay is $30.
CareSource Marketplace Core Gold Dental, Vision, And Fitness– Similar to previous plan with basic dental, vision, and fitness benefits included.
CareSource Marketplace Diabetes Gold – $1,000 deductible with $7,500 maximum out-of-pocket expenses and 30% coinsurance. $15 and $50 office visit copays with $30 Urgent Care copay. ER visits are subject to coinsurance and the deductible. Generic drugs subject to $2 copay ($5 for 90-day mail-order). Preferred brand drug copays are $60 and $150. Lab copay is $30.
CareSource Marketplace Diabetes Gold Dental, Vision, And Fitness– Similar to previous plan with basic dental, vision, and fitness benefits included.
Enhanced Plan Benefits
Vision – Necessary exams with dilation are covered with $40-$65 copay. A $250 credit for frames, lenses, and lens options is provided. A 20% credit applies to expenses more than $250. Conventional and disposable contact lenses are covered with a $0 copay and $250 allowance. Laser vision correction from LASIK and PRK provide a 15% discount.
Active&Fit – Included free with dental and vision packages, this program provides benefits without any required contracts. Fitness Centers in the program include Anytime Fitness, LA Fitness, Planet Fitness, and Snap Fitness. More than one fitness center may be utilized in the same month. Two home fitness kits are provided along with an app or wearable device to help monitor progress. Kits can be customized for persons with chronic medical conditions.
Dental – Benefits include procedures and surgeries (restorations and extractions), pediatric fluoride treatment, dental x-rays, dentures, exams and cleanings, and accidental services.
Current CareSource Ohio Health Insurance Monthly Rates
Age 28 With $30,000 Income In Hamilton County (Cincinnati)
$69 – Marketplace Bronze
$77 – Marketplace Bronze First
$201 – Marketplace Low Premium Silver 1
$211 – Marketplace Standard Silver 1
$269 – Marketplace Essential Silver 1
$399 – Marketplace Gold
Age 45 With $35,000 Income In Hamilton County (Cincinnati)
$124 – Marketplace Bronze
$135 – Marketplace Bronze First
$299 – Marketplace Low Premium Silver
$313 – Marketplace Standard Silver
$390 – Marketplace Essential Silver
$563 – Marketplace Gold
Married Couple Ages 40 With Two Children And $65,000 Income In Hamilton County (Cincinnati)
$113 – Marketplace Bronze
$143 – Marketplace Bronze First
$622 – Marketplace Low Premium Silver 1
$661 – Marketplace Standard Silver 1
$887 – Marketplace Essential Silver 1
$1,390 – Marketplace Gold
Age 30 With $27,000 Income In Montgomery County (Dayton)
$43 – Marketplace Bronze
$51 – Marketplace Bronze First
$180 – Marketplace Low Premium Silver 2
$191 – Marketplace Standard Silver 2
$252 – Marketplace Essential Silver 2
$387 – Marketplace Gold
Age 45 With $34,000 Income In Montgomery County (Dayton)
$112 – Marketplace Bronze
$123 – Marketplace Bronze First
$187 – Marketplace Low Premium Silver
$301 – Marketplace Standard Silver
$378 – Marketplace Essential Silver
$551 – Marketplace Gold
Married Couple Ages 45 With Two Children And $60,000 Income In Montgomery County (Dayton)
$113 – Marketplace Bronze
$143 – Marketplace Bronze First
$622 – Marketplace Low Premium Silver 1
$661 – Marketplace Standard Silver 1
$887 – Marketplace Essential Silver 1
$1,390 – Marketplace Gold
Age 25 With $27,000 Income In Franklin County (Columbus)
$77 – Marketplace Bronze
$85 – Marketplace Bronze First
$212 – Marketplace Silver Low Premium Silver 2
$223 – Marketplace Standard Silver 2
$283 – Marketplace Essential Silver 2
$416 – Marketplace Marketplace Gold
Age 45 With $31,000 Income In Franklin County (Columbus)
$130 – Marketplace Bronze
$141 – Marketplace Bronze First
$324 – Marketplace Silver Low Premium Silver 1
$339 – Marketplace Standard Silver 1
$425 – Marketplace Essential Silver 1
$617 – Marketplace Marketplace Gold
Married Couple Ages 40 With Two Children And $64,000 Income In Franklin County (Columbus)
$310 – Marketplace Bronze
$342 – Marketplace Bronze First
$859 – Marketplace Silver Low Premium Silver 1
$901 – Marketplace Standard Silver 1
$1,145 – Marketplace Essential Silver 1
$1,688 – Marketplace Marketplace Gold
Age 25 With $31,000 Income In Cuyahoga County (Cleveland)
$12 – Marketplace Bronze
$17 – Marketplace Bronze First
$99 – Marketplace Silver Low Premium Silver 1
$106 – Marketplace Standard Silver 1
$145 – Marketplace Essential Silver 1
$231 – Marketplace Marketplace Gold
Age 45 With $37,000 Income In Cuyahoga County (Cleveland)
$52 – Marketplace Bronze
$59 – Marketplace Bronze First
$177 – Marketplace Silver Low Premium Silver
$187 – Marketplace Standard Silver 1
$243 – Marketplace Essential Silver
$367 – Marketplace Marketplace Gold
Married Couple Ages 40 With Two Children And $75,000 Income In Cuyahoga County (Cleveland)
$5 – Marketplace Bronze
$26 – Marketplace Bronze First
$360 – Marketplace Silver Low Premium Silver
$387 – Marketplace Standard Silver 1
$546 – Marketplace Essential Silver
$897 – Marketplace Marketplace Gold
Medicare Advantage Plans
CareSource Medicare Advantage (Part C) plans provide Seniors with affordable medical benefits, and an alternative to the combination of Original Medicare and/or supplement coverage. Premiums are typically less than conventional coverage and several additional benefits are included. All applicants must be eligible for Medicare Part A, and have enrolled in Part B. If you reach your maximum out-of-pocket limit, hospital benefits will continue to be paid for the remainder of the calendar year. Additional benefits include enhanced vision benefits with $0 copay exams, preventative dental coverage, and reduced prices for hearing aids.
Two dental exams per year are included with no copays. Dentures, root canals and extractions are also provided benefits. Hearing aids are available at a cost of $199 (and higher). Contacts, glasses and eye exams are included in the vision package. Two home fitness kits (including videos) are also provided.
The Advantage and Advantage Zero Premium plans were previously available in the following counties (service area): Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Delaware, Fairfield, Fayette, Franklin, Fulton, Geauga, Greene, Hamilton, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Lake, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Mercer, Miami, Montgomery, Morrow, Ottawa, Perry, Pickaway, Portage, Preble, Putnam, Shelby, Stark, Summit, Trumbull, Union, Vinton, Warren, and Wood.
CareSource Dual Advantage is an HMO SNP plan for persons that qualify for Medicare AND Medicaid. The service area includes the following counties: Allen, Auglaize, Butler, Clermont, Clinton, Coshocton, Crawford, Erie, Franklin, Guernsey, Hardin, Harrison, Henry, Highland, Logan, Lorain, Marion, Meigs, Montgomery, Morrow, Noble, Ottawa, Paulding, Perry, Pike, Preble, Putnam, Ross, Scioto, Vinton, Warren, and Washington.
$0 monthly premium, $0 deductible, and $8,850 maximum out-of-pocket expenses for Medicare-provided services. Inpatient hospital care copay is $0. Outpatient hospital expenses are subject to a $0 copay, and the ambulatory surgical center copay is $0. Office visit copays are $0 (pcp), $0 (specialist) and $0 (Urgent Care). ER visits are subject to an $0 copay.
Diagnostic radiology services (MRIs and CT scans) are subject to a $0 copay, and tests, procedures, and lab services are subject to a $0 copay. Outpatient x-rays are subject to a $0 copay, and therapeutic radiology services are subject to 0% coinsurance.
Hearing services include a $0 copay for diagnosis and treatment, and a $0 copay for an annual routine hearing exam. The hearing aid copay is $0 for TruHearing advanced model hearing aids. Provider visits are included during the first 12 months when buying a hearing aid, along with a 60-day trial period. Basic dental services are subject to a $0 copay (replacement and removal of teeth not covered). Comprehensive benefits are covered. Preventative services include a $0 copay of cleanings, x-rays, and oral exams. A $6,000 allowance is provided for dental care.
Vision services include $0 copay for annual routine exam, contact lenses, and eyeglass frames. Eyeglass lenses receive a $0 copay. A $450 allowance is provided for contact lenses and eyeglass frames.
The inpatient mental health care copay is $0 for days 1-7, and $0 for days 8-60. Outpatient and inpatient group therapy are subject to a $0 copay. The skilled nursing facility copay is $0 days 1-20, and $0 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, and speech/language therapy) are subject to $0 copays. The ambulance copay is $0.
Foot care is covered with a $0 copay. Durable medical equipment, and prosthetic devices are subject to 0% coinsurance. Diabetes supplies and services (monitoring supplies, therapeutic inserts or shoes, and self-management training) are subject to a $0 copay, and acupuncture for chronic lower back pain is covered with a $0 copay. Chiropractic Care is subject to a $0 copay, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $0 copay.
Two meals per day for 14 days are provided after acute inpatient hospitalization or observation, with a $2,400 annual maximum. Fitness memberships are available at participating facilities. A $50 healthy food allowance can be used at specific retailers. A personal emergency alert system and $1,000 of annual flex allowance (dental, vision, and hearing) are provided.
Prescription drug 1-month and 3-month copays have a $0 copay.
Previously-Offered MA Plans
CareSource Advantage Zero Premium (HMO) – $0 monthly premium, $0 deductible, and $7,550 maximum out-of-pocket expenses. Inpatient hospital care copay is $380 for days 1-5, and $0 days 6-90. Outpatient hospital expenses are subject to a $295 copay, and the ambulance service copay is $250. Office visit copays are $15 (pcp), $0-$50 (specialist) and $45 (Urgent Care). ER visits are subject to a $90 copay, which is waived, if admitted.
Diagnostic radiology services (MRIs and CT scans) are subject to a $175 copay, and diagnostic tests and procedures are subject to a $35 copay. Lab services are subject to a $35 copay and outpatient x-rays are subject to a $50 copay.
Hearing services include a $0 copay for an annual routine hearing exam. The hearing aid copay is $699-$999 per hearing aid. Three provider visits are included during the first 12 months when buying a hearing aid, along with a 45-day trial period. A three-year extended warranty and 48 batteries (non-rechargeable models) are also provided.
Basic dental services are subject to a $50 copay (replacement and removal of teeth not covered). Comprehensive and preventative benefits subject to $1,000 maximum. Preventative services include a $0 copay of cleanings, x-rays, and oral exams (every six months).
Vision services include $0 copay for annual routine exam, diabetic retinal exam, contact lenses, and eyeglass frames. A $50 copay applies to eye exams that diagnose conditions and diseases. Eyeglass lenses receive a $0 copay. A $130 allowance is provided for contact lenses and eyeglass frames. After approved cataract surgery, a $50 copay applies to contact lenses or eyeglasses.
The inpatient mental health care copay is $230 for days 1-7, and $0 for days 8-90. Outpatient and inpatient group therapy are subject to $35 copays. The skilled nursing facility copay is $0 days 1-20, and $184 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, supervised exercise therapy, and speech/language therapy) are subject to 20% coinsurance. The ambulance copay is $225.
Foot care is covered with a $35 copay. This includes treatment and exams for diabetes-related nerve damage. Durable medical equipment, and prosthetic devices are subject to 20% coinsurance. Diabetes supplies and services are subject to a $0 copay, although acupuncture has a $30 copay. Chiropractic Care is subject to a $20 copay, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $40 copay. Renal dialysis is covered with 20% coinsurance. Hospice care from Medicare-certified hospice is covered at 100%.
Prescription drug 1-month copays are: Tier 1 ($4), Tier 2 ($10), Tier 3 ($45), Tier 4 ($100) and Tier 5 (31%). The 90-day mail order copays are Tier 1 ($8), Tier 2 ($20), Tier 3 ($90), and Tier 4 ($200).
Additional benefits include free memberships at participating fitness centers and home fitness kits provided at no cost. A 24-hour nurse advice line is also available.
CareSource Advantage (HMO) – $46 monthly premium, $0 deductible, and $7,550 maximum out-of-pocket expenses. Inpatient hospital care copay is $285 for days 1-7, and $0 days 8-90. Outpatient hospital expenses are subject to a $295 copay, and the ambulatory surgical center copay is $250. Office visit copays are $10 (pcp), $35 (specialist) and $35 (Urgent Care). ER visits are subject to an $90 copay, which is waived, if admitted.
Diagnostic radiology services (MRIs and CT scans) are subject to a $150 copay, and tests, procedures, and lab services are subject to a $0 copay. Outpatient x-rays are subject to a $25 copay, and therapeutic radiology services are subject to 20% coinsurance.
Hearing services include a $0 copay for an annual routine hearing exam. The hearing aid copay is $499-$799 per hearing aid twice per year. Three provider visits are included during the first 12 months when buying a hearing aid, along with a 45-day trial period. Basic dental services are subject to a $50 copay (replacement and removal of teeth not covered). Comprehensive benefits are subject to a $1,000 annual limit and 30% (simple extractions and minor restorations) or 50% coinsurance. Preventative services include a $0 copay of cleanings, x-rays, and oral exams.
Vision services include $0 copay for annual routine exam, contact lenses, and eyeglass frames. Eyeglass lenses receive a $0 copay. A $130 allowance is provided for contact lenses and eyeglass frames.
The inpatient mental health care copay is $285 for days 1-7, and $0 for days 8-90. Outpatient and inpatient group therapy are subject to a $35 copay. The skilled nursing facility copay is $0 days 1-20, and $184 days 21-100. Outpatient rehabilitation (cardiac services, occupational therapy, and speech/language therapy) are subject to $10-$40 copays. The ambulance copay is $225.
Foot care is covered with a $35 copay. Durable medical equipment, and prosthetic devices are subject to 20% coinsurance. Diabetes supplies and services are subject to a $0 copay, and acupuncture is covered with a $30 copay. Chiropractic Care is subject to a $20 copay, and home health care is subject to a $0 copay. Outpatient substance abuse (individual and group therapy visits) is subject to a $40 copay.
Prescription drug 1-month copays are: Tier 1 ($4), Tier 2 ($10), Tier 3 ($45), Tier 4 ($100) and Tier 5 (31%). The 90-day mail order copays are Tier 1 ($8), Tier 2 ($20), Tier 3 ($90), and Tier 4 ($200).
Additional benefits include free memberships at thousands of participating fitness centers (and YMCAs) and home fitness kits (including Fitbit) provided at no cost. A 24-hour nurse advice line is also available. Individual lifestyle coaching via phone is available, with weekly sessions covering topics including nutrition, pain and stress management, fall prevention, and mobility and activity.
MyHealth Awards (Adults Only) is a covered free benefit that provides customized health tools. Exercise goals and other wellness activities can be managed, and awards can also be earned. For example, an annual physical examination, colorectal cancer screening, and comprehensive diabetic screenings qualify for awards. An online activity account can be quickly set up to track progress and order gift cards from participating retailers.
MyStrength is a free tool that helps provide emotional support. The mind, body, and spirit are strengthened, and policyholders aged 13 and above can participate. Several features include videos and articles about attention deficit hyperactivity and autism, daily readings and quotes, awards for reaching specified goals, and learning modules for substance abuse, anxiety, and depression. Stress and weight management, smoking cessation, and helpful parenting tips are also shared.
Note: Medicare Supplement Plans in Ohio from CareSource are not offered.
Additional Perks Provided To Members
My CareSource – Online accounts allow policyholders to easily manage their coverage. Easily review benefits, claims information, change physicians, order additional or duplicate ID cards, and much more. “MyCare” is available for Medicare and Medicaid eligible applicants.
Mobile App – Extensive account information can be viewed on your phone. Bills can be paid and changes to benefits can be viewed. Physician and hospital availability can be viewed in all service areas. Claim information can also be viewed.
Medicaid Benefits
Medicaid managed-care coverage provides medical services to Buckeye State residents that are eligible for Aged, Blind, or Disabled, and Healthy Families, and Healthy Start. All of Ohio is available for coverage. There are no copays for prescription drugs or office visits. Generally, services covered by Medicaid are offered with no out-of-pocket cost. Other features include:
24-hour service that allows you to talk to registered nurses
Network of physicians, specialists, hospitals, and pharmacies
Personalized person-to-person care
Dental care
Vision care
Transport assistance to physician visits
Assistance finishing a degree or finding a job (Life Services)
Long term supportive services respite service
International coverage
Other Medicaid Benefits
Eyeglass Frames – Plastic and wire frames are available, including several Medicare-provided options.
Rides And Transportation – CareSource pays for your transportation expenses for visits to physicians and specialists. Appointments at the County Department of Job and Family Services are also covered.
Reward Programs – If “healthy choices” are made, rewards with values of $210, $395, and $415 are offered. Babies First and Kids First are popular options.
Benefits that are not included or covered include: treatment of obesity, unless medically necessary, plastic and cosmetic surgery, unnecessary medical procedures, abortions, infertility treatment, experimental procedures and services, counseling for marriage or sexual issues, acupuncture, paternity testing, and prescription drugs not covered by Ohio Medicaid pharmacy program.
Ohio Home Care Waiver Program
CareSource also manages the Ohio Home Care Waiver Program. The program allows members in central, southeast, and northeast Ohio to be treated in their homes, or locally in their community. Case managers help arrange services for persons that qualified for a waiver. Case Managers provide a Person Centered Service Plan. Enrolled individuals may be eligible for the following benefits: Adult Day Care Services, Community Transition And Integration, Home Care Attendant And Delivered Meals, Home Modification Services And Maintenance/Chore, Personal Care Aide, Personal Response Emergency System, Supplemental Adaptive Devices, and Waiver Nursing.
Note: JobConnect is a popular program that connects Medicaid members to coaching and personal support while looking for work and additional education.
Dual Demonstration (Eligible For Medicare And Medicaid)
MyCare Ohio from CareSource provides and combines coverage from Medicare and Medicaid to qualified applicants. Long-term and short-term services are included, along with physical and mental benefits. Persons over age 18 can have their long-term care and physical services managed by professionals that effectively coordinate services. Often, chronic conditions need to be treated.Medicare is the primary payor and Medicaid provides supplement benefits.
Full duals are eligible for benefits from Medicare. Partial duals are limited to premium assistance and cost-sharing. Dual-eligible applicants may include persons with multiple chronic conditions, depression, dementia, and substance abuse.
Additional resources provided to patients include skilled nursing facility information, long-term care information, a portal user guide, and easier claim submission. If you disagree with a claim determination, you may appeal the decision and file a complaint. A “Members Handbook” is included to help provide information about the process. A complete listing of covered drugs is also available, with more than 60,000 pharmacies providing service.
Community Transition Program
CTP helps Ohio residents who are recovering at home. Addiction Services and the Ohio Department of Mental Health work together to provide support, and recovery assistance. Treatment and recovery services include crisis intervention, housing support, relapse prevention, spiritual assistance, substance use and abuse disorder, ambulatory detoxification, transportation, life skills, peer recovery help, employment assistance, outpatient individual and group services, and prescription drug assisted treatment.
Eligible applicants should contact the Ohio Department of Mental Health and Addiction Services or the Community Mental Health Center. The Case Manager, once assigned, can assist in the recovery process. These services are covered under Medicaid benefits, although CareSource is not required to be your carrier. An ID card is provided once the enrollment process is complete. Note: Four years ago, the program reverted back to the State of Ohio for complete administration.
Additional educational services and programs provided by CareSource include behavioral health, newsletters, eating healthy, preventive care, eating healthy foods, “MyHealth,” “MyStrength,” and pregnancy. The Board Of Trustees includes Michael E. Ervin MD, Craig J. Brown, Douglas A. Fecher, David C. Kaelber, Ellen S. Leffak, Gary L. LeRoy, William F. Marsteller, David T. Miller, and Erhardt H. Preitauer.
Drug Transition Policy
Depending upon the drug and circumstances, temporary supplies may be available if they are not on the covered drug list. Throughout the first three months of benefits, a one-time supply of a non-formulary drug is offered. Two requirements must be met to receive the benefit. The drug must be restricted, and also can no longer be listed on the plan’s drug list. A temporary supply can be easily requested by contacting CS member services. When refilling a prescription, the pharmacy will notify you when the prescription can be refilled.
A 31-day supply is provided to persons that are currently in a long-term care facility, and refills are also provided. Retirement homes, assisted living facilities, and additional non-skilled group homes do not qualify as a long-term care facility. Members that reside in a long-term facility and have been a member more than 90 days can immediately receive a supply. A single 31-day drug supply is available.
Caregiver Information
Caregivers for spouses, children, parents, and other persons often perform unrecognized and unappreciated work and service. Medical coverage, benefits, drug coverage, and network providers are topics that typically must be addressed. The members services department is always available to provide assistance on may topics, including meals on wheels, home repair programs, and in-home care.
Additional caregiving help is available through National Caregivers Library, Family Caregiver Alliance, National Alliance For Caregiving, Leading Age Caregiving Resources, and AARP Caregiving Resource Center. These resources are not endorsed by the carrier, but simply provided as a service.
