CareSource is one of a few options that lower-income, underserved communities have for a managed health plan.
In 1989, CareSource was founded on the premise of providing quality health care coverage for Medicaid consumers. Today it offers one of the nation’s largest Medicaid managed care plans. CareSource also offers private health insurance plans on the Health Insurance Marketplace, including Medicare Advantage and MyCare Ohio plans. CareSource has more than 1.9 million members across five states. The company employs about 3,800 people and is considered a nonprofit organization.
CareSource offers The Life Services program to help Medicaid members address their needs. To reduce dependence on governmental services, the program provides life coaching, access to resources and job opportunities.
To battle the opioid epidemic, CareSource has increased access to treatment largely through outreach with the CareSource integrated Medication Assisted Treatment program, which has a wide network of providers. They also provide pharmacy edits and lock-ins, which have reduced opioid prescriptions.
The Care4U model of healthcare is a community-based multi-disciplinary care management program that navigates the challenges members have regarding their health care. CareSource’s mission is to make a lasting difference in their members’ lives by improving their health and well-being.
CareSource was originally called the Dayton Area Health Plan (DAHP) and was lead by three hospital CEOs, the first of whom was Pamela Morris who worked at CareSource until retirement, in 2018. The DAHP began with a $500,000 grant and the company now has a revenue of $8.8 billion (2017).
It was in 2000 that DAHP’s name was changed to CareSource. In 2014 CareSource celebrated 25 years as one of the nation’s largest Managed Medicaid benefits. The CareSource Foundation also celebrated its 10th Anniversary in 2016. Over ten years, the Foundation gave more than $14.5 million in grants to over 1,000 different organizations throughout Ohio.
CareSource Health Insurance serves the following states: Ohio, Kentucky, Indiana Georgia and West Virginia. In some states, like Ohio, CareSource offers MyCare, a health plan that combines Medicare and Medicaid into a single plan.
|Medicare Star Rating||2.5 stars (out of 5)|
|NAIC Complaint Index||7.17%|
The CareSource app allows you to view your digial ID Card, find a doctor, file claims, make payments and more.
Each state has their own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/. Also, remember that CareSource only covers Ohio, Kentucky, Indiana Georgia and West Virginia.
CareSource accepts claims in various formats, including paper and electronic claims. Reimbursement is based on the prevailing state Medicaid or Medicare fee schedule. With Marketplace Plans, you can make claims inquiries at (866) 286-9949 (Indiana), (855) 852-5558 (Kentucky), (937) 224-3300 (Ohio), (678) 214 7500, (Georgia) and (855) 202-1091 (West Virginia). Visit your app or www.caresource.com to find the right claim forms for the state in which you live.
CareSource’s focus is the underserved population. Most of their health plans have an income cap.
CareSource does offer government-subsidized plans and plans on the marketplace.
If you qualify for Medicare or Medicaid, you are eligible for CareSource. Your savings on their marketplace plans are also based on total household income. Government plans require that all incomes in the household be taken into consideration, unless the person is not required to file federal taxes.
CareSource covers Ohio, Kentucky, Indiana Georgia and West Virginia.
Cancellation inquiries can be made at (866) 286-9949 (Indiana), (855) 852-5558 (Kentucky), (937) 224-3300 (Ohio), (678) 214 7500, (Georgia) and (855) 202-1091 (West Virginia).
Some procedures, like MRIs, MRAs, CT scans, CTA scans and PET scans, require pre-authorization, unless they are provided in an emergency department. All services that require prior authorization from CareSource need to be authorized before the service is rendered.
CareSource24® is a free 24-hour nurse advice line. It is commonly used to manage pregnancy, asthma, diabetes and more.
You can find a pharmacy using the CareSource app or your state’s CareSource state page. For Ohio members can Find a Pharmacy here.
CareSource covers CT scans if you have prior authorization from your network healthcare provider, like a primary care physician or specialist.
CareSource offers both PPO and HMO health plans.
If you choose to add on the optional CareSource Dental, Vision and Fitness Plan, your annual eye exam and eyeglasses are covered, up to a maximum amount each year.
Medicaid-covered services are offered at no cost, with no copays for visits and prescriptions. Transportation to and from appointments are covered if you must travel 30 miles or more from your home to a health care service. You will have CareSource24, which is a 24/7 access to a registered nurse. You will also be covered for behavioral health, disease management programs.
To be covered for transportation, you must travel 30 miles or more from your home to a health care service.
You can renew your benefits using the drop-down menu for members on the CareSource website.
CareSource marketplace plans cover the essentials like pregnancy, maternity and newborn care; prescription drugs; outpatient care; emergency services; hospitalization; mental health and substance use disorder services; rehabilitative/habilitative services and devices; laboratory services; preventive and wellness services; and pediatric services, which include dental and vision.
|Address||230 N. Main St., Dayton, OH 45402|
|Phone||1 (937) 224-3300|
The information listed on this page is from our own in house research. It is accurate as of the article publish date. Visit the carrier website for additional information.
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