FAQ

Coverage you can afford, understand & use.

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 Just4Me insurance plan.
  • CareSource Plans

    • Who is CareSource?
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        CareSource is a managed care company that provides managed health coverage to more than a million members. We pride ourselves on understanding our members and helping them understand and access their health insurance services.

        We provide quality and affordable health insurance in Ohio, Kentucky, West Virginia and Indiana.

    • What type of coverage does CareSource provide on the Health Insurance Marketplace?
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        CareSource offers affordable health insurance options with no limits due to pre-existing conditions or annual benefit caps. And many people who are uninsured may even qualify for cost savings to make it more affordable.

    • What is the benefit of choosing CareSource?
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        Unlike many other insurance companies, CareSource is a nonprofit 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 pre-negotiates out-of-pocket costs with our providers. This discounts many types of services and makes health care more affordable for you.

    • What is a Qualified Health Plan (QHP)?
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        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 is an insurance plan that meets these rules. 

    • What are the different “metal levels” of CareSource plans?
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        CareSource plans are separated into “metal level” categories of Silver, Gold and Bronze, based on how you and CareSource share the costs of care. These categories have nothing to do with the quality or amount of care you get.
    • How do I know what plan is right for me?
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        CareSource plans are separated into “metal level” categories of Bronze, Silver and Gold, based on how you and CareSource share the costs of care. You can also select a dental and vision individual or family plan. A few key questions can help you decide which plan is right for you:

        • Do you want health insurance for yourself or your family?
        • Do you want dental and vision coverage?
        • How often do you think you’ll use your health care benefits, like going to the doctor, filling a prescription, or going to a specialist (like a heart doctor)?
        • Do you qualify for subsidies through the Marketplace?
  • Enrollment

    • How do I enroll in a CareSource Plan?
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        You can enroll in a CareSource plan online after November 1, 2016 or earlier if you qualify for a Special Enrollment Period (SEP):
        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
          • If you had Marketplace coverage in 2015, you'll need plan materials from your current plan that contain your plan ID
        2. Select Enroll on the CareSource.com/Marketplace main landing page. Enter your ZIP code, and then select a county if it asks.
        3. The system will then 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. 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.
        4. After you complete the enrollment form to determine your cost savings and eligibility, you’ll come back to the CareSource website where the information will be used to generate quotes based on your options.
        5. 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. You can also call CareSource Customer Service at the following numbers. A friendly, licensed Marketplace Insurance Specialist will walk you through the enrollment process.

        Indiana: 1-855-202-0622
        Kentucky: 1-888-815-6446
        Ohio: 1-800-479-9502
        West Virginia: 1-855-202-0622
    • How do I find out if I qualify for savings?
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        When you enroll, the Health Insurance Marketplace will determine your eligibility for cost savings based on your income and family size. You can estimate your cost savings and shop for CareSource plans before you enroll using our Estimate tool.

    • What cost savings are available?
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        If you qualify based on income and family size, you can get two types of cost savings through the Health Insurance Marketplace:

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

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

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

        An advance premium tax credit is a tax credit or subsidy that you can use either:

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

        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.

    • How much time will it take to enroll?
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        It may take 20 - 45 minutes to enroll through the 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?
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        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)
        • If you had Marketplace coverage in 2015, you’ll need plan materials from your current plan that contain your Plan ID
    • I’m having technical issues with my browser while trying to enroll through the Marketplace. What can I do?
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        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.

    • English is not my native language. What are my enrollment options?
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        CareSource can help you enroll in a language you understand. Call Customer Service at 1-800-479-9502 (TTY: 1-800-750-0750 or 711) 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.
    • Do I need to complete the enrollment process during one sitting or can I save and come back later?
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        On CareSource.com:  Yes. If you enroll through CareSource, you will need to complete the enrollment process in one sitting.

        On heathcare.gov:  No. You do not have to complete the enrollment process in one sitting through the Health Insurance Marketplace at healthcare.gov. 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.

    • What happens after I enroll?
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        After you enroll in a CareSource plan, you will get a letter or email acknowledging your enrollment and providing basic information. After you pay your first premium payment in full, you will get an enrollment packet and ID card for the covered members of your family. In a separate mailing you’ll get your new member kit with important plan information.

        If you are unsure if you've successfully enrolled, contact a CareSource Marketplace Insurance Specialist at one of the numbers below:

        Indiana: 1-877-806-9284
        Kentucky: 1-888-815-6446
        Ohio: 1-800-479-9502
        West Virginia: 1-855-202-0622

  • Paying for Insurance

    • How do I pay my monthly premium?
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        When you enroll in a CareSource plan during open enrollment, you need to pay the first month’s premium in full in order to be covered. You won’t receive your ID card, member handbook and other important information until you pay your full bill. If you did not pay at the time of enrollment, your invoice will be mailed to you soon. Please pay your first invoice by mail or by phone. If you decide to mail your first month's premium, please allow for mail delivery and processing time.

        After your first payment, you will receive a bill for your premium each month. Pay your premiums as early as possible each month. This lets us process and post your payment to your account. If we don’t have your payment by the end of the month, you are considered past due and your benefits are at risk.

        After your first payment, you can make premium payments using the following options:

        • Pay online:  Sign in to My CareSource® account and pay with a major credit card, debit card or bank transfer. This is a free service to you.
        • Pay by phone:  This free service is available by calling 1-800-479-9502
        • Mail your payment:  Send a check or money order to CareSource, P.O. Box 630568, Cincinnati OH 45263-0568. Please include your CareSource member ID number on the check. This will ensure payment is posted to your account.
    • Will I receive a bill each month?
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        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. Pay your premiums as early as possible each month. This lets us process and post your payment to your account. If we don’t have your payment by the end of the month, you are considered past due and your benefits are at risk.

        When you enroll in a CareSource plan, you can choose to receive your monthly bills through email or a paper bill.

    • What happens if my monthly payment is late?
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        CareSource must provide a 90-day grace period during which you can bring your premium payments up to date and avoid having your coverage terminated. However, the grace period only applies if you have paid at least one month’s premium. If you haven’t paid your first month’s premium completely by the due date on your invoice, your policy may be cancelled.

        If, by the end of the 90-day grace period, the amount owed for all outstanding premium payments is not paid in full, CareSource can terminate coverage.

        In addition, during the first 30 days of the grace period, CareSource must continue to pay claims. However, after the first 30 days of the grace period, CareSource can hold off paying any health care claims for care received during the grace period, which means the enrollee may be responsible to cover any health care services they receive during the second and third months if they fail to catch up on the amounts they owe before the end of the grace period. We are supposed to inform health care providers when a member’s claims are being held. This could mean that providers will not provide care until the premiums are paid up so that they know they will be paid.

    • How does an annual deductible work?
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        For some services, CareSource 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 pays the provider for eligible expenses after you have paid this amount. Your annual deductible starts over every January.

        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 copayment for a primary care visit, depending on your plan.

        As an example:

        If…
        Your copayment 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 is responsible for the remaining $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 copayment for the ER visit.
        CareSource 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 deducible 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 copayment or coinsurance amount for the rest of the year.

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

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

        CareSource plans have low deductibles for medical services and no deductibles for medications. Check out our NavigatePlan Comparison Brochure to compare our plans’ deductible amounts.

        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 plan. To find these documents, access the Plan Details:

    • How do coinsurance and copayments work?
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        For some services, CareSource 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. CareSource pays the provider the balance of the bill.

        As an example:

        If…
        Your copayment 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 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 pays the remaining 70 percent or $420.

        CareSource plans have low coinsurance and copayment amounts. Check out our NavigatePlan Comparison Brochure to compare our plans’ coinsurance and copayment amounts.

        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 plan.

        To find these documents, access the Plan Details:


    • How does an annual out-of-pocket maximum work?
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        Out-of-pocket costs are what you pay during the year through deductibles, copayments and coinsurance. Premiums and services not covered by CareSource do not count toward your out-of-pocket maximum. After you meet your annual out-of-pocket maximum amount, CareSource begins to pay 100 percent for covered health benefits. Your out-of-pocket maximum starts over each January.

        As an example:

        If…
        Your annual out-of-pocket maximum is $650, and your annual deductible is $200.
        You visit the emergency room (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 copayment for the ER visit.
        CareSource 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 copayment and CareSource 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 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, access the Plan Details:

  • Coverage

    • What are the benefits I get with a CareSource plan?
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        CareSource Marketplace plans cover a wide variety of health care services designed to get you healthy and keep you healthy, including:

        • Primary care and specialty physician services
        • Retail clinics
        • Prescription drug coverage
        • Outpatient services
        • Hospitalization (such as surgery)
        • Emergency services
        • Maternity and newborn care
        • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
        • Preventative and wellness services (such as mammograms, diabetes screenings, flu shots and more)
        • Rehabilitative and habilitative services and devices (to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
        • Laboratory services (such as blood draws)
        • Chronic disease management (to help you deal with diabetes and asthma)
        • 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 coverage, refer to the Evidence of Coverage for your CareSource plan.

        To find this document and more, access the Plan Details:

    • Can I get unlimited coverage for pre-existing conditions?
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        Yes! There are no pre-existing condition limits or waiting periods that apply to benefits covered by CareSource.

    • Do your essential health benefits have lifetime and annual dollar limits?
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        No. CareSource plans do not have any lifetime or annual limits on the dollar amount of essential health benefits. Essential health benefits are defined as follows:

        • Free preventive and wellness services (such as mammograms, diabetes screenings, flu shots and more)
        • Prescription drugs
        • Outpatient services (such as primary care and specialty doctor visits, urgent care services, diagnostic testing and more)
        • Hospitalization (such as surgery)
        • Emergency services
        • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
        • Pediatric services, including dental and vision care for kids
        • Maternity and newborn care
        • Laboratory services
        • Rehabilitative and habilitative services and devices (to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
    • What type of benefits are included with the optional dental and vision plans?
    • How do I find out if my doctor is in your network?
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        Use our online Find a Doctor/Provider tool to search for doctors in your area and to find out if your doctor accepts CareSource insurance.

        You can also use Find a Doctor/Provider to search for hospitals, health clinics, urgent care centers, treatment facilities, home health care agencies and other health care providers that are part of our network. 

        You can also call CareSource Customer Service at 1-800-479-9502.

    • Can I see a doctor who isn't in your network?
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        Similar to other managed care plans, if you get services from a doctor who is not in the CareSource 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 service area. In this case, CareSource will cover benefits provided outside the provider network.

        Your CareSource plan provides benefits when you receive covered services from network providers. You can find network providers in the Find a Doctor/Provider tool. 

    • Why do I need to select a Primary Care Provider (PCP)?
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        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.  If you have a Silver or Gold plan, we cover these visits at no cost to you.

        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 Customer Service at 1-800-479-9502. You can also use our Find a Doctor/Provider tool to search for doctors in your area.

    • Do your plans cover Emergency Services?
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        Yes. Our 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 primary care provider (PCP) or CareSource24®, our 24-hour nurse advice line. Your PCP or the CareSource24 nurse can talk to you about your medical problem and give you advice on what you should do.

    • Do your plans cover Urgent Care visits outside of the service area?
    • How does your prescription drug coverage work?
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        CareSource covers a wide range of prescription drugs provided by network pharmacies.

        To fill a prescription, present the written prescription from your doctor and your ID card to the pharmacist. If your doctor uses electronic prescriptions, he or she will send the prescription to the pharmacy for you. The pharmacy will then 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 generic, preferred brand, non-preferred brand or specialty high-cost drug. 

    • How do I find out if you cover my current prescriptions?
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        CareSource covers a wide range of drugs and drug types.

        You can call Customer Service at 1-800-479-9502 or search the NavigatePreferred Drug List to find out if your current prescriptions are covered.  

  • Benefits of Coverage

    • Why do I need an ID card?
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        To make sure you get your full benefits, you should show your CareSource 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.

    • Will I have to file claims?
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        Not usually. If you bring your CareSource 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 ID card and the provider makes you pay the full amount for services, you would need to file a claim with CareSource.

    • Will I have to see doctors in the CareSource network?
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        Yes. CareSource uses a network of providers. In order for your services to be covered by CareSource, you must get care from the providers in our plan’s network.

        You can call Customer Service at 1-800-479-9502 or use the Find a Doctor/Provider tool to search for doctors in your area and to find out if your doctor accepts CareSource insurance.

        You can also use Find a Doctor/Provider to search for hospitals, health clinics, urgent care centers, treatment facilities, home health care agencies and other health care providers that are part of our network.

    • Does CareSource consult with my doctor to determine treatment options?
    • What are my responsibilities as a member?
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        You are responsible for choosing your in-network 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.

    • What types of things can I do on CareSource.com?
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        Our website 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 includes the following:

        • My CareSource® – Your personal, online account that lets you pay your premium, change your doctor, request a new ID card, check your deductible and more – all with one convenient login.
        • Estimate tool, which allows you to estimate your cost savings and shop for CareSource plans before you enroll
        • Find a Doctor/Provider tool, which allows you to find network providers
        • The NavigatePreferred Drug List, which allows you to find covered medications
        • Find a Pharmacy tool, which allows you to find network pharmacies
    • Can I talk to Customer Service about my plan?
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        Yes! Please contact Customer Service at 1-800-479-9502 with any questions you have about your coverage, including:

        • Benefits
        • Premiums
        • Coinsurance or copayments, annual deductible and annual out-of-pocket maximum amount
        • Specific claims or services you have received
        • Our network of providers
        • Our authorization requirements
    • Can I talk to a nurse if I have health questions?
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        Yes! Our experienced CareSource24® nurses are available, 24/7/365 to talk about any health problem that concerns you.

        Call the CareSource24 number on your ID card 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.

    • Can someone help me manage my complex health conditions?
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        If you have a serious or complicated health problem, CareSource 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.

    • Can someone help me get care after I am released from the hospital?
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        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.

    • Can someone help me manage my medications?
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        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
        • Identifying medications that may help you save money.

        You can use our Find a Pharmacy tool to locate a network pharmacy.

    • Can someone remind me when I need to have a screening exam?
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        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.