Medical Benefits

Copayments and Fees

As a CareSource Dual Advantage member, you have a $0 copay for in-network visits to a primary care provider, specialists, skilled nursing facility, ambulatory surgical center, urgent care and more. You also have a $0 copay for lab services such as diagnostic tests and procedures and diagnostic radiology tests such as MRIs and CT scans as well as outpatient x-rays.

This information is not a complete description of benefits. View Chapter 4 Medical Benefits (what is covered) of your Evidence of Coverage (EOC) on the Plan Documents page to learn more about what’s covered through your plan.

Find A Doctor/Provider

CareSource has a contracted network of doctors, hospitals, pharmacies and other providers. That is what we call a “network provider.” To have your health care services covered by your plan, you must get them from a network provider.

Use our Find A Doctor/Provider tool to see if your doctor is in our network. Click on Get Started and fill out location information. Under the Choose Plans page, scroll to your state and filter the results under Medicare by selecting Dual Special Needs from the list.

Network Exceptions

Use providers that are part of our network when you get medical services. There are limited exceptions when you can use an out-of-network provider. View Chapter 3 Using the plan for your medical and other covered services in your Evidence of Coverage (EOC) on the Plans Documents page for full information on in-network and out-of-network copayments, as well as applicable conditions and limitations.

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. You should get urgent care from the nearest and most appropriate health care provider. Emergency care is covered both in and out of our service area.

Prior to seeking urgent care, we encourage you to call your PCP or talk with a provider via Teladoc® for guidance, but this is not required. You can find the phone number of your PCP on your CareSource member ID card. You can also call CareSource24® any time you have a question about your health. You can find the phone number of your PCP and CareSource24 on your CareSource member ID card

If you receive emergency care from an out of 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 found on our Forms page. You can also get a claim form by calling Member Services at 1-833-230-2020 (TTY: 1-833-711-4711 or 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.

Please call Member Services or see your Evidence of Coverage for more information.