Review your CareSource marketplace plan documents to make sure you get the most from your health insurance plan. You can also contact us with any questions you have about your plan coverage.
CareSource Gold Plans
Higher premiums and lower out of pocket costs.
If you expect to have a lot of doctor appointments, need many prescription medicines, or need other health services, this may be a good choice for you. Gold plans have:
Higher premiums. You pay more each month for a Gold plan than you would for another metal level.
Lower out-of-pocket costs. With a Gold plan, the amount you pay each time you get a health service, such as seeing a doctor or filling a prescription, is less than what you’d pay if you have a Bronze or Silver plan.
CareSource Silver Plans
The only plans offering cost sharing reductions (CSRs).
The CareSource Silver Plan is our most popular plan. In fact, 50% of our members find that it fits best into their lifestyle and budget.
- Low Premium Plan reduces your overall premium while still allowing for CSRs.
- Standard Silver Plan Option offers a balance between our Low Premium and Low Deductible options.
- Federal Standard offers a balance between our Low Premium and Low Deductible options.
- Essential Silver Plan simplifies your health care. Your deductible and out of pocket maximum are the same amount, and generally lower than other Silver plans, with easy to understand benefits, including 3 free PCP visits, 3 free Mental Health/Substance Use Disorder office visits, and 3 free Convenience Care Clinic visists per year, along with free preventive care and our Zero Cost Telehealth program with Teladoc. Other benefits are out-of-pocket until your deductible is satisfied and then all essential health benefits are covered with no cost share.
Financial Assistance – These are the only plans where you can take advantage of cost sharing reductions (CSRs). If you qualify for CSRs, they will lower your out-of-pocket costs – deductibles, copayments, and coinsurance. Eligibility for CSRs is determined by the Health Insurance Marketplace and is based upon your household size and income.
CareSource Bronze Plans
Lowest premiums and highest out of pocket costs.
If you don’t expect to have many doctor appointments or need many prescription drugs, this may be a good choice for you. Bronze plans have:
Lowest premiums. You pay less each month for a Bronze Plan, but these plans have the highest deductibles and other out-of-pocket costs.
- Bronze First – Our classic Bronze plan, rebranded to highlight the first dollar benefits available. (First dollar benefits mean benefits that we cover before you meet your deductible. This is not available with most Bronze plans.) This plan focuses on keeping premiums low, while still providing for preventive services and other more common health care needs to be covered before you satisfy your deductible. This plan offers first dollar benefits for primary care, specialist, convenience care clinic visits and generic prescriptions.
- Bronze Low Premium Federal Standard – A new Bronze plan design (available in select areas) that offers preventive services and generic prescription coverage pre-deductible. This plan provides all of the coverages and protections of the Affordable Care Act (ACA) while offering the lowest cost by having limited coverage available before your deductible is met.
- HSA Eligible – A CareSource marketplace plan designed to be compatible with a tax advantaged Health Savings Account (HSA). Outside of preventive services, you’ll need to satisfy your deductible before CareSource contributes to your health care costs.
HSA Bank is our recommended partner for your Health Savings Account. Learn more about HSA Bank or call their Client Assistance Line at 1-800-357-6246, 24 hours a day, 7 days a week.
The Member Handbook is a quick reference guide to your health care benefits. It allows you to quickly look up information such as how to contact us, how to request an ID card and how to pay your bill.
Evidence of Coverage (EOC)
The EOC is an important legal document that describes the relationship between CareSource, and CareSource members. It serves as your contract with CareSource and describes CareSource members’ rights, responsibilities and obligations. It also tells you how the plan works, the covered services you are entitled to, any conditions and limits related to covered services, the health care services that are not covered by the plan, and the annual deductible, copayments, and coinsurance you must pay when you receive covered services.
Access the EOC below that corresponds to your plan:
- 2023 CARESOURCE EVIDENCE OF COVERAGE
- 2023 CARESOURCE EVIDENCE OF COVERAGE – DENTAL, VISION AND FITNESS PLAN RIDER
- 2022 CARESOURCE EVIDENCE OF COVERAGE
- 2022 CARESOURCE EVIDENCE OF COVERAGE – DENTAL, VISION AND FITNESS PLAN RIDER
We want you to easily find the forms you need for your CareSource marketplace plan. Visit the Forms page to find any form when you need it.