Commonly Asked Questions
How do I become a CareSource Marketplace Plan member?
- Go to enroll.caresource.com to enroll in any CareSource Marketplace Plan. You may also call 1-844-539-1733 to reach one of our licensed agents..
- You can enroll through the federal Marketplace at https://www.healthcare.gov or by calling 1-800-318-2596 during the annual open enrollment period, or to see if you qualify for a special enrollment period at any time during the year.
- You can enroll through kynect at www.kynect.gov or by calling 1-855-4KYNECT (855-459-6328) during the annual open enrollment period, or to see if you qualify for a special enrollment period.
- If you need assistance applying, go to the “Find Local Help” section here https://www.healthcare.gov/find-assistance/.
When is the Open Enrollment Period?
- The yearly period (Typically November 1 – January 15) when people can enroll in a Marketplace health insurance plan.
How do I get a Special Enrollment period?
- Learn more about special enrollments at: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/. This is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You may qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, adopting a child, or if your household income falls below a certain amount.
- Depending on your Special Enrollment Period type, you may have 60 days before and/or 60 days following the event to enroll in a plan. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time.
- Job-based plans must provide a Special Enrollment Period of at least 30 days.
What if I have a pre-existing medical condition?
- Health plans in the Marketplace cannot deny you health insurance coverage because of a medical condition you had before signing up. Coverage for all medical conditions you may have begins on the effective date of your coverage.
Do I qualify for the advanced premium tax credit (APTC)?
- These are subsidies taken in the form of tax credits or cost-sharing reductions to help pay for your health care costs under the American Rescue Plan Act of 2021 (ARPA) and Inflation Reduction Act of 2022. Please go to www.caresource.com, Healthcare.gov or your state’s insurance enrollment website, login and update your information to see if you qualify. The subsidies are based on household income reported on your previous year’s income tax filing.
What if I need to report a change regarding my household size, new job/change income, moved out of state or need to cancel my plan?
- Please go to www.caresource.com, Healthcare.gov or your state’s exchange, log in and update your information.
- How can I learn more about the benefits CareSource offers?
- We’ll be happy to answer your questions. Call Member Services: 1-833-230-2099 (TTY: 711), Monday through Friday, 7 a.m. to 7 p.m. ET.
- You can also explore the Benefits and Services available on this website. Pick your state to see all the benefits and services for your plan.
Where are my plan documents?
Your plan documents include:
- Member Handbook
- Evidence of Coverage
- Summary of Benefits and Coverage
- Schedule of Benefits
- Your plan documents are mailed to you each year in your Member Welcome Kit.
- Go to CareSource.com and pick the Plan Documents page. Choose your state, then your plan. Make sure you choose the document that coordinates with your plan.
- You can also get to your plan document through the MyCareSource.com member portal.
What digital tools does CareSource offer?
- CareSource Website: CareSource.com/marketplace. Our website gives you general information about plans, your plan documents, pharmacy benefits, member-exclusive programs, and how to find network providers. It even has educational materials and videos. We are always updating the information available to you, so visit often when you have questions about your health or your health care plan.
- My CareSource® Member Portal: MyCareSource.com. Your plan information and documents are available through your My CareSource member portal account. MyCareSource.com is your secure, personal CareSource account. It gives you access to cost information, claims, Explanations of Benefits, invoices, and more. If you’ve had a My CareSource account in the past, be sure to update it with your new Member ID number each year you re-enroll.
My CareSource also offers tools to help you manage your physical and mental health and get help from other community resources when you need them.
- CareSource Mobile App. The CareSource Mobile App gives you access to CareSource information and services at your fingertips. The Message Center will let you know if you are due for a screening test, a doctor visit, prescription refill, or when documents are available for you to review. Get one touch access to your digital ID card, Find A Doctor, and CareSource24®. Access telehealth 24 hours a day with the Teladoc® Our app makes using your CareSource benefits easy and convenient. Download the app free from the Apple® App Store or Google Play®.
- Adults ages 18 and older have access to health assessments, small step interactive guides, videos and more! You can use MyHealth to help you set and track health and wellness goals. To get started, log in to your MyCareSource account to get started. Click Health on the top menu bar and scroll down to the to MyHealth
- Take charge of your mental health and try our wellness tool called myStrengthTM. This is a safe online tool made just for you. It can help improve your mood, mind, and body. The myStrength program gives you empowering self-help tools and wellness resources. You even get inspirational quotes and articles! You can access myStrength through your My CareSource member portal account or by going to https://www.mystrength.com/r/caresource to learn more and to sign up. You can use it with your computer, smart phone or tablet at no cost to you.
- Do you need help finding support in your community? Use our MyResources online tool to connect with local low-cost and no-cost community programs and services. You can find it on the member portal in your MyCareSource.com account.
How do I get a replacement CareSource ID card?
- You can request a new or replacement card on MyCareSource.com. You can also view a digital copy of your card on the mobile app.
What doctors and hospitals are in the CareSource network?
- You can find a list of providers that are in the CareSource network by using our Find A Doctor online search tool. The tool lets you search for doctors, pharmacies, and other types of providers by area, specialty and much more.
- You can call Member Services and they can help you find a provider or have a list of providers near you mailed to you.
How can I get an estimate of the cost of services prior to a procedure?
- You can use our Cost Estimator. Available through your member portal account on MyCareSource.com. The Cost Estimator can also show you estimated costs for a service or procedure from multiple providers in your area.
How can I find covered prescriptions?
- Use Find My Prescriptions from your portal account, MyCareSource.com, and your costs are estimated using your specific plan. For a general estimate that is not specific to your plan, you can access Find My Prescriptions through CareSource.com/marketplace.
What are some tips to lower my cost for care?
- Use 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). Not only are your costs higher in the ER, but the amount billed by the provider will also be higher. Learn more about CareSource24 in the next section, Where and How to Get Care. Call CareSource24 at 1-866-206-7879
- Teladoc® is a provider in our Zero Cost Telehealth program, available 24-hours, 7-days a week. You can speak with a provider and have a prescription called-in to a local pharmacy any time it is needed. 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 emergency room. You can learn more about Teladoc and our Zero Cost Telehealth Provider program in the next section, Where and How to Get Care. Call Teladoc at 1-800-TELADOC (835-2362).
- Urgent Care Centers can treat many of the same things that emergency rooms can, at much lower cost, and usually more quickly than a hospital emergency room.
- If you are having outpatient surgery, or a test like a colonoscopy or mammogram done, an ambulatory surgery or testing center can save you money over a hospital imaging or hospital affiliated outpatient surgery center. Talk to your provider about your options when you plan your procedure or discuss getting a test.
Using Your Benefits
Did you know your CareSource benefits include coverage for the following?
- Skilled Nursing Care
- Home Health Services
- Chiropractic Care
- Hearing screenings and hearing aids at a discounted price
- Care Management
- $0 Preventive Annual Wellness checks*
- $0 Teladoc visits
*Preventive wellness checks are at no cost to you when they are billed as an annual preventive care wellness check for an established patient by your primary care provider.
What is a Primary Care Provider and why is having one important?
- Your primary care provider (PCP) is the doctor, nurse practitioner or physician’s assistant you’ll see for your routine care. You will see them for things like yearly checkups, tests, illnesses, and everyday concerns. Plus, they can recommend additional network providers or tests if you need them. Did we mention many visits to your PCP like screenings, yearly wellness checkups, and vaccines are free to you? Prevention helps small issues from becoming big concerns!
What is a prior authorization?
Prior authorization is how we decide if CareSource will cover a service. The service must be medically necessary for your care. Medically necessary means it is needed to diagnose or treat an illness, injury, condition, disease, or its symptoms. Emergency care does not need prior authorization.
Who is responsible for requesting a prior authorization?
- Your doctor will request a prior authorization from us for services that need one. For example, some procedures and most inpatient hospital stays require a prior authorization.
- If you are seeing a CareSource network provider, it is their responsibility to get a prior approval from us for your care when needed. If your provider does not get the prior authorization, you will not be held financially responsible for any more than the cost of care you would normally pay.
- If you see a non-network provider, your care may be covered under specific circumstances (like continuing care when you first enroll), but if your provider fails to get a prior authorization from us, you may be responsible for the total cost of your care.
What is an Explanation of Benefits (EOB)?
- Each time we process a claim submitted by you or your health care provider, we explain how we processed it in the form of an explanation of benefits (EOB). The EOB is not a bill. It simply explains how your benefits were applied to that particular claim. It includes the date you received the service, the amount billed, the amount covered, the amount we paid, and any balance you’re responsible for paying the provider. Each time you receive an EOB, review it closely and compare it to the receipt or statement from the provider. (link to new video)
What are some common health insurance terms regarding payments?
- Copay: This is short for copayment. It is a fixed amount you pay for a service. This is usually collected at the time services are given. For example, a $25 dollar copayment for a doctor visit is normally collected by your doctor’s office when you go to the appointment.
- Coinsurance: The percentage of the cost of a health care service charged. Normally this is charged once you meet your deductible. For example, a test is $100 and you have a 20% coinsurance. You would owe $20 for the test and the insurance would pay the rest, once your deductible has been met. Before that, you will pay $100, but the full amount will be applied toward your deductible.
- Deductible: The annual amount you need to pay before CareSource will begin paying for most benefits.
- Out-of-pocket maximum: This is the most you could pay during a 12-month coverage period. Deductibles, copays, and coinsurance all count toward your out-of-pocket maximum. Your monthly premium or anything your plan doesn’t cover do not apply, for example if you have services done out-of-network.
- Coordination of Benefits (COB): This is when you are covered under one or more group or individual plans. For example, you have a plan, but you are also covered by your spouse’s employer sponsored coverage.
An important part of coordinating benefits is determining the order in which the plans provide benefits. One plan is responsible for providing benefits first. This is called the primary plan. The primary plan provides its full benefits as if there were no other plans involved. The other plans then become secondary. Further information about coordination of benefits can be found in your Evidence of Coverage.
- Medical Necessity or Medically Necessary: This means health care services or supplies needed to diagnose or treat an illness or injury or its symptoms. These services or supplies must meet accepted standards of medicine.
When does my child need their own plan?
- Dependent children can be added to your plan, and stay on your plan until they turn 26. Please visit https://www.healthcare.gov/young-adults/children-under-26 for more information.
How do I pay my monthly premium?
- Go to caresource.com/MPpay and enter your member information to be taken directly to the payment screen.
- Go to your My CareSource account and select Pay Bill from the My Help
- You can choose Make a Payment for a one-time payment or Manage Automatic Payments to set up automatic monthly payments.
- Either option will take you to our secure, online payment processing vendor.
- Enter the requested information to make your payment or set up your automatic payments.
- You can also make your payment using Google Pay or Apple Pay when you pay online.
- Pay by phone
- Call Member Services at 1-833-230-2099 and tell our automated attendant that you would like to make a payment.
- Phone payments can be made through credit card, debit card or checking account.
- Pay by mail
- Detach the bottom portion of your invoice and write in the amount of your check or money order.
- Include the bottom portion (remittance slip) of your invoice and your check or money order.
- Make sure that our address shows through the window of the envelope.
- Please include your member ID number on the memo portion of the check or money order
Contact Us / Getting Help
How can I contact CareSource?
- Call Member Services: 1-833-230-2099 (TTY: 711), 7 a.m. to 7 p.m. ET, Monday through Friday
When is Member Services closed?
- New Year’s Day (observed)
- Martin Luther King, Jr. Day (observed)
- Memorial Day
- Independence Day (observed)
- Labor Day
- Thanksgiving (observed)
- Christmas Eve (observed)
- Christmas Day (observed)
Need Personal Assistance?
Is there a CareSource member in your family who does not speak English, has limited reading skills or has trouble seeing or hearing?
We can get someone who can speak your language to help you talk with us. This is a free service to our members. If you have any problems reading or understanding this information, please call Member Services at 1-833-230-2099 or call the 711 TTY for hearing impaired members. We can read the information aloud for you, in English or in your primary language. We also can help you if you are visually or hearing impaired. This service is free to you.
What if I have a health question after hours?
- CareSource24® is available 24 hours a day, 7 days a week, including holidays. Call the number on the back of your ID card. Get help with how to care for an illness or injury at home or advice on when to go to a doctor or the ER.
What are some other crisis and support numbers and sites I can use?
- If you have a medical emergency call 9-1-1 or go to the nearest emergency room.
- If you are having a mental health crisis, or if you are suicidal, call the National Suicide Prevention Lifeline: 9-8-8
- Crisis Text Line: Text ‘HELLO’ to 741741
- National Domestic Violence Hotline: 1-800-799-SAFE (7233) or text ‘START’ to 88788
- National Treatment Service Locator: 1-800-662-HELP (4357)
Member Services: 1-833-230-2099 (TTY: 711), Monday through Friday, 7 a.m. to 7 p.m.