Cost Saving Tips
Marketplace plans have two types of costs: premium and the cost for care. Premium is the monthly payment you make to keep your coverage and all the benefits and services that come with your CareSource plan. Cost for care is the cost for health care services that you and CareSource share. This page focuses on helping you lower your cost for care.
Your costs for care consist of provider costs and cost shares.
- Provider costs. We work with providers to agree on an overall cost for services. Overall cost considers the place (ER, office, clinic) and the cost of working with the provider. This has a high impact on the cost of the service you get.
For example, going to the hospital ER for a UTI or ear infection is going to cost you much more than going to an Urgent Care or your PCP’s office for the same issue.
- Cost shares are based on the plan you picked and tell you how we share the cost of services. Cost shares are stated as copays, coinsurance, and annual deductible, and apply to most services.
Call the CareSource24® Nurse Advice Line to make sure you are going to the right place for care, such as seeing your PCP instead of going to the emergency room (ER). Your cost share is much higher for a visit to the ER. Our nurses can also give you advice and help you find a provider if needed.
Learn more about CareSource24 on our Where to Get Care page.
Use Network Providers
Make sure you are using CareSource Marketplace network providers. Use the Find A Doctor tool to find a provider near you.
Visit your PCP more often and make the most of your free preventive care. This helps you better manage your health and can cut your costs. Much like upkeep on a car, it costs more if your brakes go out and you crash instead of getting them checked and serviced routinely. Visiting your doctor often also lets you plan for needed health care procedures.
Talk about cost with your provider. When they know it is important to you, they will keep it in mind when prescribing drugs and sending you for tests or other kinds of care.
Talk About Your Medications
Talk with your provider about getting the most cost-effective drug for your health care needs. Many things go into a provider’s choice of drug for you. We do not suggest only thinking of cost, but there may be a few choices of drug for a certain condition.
There may be a lower-cost drug option that has the same effect as higher cost drugs. And of course, generic drugs are always a lower-cost choice that are proven safe and have same effect as their name-brand equal.
Ask your doctor if the drug is on the CareSource Marketplace formulary, or if there is a similar drug that may work as well for your need that is on the formulary.
You can also see if a drug is on the formulary and what it may cost by checking Find My Prescriptions Price a Medication tool. You will need to know your Marketplace plan name to get the right drug pricing. It will tell you if a drug is covered and the expected cost.
Speak openly with your provider and you might save a lot of money.
Shop around for specialty care. Many of us cut coupons, shop for deals, and wait for sales. Using those skills on your health care can save you money. When you have the chance to plan for your health care needs, you can shop to find the best provider at the best price for you. Before you get care, many providers will give you an idea of their cost and what you may pay.
Try Our Total Cost Navigator (TCN)
Use this online tool to find to do a cost comparison on the service or procedure you need. We will be upgrading soon to a new cost estimating tool with at least 500 common services you can look up and compare. You can compare providers, as well as hospitals and outpatient centers in your area to see average costs. You can find the Cost Navigator tool in My CareSource.
Avoid the ER for Non-Emergencies
Use Our Zero-Cost Telehealth Provider. Teladoc® is our 24-hour, 7 day a week telehealth provider.
- You can talk with a provider and have a prescription* called in to a local pharmacy any time. It is fast and easy to use when you can’t reach your PCP, don’t want to wait, but don’t need the hospital ER.
- You can also use Teladoc services for mental health and substance use disorder counseling by appointment from 7 a.m. to 9 p.m. Eastern Time, 7 days a week.
- Learn more about Teladoc and our Zero-Cost Telehealth Provider program on our Telehealth page. Call 1-800-TELADOC (835-2362) or visit www.Teladoc.com/CareSource.
*Teladoc providers cannot prescribe DEA controlled substances.
Consider Using a Convenience Care Clinic**. It is the same cost as a PCP visit and often offer same day visits. Most are open weekends and evenings. These clinics are found inside many local retail stores such as CVS and Walmart. Learn more about Convenience Care clinics.
**Convenience Care Clinic benefits are not available to West Virginia Marketplace members.
Visit an Urgent Care Clinic. For more serious injuries and common sickness, an urgent care clinic may be a better choice than an ER. You can get in and out faster, and for a lower copay or coinsurance. Most urgent care clinics are open evenings and weekends when your PCP’s office may not be. Learn more about Urgent Care Clinics.