Coverage you can afford, understand & use

Afford*

  • No Copays for Primary Care Visits with Most Plans
  • Free Generic Prescriptions with Most Plans
  • Free Preventive Care
  • Low Monthly Premiums
  • Low Annual Deductibles

Understand

  • Why You Need Health Insurance
  • Protection When You Get Sick
  • Protection Because Accidents Happen
  • No Denial for Pre-Existing Conditions

Use

  • Improve Your Health
  • Doctor Visits
  • Urgent Care
  • Flu Shots
  • Hospitalization
  • Emergency Services
  • Prescription Drugs

Silver
Greatest cost savings based on income & family size

  • Low monthly premiums
  • Higher annual deductible, copays, coinsurance & out-of-pocket costs

Gold
Coverage for those who visit the doctor frequently

  • Higher monthly premiums
  • Lower out-of-pocket costs

Bronze
Coverage for those who rarely need a doctor

  • Lowest monthly premiums
  • Highest out-of-pocket costs

Plan Features*

  • Free ($0 copay) primary care visits (Gold and Silver plans)
  • Free ($0 copay) retail clinic visits (Gold and Silver plans)
  • Free ($0 copay) generic medications (Gold and Silver plans)
  • No deductible for prescriptions (Gold and Silver plans)
  • Low premiums and low annual deductibles
  • Focused network of doctors & providers
  • CareSource24®, 24/7/365 nurse advice line
  • Optional adult dental & vision coverage in some states

Essential Health Benefits

  • Free preventive & wellness services (mammograms, diabetes screenings, flu shots & more)
  • Prescription drugs
  • Outpatient services (doctor visits, urgent care, diagnostic testing & more)
  • Hospitalization (such as surgery)
  • Emergency services
  • Mental health, behavioral health & substance use disorder services (includes counseling & psychotherapy)
  • Pediatric services including dental & vision care for kids
  • Maternity & newborn care
  • Laboratory services
  • Rehabilitative/habilitative services & devices

Dental & Vision in some states

  • An optional benefit covering members 18 & over
  • Two routine dental exams with cleanings per year
  • One routine eye exam per year
  • Prescription lenses, contacts & frames
  • Allowances for basic dental (X-rays & fillings) & major dental (impactions & dentures)
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CareSource Just4Me Special Enrollment Period

Did you get married, have a baby, recently move or switch jobs?

Did you know you can enroll in CareSource Just4Me after open enrollment has ended?

If you have a qualifying life changing event, you are eligible for the special enrollment period (SEP) through the state or federal Marketplace.

The special enrollment period is going on now.

Get started today!

Start an application. After you enter your ZIP code, you will be routed to the state or federal Marketplace to complete your application.

Life Changing Events Include

  • Getting married
  • Having a baby
  • Moving outside your insurer’s coverage area
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Adopting a child or placing a child for adoption or foster care
  • Losing other health coverage due to losing job-based coverage, divorce, the end of an individual policy plan year in 2015, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and other similar circumstances
  • Gaining status as a member of an Indian tribe - Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
  • Having a change in income or household status that affects eligibility for advance premium tax credits or cost-sharing reductions IF you are already enrolled in coverage through the Marketplace

Important:

Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.

Already enrolled in a CareSource Just4Me plan?

Remember, if you have a life changing event you will need to check your personal information on the Marketplace to ensure you still qualify for the same health insurance coverage. Get started by entering your ZIP code. You will be routed to the state or federal Marketplace to begin.

Do you qualify for the special enrollment period?

Get started by entering your ZIP code. You will be routed to the state or federal Marketplace to complete your application.

ADV-SEP Web-OH(HIX)-65a

ADV-SEP Web-WV(HIX)-65a

What do I Pay?

Health insurance costs can be confusing. That’s why it’s important that you understand what you pay and what CareSource Just4Me pays when you use your benefits. Learn more about how to pay for CareSource Just4Me.


Premium

A premium is an amount you pay for your insurance plan each month.

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You pay this amount even if you don't use medical care that month. Your health insurance premium is similar to your auto insurance premium. You pay it monthly so that you are covered when you need it.


Coinsurance & Copayment

Coinsurance & copayments (or copays) are set amounts you pay each time you use some services, such as going to see your primary care provider or specialist.

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When services have a coinsurance or copay, you pay the health care provider that amount, usually at the time of service. CareSource Just4Me pays the provider the balance of the bill.

  • Coinsurance is typically a percent of a bill.
  • Copayment is typically a set dollar amount.

If...

Your copayment for a primary doctor’s office visit is $20.

You visit your doctor, and the amount is $125.

You pay the doctor the $20 copayment.

CareSource Just4Me pays the doctor $105.

If...

Your coinsurance for a medical procedure is 30 percent.

The amount of the medical procedure is $600.

You pay the provider 30 percent or $180.

CareSource Just4Me pays the remaining 70 percent or $420.


Deductible

An amount of money that insurance plans require you to pay once a year before CareSource starts to pay its share.

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The deductible does not apply to all health care services. For example, doctor’s office visits to your primary care provider do not have an annual deductible. Even if you have not yet met your annual deductible, you can still see your primary care provider. You may have to pay a copay for a primary care visit, depending on your plan.

For some services, CareSource Just4Me pays eligible expenses after you have met your annual deductible. When services have an annual deductible, you pay the health care provider for services until you have met the annual deductible amount. CareSource Just4Me pays the provider for eligible expenses after you have paid this amount. Your annual deductible starts over every January.

If...

Your copay for a primary care (doctor’s office) visit is $20.

You visit your doctor, and the amount is $125.

You pay the doctor the $20 copayment.

CareSource Just4Me is responsible for the remainder of the amount, $105.

To visit the emergency room (ER), a deductible does apply.

If...

Your plan requires you to pay $300 for an ER visit after you’ve met your deductible.

Your annual deductible is $200, and your ER amount is $2,200.

This means you need to pay $200 to meet your deductible plus the $300 copay for the ER visit.

CareSource Just4Me is responsible for the remainder of the amount, $1,700.

At this point, you have met your annual deductible of $200 for the year.

This deductible applies to other services too. After you have met your annual deductible (in this example, $200), any service that has a deductible will only require you to pay the copay or coinsurance amount for the rest of the year.

Please note that not all out-of-pocket costs go toward meeting your deductible. Coinsurance, copays and premiums do not count toward your annual deductible.

As in the example above, the $20 copay for the doctor’s office visit did not go toward the $200 deductible amount.


Out-of-Pocket

Out-of-pocket costs are what you pay during the year through deductibles, copays and coinsurance.

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Premiums and services not covered by CareSource Just4Me do not count toward your out-of-pocket maximum. After you meet your annual out-of-pocket maximum, CareSource Just4Me begins to pay 100 percent for covered health benefits. Your out-of-pocket maximum starts over each January.

If...

Your annual out-of-pocket maximum is $650, and your annual deductible is $200.

You visit the ER, and the amount is $2,200.

Your plan requires you to pay $300 for an ER visit after you’ve met your deductible.

This means you need to pay $200 to meet your deductible plus the $300 copay for the ER visit.

CareSource Just4Me is responsible for the remainder of the amount, $1,700.

At this point, you have paid $500 toward your out-of-pocket maximum and have met your deductible.

Now, your doctor recommends that you have a magnetic resonance imaging (MRI) scan.

If...

Your plan requires you to pay $150 for an MRI after meeting your deductible.

The MRI amount is $2,500.

Because you’ve already met your deductible, you pay the $150 copay and CareSource Just4Me is responsible for the remaining $2,350.

At this point, you have met your $650 annual out-of-pocket maximum. For the rest of the benefit year, CareSource Just4Me will pay 100 percent of covered services as defined in the plan’s Summary of Benefits and Coverage or Schedule of Benefits. To find these documents for your CareSource Just4Me plan, access our Plan Details.

Want to learn more about paying for insurance, enrolling in a plan and coverage and benefits? Access our Frequently Asked Questions for more information.

How Can I Save?

When you enroll, the Health Insurance Marketplace determines your eligibility for cost savings based on your income and family size.

View Table

Simulation of eligibility ranges:

Number of people in your household123456
Yearly Income$16,243- $47,080$21,983- $63,720$27,724- $80,360$33,465- $97,000$39,206- $113,640$44,947- $130,280

Two types of cost savings through the Health Insurance Marketplace:

  • Cost sharing reduction
  • Advance premium tax credit (or subsidy)

Cost Sharing Reduction

A cost sharing reduction is a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance and copayments.

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When you enroll through the Marketplace and review the plans you qualify for, this discount will be built into your Silver level plans. This discount is what makes the Silver plans so cost effective.


Advance Premium Tax Credit

An advance premium tax credit is a tax credit or subsidy that can be used in two ways.

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If you use the tax credit to lower your monthly premiums, you get the savings throughout the year. If you apply your tax credit to next year’s tax return, you increase your chance of getting money back at tax time. You decide how to use your tax credit when you enroll through the Health Insurance Marketplace.

  • Right away to lower your monthly premium payments
  • When you file your federal tax return