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How to Enroll in CareSource Advantage®

CareSource Advantage® (HMO SNP) is a special needs health care plan committed to helping you get the care you need. CareSource Advantage is a coordinated care plan with a Medicare Advantage contract and a contract with the Ohio Medicaid program. It is available to those who are eligible for Medicare Part A and Part B, as well as Medicaid.

Enrollment with CareSource Advantage is simple. 

  • Click the link to the 2014 Enrollment Form.
  • Print the form.
  • Fill out the form completely.
  • Sign it.
  • Mail it to us at:
CareSourceAdvantage
P.O. Box 807
Dayton, OH 45401-807

If you have questions, please call 1-800-708-8729
(TTY for the hearing impaired: 1-800-750-0750 or 711)
Hours of operation: Monday through Friday, 8 a.m. to 8 p.m.

We know you may have more questions. Here is a list of questions we are frequently asked:


What if I need assistance in completing the enrollment form?

If you need assistance in completing the enrollment form, please contact CareSource Advantage at 1-800-708-8729 (TTY for the hearing impaired: 1-800-750-0750 or 711) Monday through Friday, 8 a.m. to 8 p.m.

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Am I eligible to enroll?

  • Are entitled to Medicare Part A and enrolled in Part B
  • Have full Medicaid benefits
  • Do not have end-stage renal disease (ESRD)
  • Live in our CareSource Advantage service area
  • Make a choice during a valid election period
  • Agree to the rules of the CareSource Advantage plan
  • You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party

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When can I enroll?

You may request enrollment in CareSource Advantage® (HMO SNP) at the following times:

  • When you first become eligible for Medicare
  • Any month you are considered dual eligible (eligible for both Medicare and Medicaid)

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What else should I know about CareSource Advantage?

CareSource Advantage is a coordinated care plan with a Medicare Advantage contract and a contract with the Ohio Medicaid program. Our contract is renewed annually, and coverage beyond the end of the contract year is not guaranteed. If our contract is not renewed, you will be notified in 90 days and given your options for future coverage.

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What happens if I am enrolled with another company?

If you choose to enroll in CareSource Advantage and you are currently enrolled with another Medicare Advantage plan, you will be automatically disenrolled from that plan.

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Why do I have to select my Primary Care Provider now?

As part of the enrollment process, you will be asked to select a Primary Care Provider (PCP) from our provider network. Your PCP will be responsible for coordinating all of your health care needs while you are enrolled with CareSource Advantage. It is important to know that as a CareSource Advantage member if you receive routine care from providers who are not a part of our network (except in emergencies), neither CareSource nor Medicare will be responsible for the cost of care. To see our list of PCPs, please view the following:

We can help you select a PCP. Please call our Member Services Department at 1-800-708-8729, Monday through Friday, 8 a.m. to 8 p.m. (TTY users should call 1-800-750-0750 or 711).

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What should I expect after I mail the form?

A CareSource Advantage Representative will be in contact with you to arrange an appointment to review information regarding the CareSource Advantage plan.

You will also receive several notices from us. These include the following:

  • A letter that we received your completed enrollment form. It will also give you your coverage effective date.
  • A member identification card (ID card).
  • A request for more information if needed.
  • A letter that says your enrollment was approved.

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What if I would like to have a family member or friend help me manage my CareSource Advantage® (HMO SNP) benefits?

If you would like to appoint a person to file a grievance, request a coverage determination or exception, or request an appeal on your behalf, you and the person you would like to appoint must fill out the Appointment of Representative Form (CMS-1696) and submit it to CareSource.

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What type of Quality Program does CareSource have?

CareSource wants you to have the best care. We have a Quality Program to make sure you get the best care. CareSource sets goals each year to make our services for you and the doctors and hospitals that care for you better.

The Quality Program:

  • Helps make health care safer by educating you and our doctors and hospitals who care for you.
  • Checks doctors and hospitals to be sure you get a skilled health care team.
  • Looks into and takes needed action when you have a problem with your care.
  • Supplies Preventive Health Guidelines and Clinical Practice Guidelines to help you and your doctor know what care you need.
  • Collects Healthcare Effectiveness Data and Information Set (HEDIS®) scores. These scores tell us when you received care through claims data or health care records. These scores look at how often you get care to keep you healthy such as checkups with your doctor, care after you have been discharged from the hospital, and care for conditions such as diabetes, asthma, high blood pressure, and Chronic Obstructive Pulmonary Disease (COPD).
  • Studies satisfaction with care through the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). This survey is carried out by an independent survey company. The survey tells us if you are happy with your doctors and the help you get from CareSource staff.

HEDIS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

CAHPS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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How do I find out about the CareSource Advantage Plan Ratings?

To view the Plan Rating, please follow this link to CareSource Advantage Plan Ratings document.

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

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What if I have a grievance or appeal?

A grievance is a complaint that shows you are not satisfied with the plan or pharmacy's service. We have a process to receive grievances, exceptions, and appeals. For information about that process, please view the 2014 Grievances, Exceptions and Appeals Process. For instructions on how to file a grievance, exception or appeal, please view the 2014 Grievances, Exceptions and Appeals Filing Instructions.

The specific fax and address information is as follows:

CareSource Advantage (HMO SNP)
Attn: Grievance Department
P.O. Box 1947
Dayton, OH 45401 -1947
Fax: 877-459-0010
Part C and Part D Grievances
CareSource Advantage (HMO SNP) 
Attn: Grievance Department
P.O. Box 1947
Dayton, OH 45401-1947
Fax: 855-763-6790

You have the right to see a report showing the total number of grievances, appeals and exceptions that have been filed for the plan. To obtain a copy, please contact Member Services.

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How do I contact CareSource Advantage?

If you would like more information about CareSource Advantage or have questions about the enrollment process, please call our Member Services Department at 1-800-708-8729, Monday through Friday, 8 a.m. to 8 p.m. (TTY users should call 1-800-750-0750 or 711).

Written Requests

Our 2014 Evidence of Coverage provides information about how to contact our Member Services Department by fax or mail.

The specific fax and address information is as follows:
FAX: 1-855-761-9052
ADDRESS:

CareSource Advantage® (HMO SNP)
P.O. Box 1949
Dayton, OH 45401-1949

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What if I decide CareSource Advantage is not for me?

You can ask to be disenrolled from CareSource Advantage anytime. However, it will be effective the first day of the month following receipt of the written request. View your 2014 Rights and Responsibilities upon Disenrollment online for more information.

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Updated April 17, 2014

H6178_OHMSNP885
Pending CMS Approval