Where To Get Care

CareSource offers a focused network of health care partners. In order to have your health care services covered by your CareSource plan, you must get them from a network provider. The only exceptions are:

  • In cases of emergency;
  • If you need medically necessary, covered urgent care services when traveling out of our service area; or
  • When specifically authorized by CareSource. 

You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find in network providers and pharmacies for your plan, as well as search by specialty and more.

CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.

The Access Opportunity Form gives you a chance to suggest a doctor for our network, tell us about things like if it is easy to schedule appointments, and more.

CareSource Medicare Advantage plans offer a focused network of health care providers. In order to have your health care services covred by your CareSource plan, you must get them from a network provider. 

You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find providers in network for your plan, as well as search by specialty and more. 

Network Exceptions

It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are:

  • In cases of emergency
  • If you need medically necessary, covered urgent care services when traveling out of our service area
  • Out-of-area dialysis services
  • Cases in which CareSource authorizes use of out-of-network providers
  • In cases of emergency;
  • If you need medically necessary, covered urgent care services when traveling out of our service area; or
  • When specifically authorized by CareSource.

You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find providers in network for your plan, as well as search by specialty and more.

Find a Doctor/Provider  Find a Doctor/ProviderFind a Doctor/Provider

CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.

The Access Opportunity Form gives you a chance to suggest a doctor for our network, tell us about things like if it is easy to schedule appointments, and more.

Your Primary Care Provider (PCP)

You can choose a PCP who is a network provider. Your PCP will work with you to direct your health care. He or she will treat you for most of your routine health care needs. Visit My CareSource to choose or change your PCP. You may also call Member Services.

You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by accessing additional sites.

Going to a PCP is one of the most cost effective ways to access your benefits – ensuring you are getting the most value from of your health care dollar. When you tell CareSource who you have chosen to be your Primary Care Provider, it helps to ensure that your visits are billed at the PCP cost share level.

Going to the same PCP each time you need care will help your PCP get to know you and your needs. The more familiar your PCP is with you and your medical history, the better your PCP will be able to treat you.

If needed, your PCP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types of specialists.

Each member of CareSource has a Primary Care Provider (PCP). Your PCP is an individual physician, physician group practice, advanced practice nurse or advanced practice nurse group practice trained in family medicine (general practice), internal medicine or pediatrics. Your PCP is your personal doctor. He or she will:

  • Work with you to direct your health care
  • Treat you for most of your health needs
  • Send you to a specialist, if needed
  • Admit you to the hospital

If you haven’t chosen a PCP yet, you can call Member Services or log on to My CareSource for more information.

You may be a new patient to your PCP. If so, call to schedule a visit. This will help your PCP get to know your health needs right away. You should go within 90 days of joining CareSource.

Please keep all appointments you make. If you need to cancel or change times, call your doctor. You should call at least 24 hours in advance.

Your PCP helps you get preventive care. Make regular visits to your PCP. You should do this even if you do not feel sick. Routine checkups can help your PCP find problems early. Then they can be treated before they get worse.

Preventive care includes:

  • Regular checkups
  • Immunizations for children
  • Tests and screenings, when needed

You should see your PCP for all routine visits. Some examples are:

  • Routine checkups and tests
  • Colds/flu
  • Earache
  • Rash
  • Sore throat
  • Removal of stitches
  • Pain management

Visit My CareSource to choose or change your PCP. You may also call Member Services. You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by accessing additional sites.

Going to the same PCP each time you need care will help your PCP get to know you and your needs. The more familiar your PCP is with you and your medical history, the better your PCP will be able to treat you.

If needed, your PCP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types of specialists.

Your Primary Medical Provider (PMP)

You can choose any PMP who is a network provider. Your PMP will work with you to direct your health care. He or she will treat you for most of your routine health care needs. Visit My CareSource® to choose or change your PMP. You may also call Member Services.

You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by visiting sites.

Going to the same PMP each time you need care will help your PMP get to know you and your needs. The more familiar your PMP is with you and your medical history, the better your PMP will be able to treat you.

If needed, your PMP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PMP before you see many types of specialists.

Help Us Improve Our Provider Network

CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.

The Access Opportunity Form gives you a chance to suggest a doctor for our network, tell us about things like if it is easy to schedule appointments, and more.

Family Planning Providers

You do not need a referral to see a family planning provider. If you need help finding a family planning provider, you will find a list of network family planning providers in the Find a Doctor/Provider tool. If you need help choosing a family planning provider, call Member Services at 1-855-202-0729 (TTY: 1-800-255-0056 or 711). 

You may see a network family planning provider or a qualified out-of-network family planning provider for your care. CareSource will cover in-network and qualified out-of-network family planning provider services.

Low-Cost Primary Care Services

The Georgia Association for Primary Health Care helps people with no insurance or not enough insurance to get primary care. This will help Planning for Healthy Babies® enrollees find affordable primary care services they might not have access to under their family planning health plan.

Visit the website to learn more.

Where to Get Care After Hours

We want you to get the right care from the right health care provider when you need it. If your doctor’s office is closed or if you are very sick or hurt, you have options.

Convenience Care Clinics

If you are not able to see your PCP, we want to make it easy for you and your family to get medical help when you need it most. CareSource members can go to select clinics inside of CVS (MinuteClinic®), Kroger (The Little Clinic) and Walgreens to see board-certified family nurse practitioners for basic care. At the clinic, you can*

  • Get vaccines
  • Get health screenings and physicals
  • Get care for aches and pains, illnesses and minor injuries

Most clinics are open into the evening, 7 days a week.  Appointments are usually available the same-day, and walk-ins are welcome. Retail Convenience Care Clinics are part of the CareSource commitment to providing convenient health care access. You can find these network providers through Find a Doctor/Provider, our online search tool.

*childrens immunizations are not recommended and not covered by insurance.

CareSource24® Nurse Advice Line

CareSource24 provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call CareSource24 toll-free 24 hours a day, 7 days a week, 365 days a year at:

1-866-206-4240 (TTY: 1-800-750-0750 or 711)

1-866-206-7880 (TTY: 1-800-743-3333 or 711) 

1-866-206-7879 (TTY: 1-800-648-6056 or 711)-866-206-0701 (TTY: 1-800-982-8771 or 711)1-866-206-0554 (TTY: 1-800-750-0750 or 711) 1-866-206-0569 (TTY: 1-800-750-0750 or 711)1-844-206-5947 (TTY: 1-800-743-3333 or 711)1-844-206-5944 (TTY: 1-800-255-0056 or 711)

Our nurses can help you:

  • Decide when self-care, a doctor visit or the emergency room is appropriate
  • Understand a medical condition or recent diagnosis
  • Find out more about prescriptions or over-the-counter medicines

Urgent Care 

Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency but needs care right away. If you think you need to get urgently needed care, you can:

  • Call your PCP for advice.
  • Call CareSource24, our nurse advice line.
  • Go to a network urgent care center listed in our Find a Doctor/Provider

After you go, always call your PCP to schedule follow-up care.

When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.

Telemedicine 

With telemedicine, you can use your phone, a mobile app or computer to have a consultation with a board certified physician anywhere, anytime. It’s a good idea to call the CareSource24 Nurse Advice Line first.  They can help you determine the best course of action for your symptoms. They may refer you to MYidealDOCTORTM.

MYidealDOCTOR is a CareSource telemedicine provider. It provides members with 24/7/365 on-demand access to board certified physicians for consulting, diagnosing and prescribing with interactive audio or video for common illnesses. Members are normally contacted within 15 minutes of requesting a consultation.

Best of all, a visit with MYidealDOCTOR is the same copay as a regular primary care visit.  

MYidealDOCTOR offers behavioral health counseling sessions by web video and by phone with licensed psychologists, licensed clinical social workers and professional counselors from 8 a.m.  to 8 p.m. EST. To schedule an appointment, call 855-879-4332 or use the MYidealDOCTOR mobile app. You will be asked to take an assessment online before your appointment. Behavioral health visits need to be scheduled in advance.

Get More Details About MYidealDOCTOR.

CareSource also works with GPT to give you more access to specialty care through another type of telemedicine. You can see a provider that is far away using medical cameras and live video, from an office close to you. If you live in a rural area, this gives you better access to the care you need.

Your primary care physician (PCP) can refer you to a specialist. The GPT scheduling center can then schedule your appointment. You can meet with the specialist by video. This gives you a face-to-face visit. The specialist offers treatment and can then follow up with your PCP. You should also follow up with your PCP after the appointment with the specialist.

To schedule a visit, fill out an intake form at your PCP office or call the GPT scheduling center at 1- 866-754-4325.

Convenience Care Clinics

These clinics are available when your primary care physician may not be available. You can find these convenient clinics inside local CVS and Kroger stores. Visit a clinic when you can’t see your PCP and need to be seen quickly. Common care includes minor injuries, illness or immunizations. This is not an emergency service, but can be used when you can’t get in to see your PCP.  You can find a Convenience Care Clinic near you by searching “clinics” in our Find A Doctor/Provider tool. Find a Doctor/Provider tool. Find a Doctor/Provider tool. Find a Doctor/Provider tool. Find a Doctor/Provider tool.

Urgent Care

Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency but needs care right away.

If you think you need to get urgently needed care, you can:

  • Call your PCP for advice.
  • Call your PMP for advice. 
  • Call CareSource24, our nurse advice line.
  • Go to a network urgent care center listed in our Find a Doctor/Provider tool.

After you go, always call your PMP to schedule follow-up care.

After you go, always call your PCP to schedule follow-up care.

When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.

Emergency Services

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. Some examples of when emergency services are needed include:

If you have an emergency situation now, call 9-1-1 or go to the nearest emergency room. Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. We cover care for emergencies both in and out of the county where you live.  Some examples of when emergency services are needed include:

  • Miscarriage/pregnancy with vaginal bleeding
  • Severe chest pain
  • Loss of consciousness
  • Uncontrolled bleeding
  • Major burns
  • Miscarriage/pregnancy with vaginal bleeding
  • Severe chest pain
  • Shortness of breath
  • Loss of consciousness
  • Seizures/convulsions
  • Uncontrolled bleeding
  • Severe vomiting
  • Rape
  • Major burns

P4HB covers some emergency services. Those services must be related to conditions covered by P4HB. Some examples of when emergency services are needed include:

  • Blood clots
  • Perforated uterus due to IUD
  • Colposcopy procedure

Emergency care is covered both in and out of our service area, within the United States. You do not have to contact CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your primary care provider or the CareSource24 Nurse Advice Line.  

Emergency care is covered both in and out of our service area, within the United States. You do not have to contact CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your primary care provider or the CareSource24 Nurse Advice Line or your doctor.

Emergency Services may be the most expensive out of pocket cost for members, and should be used only when you have a true medical emergency. If you are unsure of whether you should use Emergency Services, please call our CareSource24 24-hour nurse advice line.

Emergency care is covered both in and out of our service area, within the United States. You do not have to contact CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your Primary Medical Provider or the CareSource24 Nurse Advice Line.  
HIP Members will be charged an $8 copay for non-emergency visits to the ER.

When You are Outside of our Service Area

If you get sick or hurt while traveling outside of our service area, you can get medically necessary covered services from a provider not in our network.

Prior to seeking urgent care, we encourage you to call your PCP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider.

If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, you will need to submit the bill you receive to CareSource with a claim form. You may obtain a claim form on the Forms page or by calling Member Services.

If you have additional questions about where to get care after hours or outside the service area, refer to the Evidence of Coverage for your CareSource plan.

Prior to seeking urgent care, we encourage you to call your PCP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider.

Prior to seeking urgent care, we encourage you to call you PMP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider.

If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, you will need to submit the bill you receive to CareSource with a claim form. You may obtain a claim form on the Forms page or by calling Member Services.

If you have additional questions about where to get care after hours or outside the service area, refer to the Member Handbook or Evidence of Coverage for your CareSource plan.

If you have additional questions about where to get care after hours or outside the service area, refer to the member handbook for your CareSource plan.

Community Transition Program (CTP) offers a focused network of providers referred to as health care partners. In order to have your health care services covered by your CTP plan, you must get them from a network provider.

You were assigned a provider when you enrolled in the program and this provider will be listed on your member handout. If you would like to be linked with a different CTP network provider please contact us.

Member Services: 1-844-539-1728 (TTY: 1-800-750-0750 or 711)

CareSource wants you to be happy with the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.

The Access Opportunity Form gives you a chance to suggest a CTP provider for our network, tell us about things like if it is easy to schedule appointments, and more.

You can also find additional resources through the Ohio Reentry Resource Guide. Please note, these resources are not CTP-covered benefits, but they may offer programs or services that CTP members would find helpful.

Find a Walmart Vision Center

CareSource is partnering with Walmart Vision Centers to offer vision services to CareSource Medicaid members in Ohio. All Walmart Vision Centers will offer optical goods to CareSource members; select Walmart Vision Centers will offer eye exams to CareSource members.

  • You must contact your desired location to verify that the optometrist is in-network prior to scheduling an appointment.

To find a Walmart Vision Center you can use our Find a Doctor/Provider tool or visit the Walmart website. To use Find a Doctor/Provider:

Step 1: Enter your zip code

Step 2: Select vision providers at the bottom of the list

Step 3: Click Search

It is always a good idea to call the desired location to verify the optometrist is accepting CareSource Medicaid (in network) prior to scheduling an appointment.

Please note that while CareSource strives to keep our records up-to-date, members must call before having services to make sure the vision provider takes CareSource Ohio Medicaid.

If you have a question or need to contact CareSource, please call Member Services

CareSource offers a focused network of health care partners. In order to have your health care services covered by your CareSource plan, you must get them from a network provider in most cases.

You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find providers in network for your plan, as well as search by specialty and more.

Out-of-Network

We have a broad health partner network to serve your physical and behavioral health needs. There are a few exceptions when you may be able to see a non-network provider. In some instances prior approval may be needed.

  • In cases of emergency (prior approval is not needed)
  • If you need medically necessary, covered urgent care services whentraveling out of our service area
  • During a defined “transition period” when you first join MyCare Ohio
  • During a declared disaster
  • When specifically authorized by CareSource

Your Primary Care Provider (PCP)

If you have both your Medicare and Medicaid from Caresource MyCare Ohio you must choose a primary care provider (PCP) who is a network provider. Your PCP is an individual physician or physician or physician group practice, certified nurse practitioner or physician assistant. Your PCP will work with you to direct your health care. He or she will treat you for most of your routine health care needs. Your PCP will also:

  • Coordinate your preventive care and checkups
  • Send you to other doctors (specialists) when needed
  • Admit you to the hospital if necessary
  • Get prior authorization from CareSource MyCare Ohio for some services

You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by accessing additional sites. If you need help finding a PCP please let us know.

It is best to see your PCP as soon as possible after you become a member of Caresource MyCare Ohio. The name and office telephone number of your PCP is printed on your member ID card.  Going to the same PCP each time you need care will help your PCP get to know you and your needs. The more familiar your PCP is with you and your medical history, the better your PCP will be able to treat you.

If needed, your PCP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types of specialists. It is still important to contact your PCP before you see a specialist or after you have an urgent or emergency department visit. This allows your PCP to manage your care.

Visit My CareSource to choose or change your PCP. You may also call Member Services.

Important Note: If you have your Medicare coverage through another plan (and only Medicaid through CareSource MyCare Ohio), your PCP must be designated through your Medicare plan. Contact your Medicare plan to choose your PCP. Make sure that any specialists you see are part of your Medicare plan’s network of providers.

Where to Get Care After Hours

We want you to get the right care from the right health care provider when you need it. If your doctor’s office is closed or if you are very sick or hurt, you have options.

CareSource24® Nurse Advice Line

CareSource24 provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call CareSource24 toll-free 24 hours a day, 7 days a week, 365 days a year at:

1-866-206-7861 (TTY: 1-800-750-0750 or 711) 

Our nurses can help you:

  • Decide when self-care, a doctor visit or the emergency room is appropriate
  • Understand a medical condition or recent diagnosis
  • Find out more about prescriptions or over-the-counter medicines

Convenience Care Clinics

If you are not able to see your primary care doctor, a retail Convenience Care clinic can provide medical help when you need it most.  A clinic visit is quicker and much less expensive than an emergency room visit for basic care. 

At a Convenience Care clinic, members can get a flu shot, get care for aches and pains, or get treatment for minor illnesses and injuries from a board-certified nurse practitioner.*

Most clinics are open into the evening, 7 days a week.  Appointments can be scheduled in advance, and walk-ins are welcome. Retail clinics are part of the CareSource commitment to providing convenient health care access. You can find these network providers through Find a Doctor/Provider, our online search tool.

*physicals are not covered at the clinics; some immunizations are not covered by insurance.

Urgent Care

Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency but needs care right away.

If you think you need to get urgently needed care, you can:

  • Call your PCP for advice.
  • Call CareSource24, our nurse advice line.
  • When possible, go to a network urgent care center listed in our Find a Doctor/Provider tool.
  • After you go, always call your PCP to schedule follow-up care.

When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.

Emergency Services

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. Some examples of when emergency services are needed include:

  • Miscarriage/pregnancy with vaginal bleeding
  • Severe chest pain
  • Loss of consciousness
  • Uncontrolled bleeding
  • Major burns

Emergency care is covered both in and out of our service area, within the United States.  You do not have to contact CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. You don’t need to get approval or a referral from your doctor. As soon as possible, typically within 48 hours, you or someone else must tell us about your emergency. If you are not sure whether you need to go to the emergency room, call your primary care provider or the CareSource24 Nurse Advice Line or your doctor.

CareSource covers emergency services needed during a declared disaster. Prior authorizations would not be necessary. We know that the situation may require you get care outside of our network. There would be no charge to you if a non-contracted provider was used.  A non-contracted provider may not bill you for the service.

Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), 7 a.m. – 7 p.m., Monday – FridayMember Services: 1-844-607-2829 (TTY: 1-800-743-3333), 8 a.m. to 8 p.m., Monday – Friday Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711) 7 a.m. to 7 p.m. Monday – FridayMember Services: 1-800-479-9502 (TTY: 1-800-750-0750 or 711), Monday through Friday, 7 a.m. to 7 p.m.Member Services: 1-888-815-6446 (TTY: 1-800-648-6056 or 711), Monday through Friday, 7 a.m. to 7 p.m.Member Services: 1-877-806-9284 (TTY: 1-800-743-3333 or 711), Monday through Friday, 7 a.m. to 7 p.m. Member Services: 1-855-202-0622 (TTY: 1-800-982-8771 or 711), Monday through Friday, 7 a.m. to 7 p.m.Member Services: 1-844-607-2827 (TTY: 1-800-750-0750 or 711). We are open 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.Member Services: 1-844-539-1728 (TTY: 1-800-750-0750 or 711)Member Services: 1-855-475-3163 (TTY: 1-800-750-0750 or 711), 8 a.m. to 8 p.m., Monday – Friday.  

You must use the in-network providers except in emergency or urgent care situations. If you obtain routine care from out-of-network-providers, neither Medicare nor CareSource will be responsible for the costs, unless specifically authorized by CareSource. You must use in-network pharmacies to access the prescription drug benefit, except under non-routine circumstances when you cannot reasonably use an in-network pharmacy.

Humana – CareSource offers a focused network of health care partners. In order to have your health care services covered by your Humana – CareSource plan, you must get them from a network provider. The only exceptions are:

  • In cases of emergency;
  • If you need medically necessary, covered urgent care services when traveling out of our service area; or
  • When specifically authorized by Humana – CareSource.

You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find providers in network for your plan, search by specialty and more.

Humana – CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.

The Access Opportunity Form gives you a chance to suggest a doctor for our network, tell us about things like if it is easy to schedule appointments, and more.

Your Primary Care Provider (PCP)

You can choose a PCP who is a network provider. Your PCP will work with you to direct your health care. He or she will treat you for most of your routine health care needs. Visit My CareSource to choose or change your PCP. You may also call Member Services.

You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by accessing additional sites.

Going to the same PCP each time you need care will help your PCP get to know you and your needs. The more familiar your PCP is with you and your medical history, the better your PCP will be able to treat you.

If needed, your PCP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types of specialists.

Where to get Care after Hours

We want you to get the right care from the right health care provider when you need it. If your doctor’s office is closed or if you are very sick or hurt, you have options.

24-Hour Nurse Advice Line

Our 24-Hour Nurse Advice Line provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call our 24-Hour Nurse Advice Line toll-free 24 hours a day, 7 days a week, 365 days a year at 1-866-206-9599 (TTY: 1-800-648-6056 or 711).

Our nurses can help you:

  • Decide when self-care, a doctor visit or the emergency room is appropriate
  • Understand a medical condition or recent diagnosis
  • Find out more about prescriptions or over-the-counter medicines

Urgent Care

Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency but needs care right away.

If you think you need to get urgently needed care, you can:

  • Call your PCP for advice.
  • Call our 24-Hour nurse advice Line (1-866-206-9599).
  • Go to a network urgent care center listed in our Find a Doctor/Provider

After you go, always call your PCP to schedule follow-up care.

When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.

Emergency Services

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. Some examples of when emergency services are needed include:

  • Miscarriage/pregnancy with vaginal bleeding
  • Severe chest pain
  • Loss of consciousness
  • Uncontrolled bleeding
  • Major burns

Emergency care is covered both in and out of our service area, within the United States. You do not have to contact Humana – CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your primary care provider or our 24-Hour Nurse Advice Line.  

When you are outside of our service area

Prior to seeking urgent care, we encourage you to call your PCP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider.

If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, and you paid for the service out of pocket, you will need to submit the bill you receive to Humana – CareSource with a claim form. You may obtain a claim form on the Forms page or by calling Member Services. If you did not pay out of pocket, the provider will work directly with Humana – CareSource and you will not need to submit the bill or form to us.  

If you have additional questions about where to get care after hours or outside the service area, refer to the member handbook for your Humana – CareSource plan.

Member Services:  1-855-852-7005 (TTY: 1-800-648-6056 or 711) 7 a.m. – 7 p.m., Monday – Friday EST.

CareSource is an HMO with a Medicare contract. Enrollment in CareSource Advantage® Zero Premium (HMO), CareSource Advantage® (HMO) and CareSource Advantage Plus® (HMO) depends on contract renewal.

 

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

   


CareSource® MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. The Formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary.


CareSource® MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. This information is not a complete description of benefits. Limitations and restrictions may apply. For more information, call CareSource MyCare Ohio Member Services or read the CareSource MyCare Ohio Member Handbook. Benefits may change on January 1 of each year.


MyCare Ohio Logo Updated 09/28/2018
H8452_OHMMC-1225
CMS Approved 10/1/2018