Plan Documents
Review the plan documents to make sure you get the most from your plan. If you would like a printed copy of any of these documents, call Member Services and we can send it to you. You can also find plan documents in your CareSource MyLife account.
Evidence of Coverage (EOC)
Your EOC is a guide to your health care benefits. It tells you how our plan works, the covered services you get, services that are not included and your rights and responsibilities.
- 2026 Evidence of Coverage (EOC) CareSource Dual Advantage (TM) (10/14/2025) Last updated on 10/14/2025
- 2026 Evidence of Coverage (EOC) CareSource Dual Advantage (TM) Plus (10/29/2025) Last updated on 10/29/2025
- 2025 Evidence of Coverage (EOC) (5/20/2025) Last updated on 5/20/2025
Benefits at a Glance
Use the Benefits at-a-Glance to put your benefits to work for you! View the EOC for a full explanation of your benefits.
Summary of Benefits
The Summary of Benefits includes your covered benefits and any limitations. This is only a summary. View the EOC for a full list of benefits.
- 2026 Summary of Benefits CareSource Dual Advantage (TM) (10/06/2025) Last updated on 10/06/2025
- 2026 Summary of Benefits CareSource Dual Advantage (TM) Plus (10/06/2025) Last updated on 10/06/2025
- 2025 Summary of Benefits (10/01/2024) Last updated on 10/01/2024
Annual Notice of Change
The Annual Notice of Change (ANOC) outlines changes to your benefits for the upcoming year:
| 2026 – Find Your County Below | |
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Appling, Atkinson, Bacon, Baldwin, Banks, Barrow, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Bryan, Burke, Butts, Camden, Candler, Charlton, Chattahoochee, Cherokee, Clarke, Clayton, Clinch, Cobb, Coffee, Columbia, Coweta, Crawford, Crisp, Dawson, Dodge, Dooly, Douglas, Echols, Elbert, Emanuel, Evans, Fannin, Fayette, Forsyth, Franklin, Fulton, Gilmer, Glascock, Greene, Gwinnett, Habersham, Hancock, Haralson, Heard, Henry, Houston, Irwin, Jackson, Jasper, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lanier, Laurens, Lincoln, Long, Lumpkin, Macon, Madison, Marion, McDuffie, McIntosh, Meriwether, Monroe, Montgomery, Morgan, Murray, Newton, Oconee, Oglethorpe, Paulding, Peach, Pickens, Pike, Polk, Pulaski, Putnam, Richmond, Rockdale, Screven, Spalding, Stephens, Talbot, Taliaferro, Tattnall, Taylor, Telfair, Tift, Toombs, Treutlen, Turner, Twiggs, Upson, Walton, Ware, Warren, Washington, Wayne, Wheeler, White, Wilcox, Wilkes, Wilkinson |
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| 2025 – Find Your County Below | |
|---|---|
Bibb, Clarke, Clayton, Cobb, Coweta, Dawson, Douglas, Fulton, Gwinnett, Habersham, Henry, Lumpkin, Rockdale, Stephens |
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Baldwin, Barrow, Cherokee, Fayette, Forsyth, Greene, Houston, Jackson, Madison, Monroe, Morgan, Newton, Oconee, Oglethorpe, Paulding, Peach, Putnam, Spalding, Walton |
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Provider and Pharmacy Directory
The Find a Doctor tool has our most up-to-date list of network providers. You will find office hours, whether the office is on a bus line, if the provider is seeing new patients and more. The Find a Pharmacy tool has the most updated list of pharmacies.
- 2026 Full Provider/Pharmacy Directory (10/15/2025) Last updated on 10/15/2025
- 2025 Full Provider/Pharmacy Directory (11/26/2025) Last updated on 11/26/2025
You can also get a directory mailed to you. Our listings are updated daily, so the Find a Doctor tool has our most up-to-date list of network providers.
Forms
Visit the Forms page to find forms when you need them.
Prior Authorization List
Prior authorization is the approval that may be needed before you get a service. The service must be medically necessary for your care. Your provider will take care of this for you.
- 2026 Prior Authorization List CareSource Dual Advantage (TM)
- 2026 Prior Authorization List CareSource Dual Advantage (TM) Plus
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2025 Prior Authorization List
Last updated on 01/01/2025
Your provider can submit a request for a prior authorization using the Prior Authorization Request Form.
Prescription Drug Benefit Documents
- Comprehensive Formulary – A list of all drugs covered under your plan.
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2026 Comprehensive Formulary CareSource Dual Advantage
(Last updated 10/20/2025) -
2026 Comprehensive Formulary CareSource Dual Advantage Plus
(Last updated 10/20/2025) -
2025 Comprehensive Formulary
(Last updated 12/01/2025)
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2026 Comprehensive Formulary CareSource Dual Advantage
- Notice of Formulary Changes– Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates.
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2025 Notice of Formulary Changes
(Last updated 12/01/2025)
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2025 Notice of Formulary Changes
- Preferred Diabetic Supply List – We cover diabetic testing supplies. This list has the preferred products.
- 2026 Preferred Diabetic Supply List (Coming Soon)
- 2025 Preferred Diabetic Supply List (Last updated 01/01/2025)
- Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.
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2026 Medicare Part D prior authorization Criteria
Last updated on 10/15/2025 -
2025 Medicare Part D prior authorization Criteria
Last updated on 12/01/2025 - 2026 Medicare Part B Drug Prior Authorization Policies (Coming Soon)
- 2025 Medicare Part B Drug Prior Authorization Policies
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2026 Medicare Part D prior authorization Criteria
- Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed.
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2026 Step Therapy Criteria
Last updated 10/15/2025 2025 Step Therapy Criteria
Last updated 12/01/2025
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2026 Step Therapy Criteria
Drug Transition Policy – Learn about our policy for potentially covering a drug you currently take that is not listed in our formulary.
Coverage Determination Request Form online or hard copy Last updated on 11/01/2025 – If you believe you are entitled to payment or coverage on a certain drug, you can request a coverage determination by completing this form.
Coverage Redetermination Request Form online or hard copy Last updated on 11/01/2025 – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form.
Star Ratings
Star Ratings are given to the CareSource Dual Advantage plan by the Centers for Medicare & Medicaid Services (CMS). Plans are rated on a 5-point scale. Go to www.medicare.gov to learn more about Star Ratings.