Frequently Asked Questions

Find out why a CareSource Just4MeTM insurance plan is just right for you.  Review our FAQs for answers to your questions.  

Need additional information?  Call us at 1-800-479-9502 or provide your contact information and we will contact you.  We can help you navigate the Health Insurance Marketplace and enroll in a CareSource Just4MeTM insurance plan.

  • CareSource Just4Me™

    • What is CareSource?
      • CareSource is a non-profit managed care company based in Ohio. We currently provide managed health care coverage to more than 950,000 Ohioans with high member satisfaction rates.  Unlike most insurance companies, CareSource is a non-profit organization; we are focused more on people than profits. We pride ourselves on understanding our members and helping them understand and access their health insurance services.

        Since it began 24 years ago, CareSource has grown to be one of the largest Medicaid managed health care plans in the country. But now, we are expanding to offer health insurance plans to all Ohioans through the Health Insurance Marketplace. CareSource is an Ohio-licensed health insuring corporation.

        Starting in 2014, CareSource will use its network of health care providers and its regional presence to provide quality and affordable health insurance coverage to all Ohio customers through a new health insurance plan, Just4Me™.

    • What is CareSource Just4Me™?
      • CareSource Just4Me™ is the name of a new health insurance plan that CareSource is offering to all Ohioans through the Health Insurance Marketplace. It offers affordable health insurance options with no limits due to pre-existing conditions or annual benefit caps. And many Ohioans who are uninsured may even qualify for advance tax credits to make it more affordable. Just4Me™ continues the CareSource history of making health care coverage easy to understand and access – it’s Health Care with Heart!

    • What is the benefit of buying health insurance coverage through CareSource?
      • Unlike many other insurance companies, CareSource is a non-profit organization focused more on people than profits. We pride ourselves on understanding our members and helping them understand and access their health insurance services. CareSource currently provides managed health care coverage to more than 950,000 Ohioans with high member satisfaction rates.

        Also, because CareSource offers Medicaid and Medicare Advantage plans in Ohio, members who are transitioning off of Medicaid may enroll in Just4Me™ with ease – changing physicians may not be necessary. Other families can enjoy the ease of having one managed care company coordinate benefits for their entire family – those on Medicaid and those purchasing Just4Me™ coverage.

    • What is a Qualified Health Plan (QHP)?
      • The Patient Protection and Affordable Care Act, also known as health care reform, created rules for insurance plans offered through the Health Insurance Marketplace. The plans that meet these rules are defined as "Qualified Health Plans" or “QHPs.” CareSource Just4Me™ is a new insurance plan that meets these rules. We will begin enrolling Ohioans into CareSource Just4Me™ in October 2013, with coverage to begin January 1, 2014.

  • Just4Me™ Enrollment

    • How do I enroll in CareSource Just4Me™?
      • To enroll in CareSource Just4Me™ online after October 1, 2013:

        1. Begin by collecting the following information for yourself and the family members you want to enroll:
          • Social security number or document number for legal immigrants
          • Employer and income information, for example, wage and tax statements from pay stubs or W-2 forms for the most recent year
          • Policy number if currently covered by health insurance
          • Information about the employer’s health insurance plan if eligible for employer health insurance coverage (even if the coverage is offered through another person’s job, for example, a spouse’s or a parent’s), for example, whether the plan covers the employee’s spouse or dependents and how much the plan costs
        2. Create a Just4Me™ account with a username and password of your choice.
        3. Select your county so that we can verify that you live in a Just4Me™ coverage area.
        4. The system will connect you to the Health Insurance Marketplace. You will enter a separate username and a password of your choice for the Marketplace, then complete a form used to verify your eligibility and see if you qualify for cost savings that will lower your monthly payment. It will also let you know if you or your family members are eligible for other health care coverage programs such as Medicaid or the Children’s Health Insurance Program (CHIP).  Note:  This process may take 20+ minutes. If you stop during the process, you can use your Marketplace login to begin where you left off.
        5. After you complete the enrollment form to determine your cost savings and eligibility, you’ll be routed back to the CareSource Just4Me™ website where the information will be used to generate quotes based on your options. You can then compare and select a plan, select a primary care provider (PCP), make a payment, and complete the enrollment process.

        Ready to enroll?  Click here to begin.

        Need help enrolling?

        CareSource is providing  in-person enrollment help through sessions offered in communities throughout Ohio.  Click here to see a list of the sessions that are currently scheduled.

        You can also call CareSource Just4Me™ Customer Service at 1-800-479-9502. A friendly, licensed Customer Support Representative will walk you through the enrollment process. 

    • How do I find out if I qualify for cost-sharing reductions or advance premium tax credits?
      • The CareSource Am I Eligible? Estimator allows you to enter your family income and size and calculate an estimate of your cost savings. To confirm and apply your cost-sharing reductions and advance premium tax credit, just follow the steps to enroll online. The Health Insurance Marketplace will confirm your eligibility for cost sharing reductions and the amount of your tax credit (if applicable) and will bring you back to the CareSource Just4Me™ website to apply these cost savings to your health insurance plan.

        It is estimated that over 900,000 people in Ohio will qualify for these cost savings. 

    • How much time will it take to enroll?
      • It may take 20 - 45 minutes to enroll through the Ohio Health Insurance Marketplace and determine your eligibility for cost savings. We recommend you gather all of the information needed for enrollment before you begin to speed the process.

    • What information do I need before I begin the enrollment process?
      • You’ll need the following information for yourself and the family members you want to enroll:

        • Social security number or document number for legal immigrants
        • Employer and income information, for example, wage and tax statements from pay stubs or W-2 forms
        • Policy number if currently covered by health insurance
        • Information about the employer’s health insurance plan if eligible for employer health insurance coverage (even if the coverage is offered through another person’s job, for example, a spouse’s or a parent’s)
    • Do I need to complete the enrollment process during one sitting or can I stop and finish at a later time?
      • You do not have to complete the enrollment process in one sitting.  At any time, you can stop and save your work. When you return to finish the enrollment, you will enter the user ID and password that you created to re-access the enrollment process. The information that you entered originally will be there.

    • English is not my native language. What are my enrollment options?
      • CareSource can help you enroll in a language you understand.  Call Customer Service at 1-800-479-9502 and we will get someone who can speak your language to help you.  If you need help with the Marketplace, it is available through a toll-free call center staffed 24/7. Just call 1-800-318-2596. The Marketplace language line provides information in 150 languages.  A Spanish website, www.cuidadodesalud.gov, is available and you can have a web chat in Spanish too.

    • I’m having technical issues with my browser while trying to enroll through the Marketplace. What can I do?
      • You can make sure that your internet browser (for example, Microsoft Internet Explorer, Google Chrome or Mozilla Firefox) is up to date before starting the enrollment process.  

        If you are having issues enrolling with your current browser, you might try installing and using a different browser. For example, if you’ve had problems enrolling using Internet Explorer, you may want to install Google Chrome.

        See below for instructions to update or install the most commonly used internet browsers.

        Microsoft Internet Explorer (IE)

        Microsoft uses the Windows Update feature to install the latest version of IE. If you have installed all of the latest updates from Microsoft, you should be running the latest version of IE. To check for updates, access the Start menu, select All Programs, and then click Windows Update.

        You can click here to install the most current version of IE.

        Google Chrome

        Chrome is updated automatically when updates are released to the public. To find out if you are running the most current version, access the Menu icon and then click About Google Chrome. If Chrome is up to date, you will see a check mark with the statement “Google Chrome is up to date.” When updates are available, they will display on the Menu.

        To install Google Chrome, click here.

        Mozilla Firefox

        When updates are available, Firefox automatically downloads them and prompts you to install them. To check to see if your version of Firefox is up to date, access the File menu and click Help. If you don’t see the File menu you can press the Alt key. On the Help menu, click About Firefox. If you are running the most up-to-date version, you will see the message “Firefox is up to date.” If not, you’ll have an option to download the latest updates.

        Click here to download and install the latest version of Firefox.

    • What happens after I enroll?
      • After you enroll in CareSource Just4Me™, you will get a letter or email acknowledging your enrollment and providing you basic information. Shortly before your coverage begins on January 1, 2014, you will get an enrollment packet and ID card for the covered members of your family.

    • Do I need to select a Primary Care Provider (PCP)?
      • Yes, you should. In order for your doctor visits to be paid for by CareSource Just4Me™, you must get care from providers in our plan’s network. A primary care provider (PCP) helps guide your health care and treat you for routine health care needs.  If needed, your PCP will send you to other doctors (specialists) or admit you to the hospital.  Establishing yourself as a patient with a PCP before you get sick can also help you get in to see a doctor faster when you need care.

        We can help you find a PCP in your area.  Call Just4Me™ Customer Service at 1-800-479-9502. You can also use our Provider Directory to search for doctors in your area.

    • What if I qualify for cost savings through the Marketplace and my income changes after I enroll?
      • When you enroll, you estimate your earnings for next year, and this estimate determines your cost savings.  You must report any income change, up or down, that impacts your eligibility for cost savings to the Marketplace at www.HealthCare.gov. Otherwise, you may miss out on the cost savings or end up owing money if you no longer qualify for the cost savings. So, if your income changes your estimated earnings for the year, for example, through a job change or job loss, you should report it to the Marketplace.

        You must also notify the Marketplace in the following situations:

        • If you become pregnant
        • If you have a baby
        • If your address or phone number changes
        • If your immigration status changes
        • If your marital status changes
        • If you become eligible for other health care coverage
  • Paying for Insurance

    • How do I pay the monthly premium amount for CareSource Just4Me™ health insurance?
      • When you enroll in a CareSource Just4Me™ health insurance plan, you will need to pay the first month’s premium in full by January 31 in order to be covered starting January 1, 2014. Starting in 2014, you will receive a bill for your premium each month. You can make premium payments using the following options:

        • Online at CareSourceJust4Me.com, with a major credit card, debit card, automated clearing house (ACH) payment or electronic check
        • By mailing a check or money order to CareSource, P.O. Box 630568, Cincinnati OH 45263-0568. Please include your CareSource Member ID number on your check if you did not print a payment coupon.
    • Will I receive a bill each month?
      • Yes. CareSource will send you a bill each month for the next month’s coverage. For example, you will receive a bill in January for February’s coverage. Your payment is due upon receipt of the bill.

    • What does it mean to have an annual deductible?
      • For some services, insurance will pay 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 paid the annual deductible amount.  CareSource Just4Me™ begins to pay the provider for eligible expenses after you have paid this amount. A benefit of being a CareSource member is the out-of-pocket costs are pre-negotiated by CareSource with the provider, thus providing a substantial discount for many types of services.

        To determine the services that have an annual deductible, refer to the Summary of Benefits and Coverage or the Schedule of Benefits for your CareSource Just4Me™ insurance plan. 

    • What does it mean to have a coinsurance or copayment amount?
      • For some services, insurance pays eligible expenses after you have paid a coinsurance or copayment amount. Coinsurance is typically a percent of a bill; copayment is typically a set dollar amount. When services have a coinsurance or copayment amount, you pay the health care provider that amount, usually at the time of service. The provider files a claim with CareSource for the rest of the bill, and CareSource pays the provider directly.

        To determine the services that have a coinsurance or copayment amount, refer to the Summary of Benefits and Coverage or the Schedule of Benefits for your CareSource Just4Me™ insurance plan.

  • Just4Me™ Coverage

    • What health care benefits are covered through CareSource Just4Me™?
      • CareSource Just4Me™ covers a wide variety of health care services designed to get you healthy and keep you healthy, including:

        • Primary care and specialty physician services
        • Outpatient services
        • Hospitalization
        • Emergency services
        • Maternity and newborn care
        • Mental health and substance abuse treatment
        • Prescription drug coverage
        • Preventative and wellness services
        • Rehabilitative and habilitative services and devices
        • Laboratory services
        • Chronic disease management
        • Long-term care services
        • Covered clinical trials
        • Podiatry Care
        • Pediatric health and vision services
        • Optional dental and vision coverage for adults

        For more detailed information about Just4Me™ coverage, refer to the Evidence of Coverage for your CareSource Just4Me™ insurance plan.

    • Can I have unlimited coverage for a pre-existing condition?
      • Yes! There are no pre-existing condition limits or waiting periods that apply to benefits covered by the CareSource Just4Me™ plans.

    • Can I have unlimited annual and lifetime benefits on the dollar value of Essential Health Benefits?
      • Yes! The CareSource Just4Me™ plans do not have any lifetime or annual limits on the dollar amount of Essential Health Benefits.  Essential Health Benefits are defined as follows:

        • Ambulatory patient services
        • Emergency services
        • Hospitalization
        • Maternity and newborn care
        • Mental health and substance use disorder services, including behavioral health treatment
        • Prescription drugs
        • Rehabilitative and habilitative services and devices
        • Laboratory services
        • Preventive and wellness services and chronic disease management
        • Pediatric services, including oral and vision care
    • How can I find out if my doctor accepts CareSource Just4Me™ insurance?
      • You can call CareSource Just4Me™ Customer Service at 1-800-479-9502 or look in the Provider Directory to search for doctors in your area and to find out if your doctor accepts CareSource Just4Me™ insurance. You can also use the Provider Directory to search for hospitals, health clinics, urgent care centers, treatment facilities, home health care agencies and other health care providers that accept CareSource Just4Me™ insurance. 

    • Can I get services from a doctor who is not in the CareSource Just4Me™ Provider Directory?
      • Similar to other managed care plans, if you get services from a doctor who is not in the CareSource Just4Me™ network, your costs will not be covered, with few exceptions. One such exception is if an emergency occurs while you are out of the CareSource Just4Me™ service area. In this case, CareSource Just4Me™ will cover benefits provided outside the provider network. Your CareSource Just4Me™ health insurance plan provides benefits when you receive covered services from network providers.  You can find network providers in the Provider Directory

    • Do CareSource Just4Me™ health insurance plans cover emergency health services?
      • Yes. CareSource Just4Me™ plans provide benefits for emergencies that occur anywhere within the United States. Benefits for emergency health services include facility costs and physician services, and supplies and prescription drugs charged by that facility.

        You do not have to get authorization before you get emergency health services. If you have an emergency, call 911 or go to the nearest emergency room or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your PCP or CareSource24®, our 24-hour nurse advice line. Your PCP or CareSource24 nurse can talk to you about your medical problem and give you advice on what you should do.

    • Do CareSource Just4Me™ health insurance plans cover urgent care services outside the service area?
      • Yes.  If you get hurt or sick while traveling outside the service area, but within the United States, CareSource Just4Me™ will pay for medically necessary urgent care services that you receive from non-network providers. Before seeking urgent care services, we recommend that you call your PCP for guidance; but, you are not required to do so. You should obtain urgent care services from the nearest and most appropriate health care provider.

        For more information about coverage for urgent care services, refer to the Evidence of Coverage for your CareSource Just4Me™ insurance plan. 

    • How does prescription drug coverage work?
      • CareSource covers a wide range of prescription drugs provided by network pharmacies. To see a list of the drugs we cover, search our Medicine Directory. To find a network pharmacy, use our Find a Pharmacy tool.  

        To fill a prescription, present your written prescription from your physician and your ID card to the pharmacist. The pharmacy will file your claim for you. If you owe a copayment or coinsurance amount, you will be charged when you fill your prescription.

        Your copayment or coinsurance amount may vary based on whether the prescription drug has been classified as a first, second, third, fourth, or fifth "tier" drug. Tiers are based on clinical information, the cost of the drug compared to other similar drugs used to treat the same or similar condition, the availability of over-the-counter alternatives, and certain clinical economic factors.

    • How can I find out if my prescriptions are covered with CareSource Just4Me™ insurance?
      • CareSource Just4Me™ insurance covers a wide range of drugs and drug types. You can call Just4Me™ Customer Service at 1-800-479-9502 or search through a list of covered medications to find out if your current prescriptions are covered. After you enroll in a CareSource Just4Me™ health insurance plan, your doctor can use the list to find out what drugs are covered when prescribing your medicines. 

  • Benefits of Just4Me™ Coverage

    • Why do I need an ID card?
      • To make sure you get your full benefits, you should show your CareSource Just4Me™ ID card every time you get health care services from a network provider or pharmacy. If you do not show your ID card, your provider may fail to bill CareSource for the services delivered, which could cause a delay in services.

    • Do I file paperwork for claims under a CareSource Just4Me™ health insurance plan?
      • Not usually. If you bring your Just4Me™ ID card and receive care from a network provider, the provider is responsible for filing the claim and requesting payment from us. You are responsible for any coinsurance, copayment, annual deductible or any amount that is more than the eligible expense. If you don’t present your Just4Me™ ID card and the provider makes you pay the full amount for services, you would need to file a claim with CareSource.

    • Does CareSource consult with my doctor to determine my treatment?
      • No. CareSource does not provide medical services or make treatment decisions. CareSource does not decide what care you need or will receive. You and your physician make those decisions. CareSource does determine, according to the plan's policies and nationally recognized guidelines, what medically-necessary benefits are covered services under the plans. The plans may not pay for all treatments you or your physician may believe are necessary. You can find more information about what services the plans cover in the Evidence of Coverage for your CareSource Just4Me™ insurance plan or by calling Just4Me™ Customer Service at 1-800-479-9502.  

    • What are my responsibilities as a CareSource Just4Me™ member?
      • You are responsible for choosing your providers. You are responsible for paying, directly to your provider, any amount identified as a member responsibility, including copayments, coinsurance, any annual deductible and any amounts that are more than eligible expenses. You are responsible for paying, directly to your provider, the cost of any non-covered service. You are responsible for deciding with your provider what care you should and should not receive.

    • Can I call and speak to a Customer Service Representative if I have questions about my Just4Me™ health insurance coverage?
      • Yes! Please contact Just4Me™ Customer Service at 1-800-479-9502 with any questions you have about your benefits, including any questions about your coverage and benefit levels, annual deductibles, coinsurance or copayments, and annual out-of-pocket maximum amounts; specific claims or services you have received; our network of providers; and our authorization requirements.

    • Can I speak to a nurse if I have health concerns and need answers?
      • Yes! Health worries don't always happen during business hours. Our experienced nurses are available on CareSource24®, 24 hours a day, to talk about any health problems that concern our members. You can call us if you have questions, need advice, or if you are wondering what type of provider is recommended for your care needs. We can help you decide if you can care for yourself or a sick family member at home or if you should seek help from a medical professional.  Please remember to call 911 if you are experiencing an emergency.

    • What information is available online at CareSourceJust4Me.com?
      • CareSource's member website, CareSourceJust4Me.com, provides information at your fingertips anywhere and anytime you have access to the internet. Our website opens the door to a wealth of health information and convenient self-service tools to meet your needs.

        Some of the helpful tools and information you will find at CareSourceJust4Me.com include the following:

    • What if I need help managing complex health care needs?
      • If you have a serious or complicated health problem, CareSource Just4Me™ Case Managers can help guide you through the health care system to get the coordinated, quality care you need. Our experienced team works with you and your doctor to make certain you are getting the best care possible. We do the coordination for you so that you can concentrate on your health.

    • What if I have completed a hospital stay and need help when I return home?
      • CareSource Bridge to Home® is a free program for hospitalized members to help coordinate the care needed to safely go home after a hospital stay. Our experienced team works with you and your doctor to make certain you have all the equipment and medicine you need at home. We make certain you are taking the medicine you need, when you need it, and help you reach your recovery goals. We also work to make sure that you understand your care and who to call when the doctor's office is closed. Our Bridge to Home program is here to make coming home from the hospital as smooth as possible for you and your family.

    • What if I need help managing my medications?
      • At CareSource, we believe it is critical that you are on the right medications for your health conditions and that you take your medications correctly. We offer the Medication Therapy Management Program (MTM) free of charge to help you do just that. We encourage you to meet with your pharmacist and discuss your medications. Your pharmacists are available for consultation, and we encourage them to do so as part of our program. Your pharmacist can help by reviewing all your prescriptions and over-the-counter medications, educating you on how to use your medications correctly, identifying medications that may interact with each other, and identifying medications that may help you save money. You can use our Just4Me™ Find a Pharmacy tool to locate a network pharmacy.

    • What if I need health care reminders?
      • To help you stay healthy, CareSource will send you reminders to schedule recommended screening exams. Reminders can be for mammograms, child and adolescent immunizations, cervical cancer screenings, comprehensive screenings for individuals with diabetes, and influenza/pneumonia immunizations.

        There is no need to enroll in this program. You will receive a reminder automatically if you have not had a recommended screening exam.





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