Benefits & Services
As a CareSource member, you can get the same necessary medical services that are covered by the regular Ohio Medicaid program. And we never charge a copay for any medical service.
Our members get all medically necessary Medicaid-covered services at no cost. Some examples are preventive checkups and inpatient and outpatient hospital services.
And, you get more. As a CareSource member, you’ll enjoy:
- No copays for health care visits
- No copays for prescriptions*
- A large network of doctors, hospitals and pharmacies
- Transportation to and from doctor appointments**
- Vision and dental care including checkups, teeth cleanings and eyeglasses
- CareSource24®– Speak with a registered nurse 24/7
- Incentive programs, like Babies First, that reward members for healthy habits
- Care management – One-on-one care to coordinate your health needs
- Behavioral health – Linking members to the care they need for their whole self, mind and body
- Disease management programs to help members manage their asthma and diabetes
- Consumer Councils – Join us in person to share your thoughts and learn about other community resources
*While CareSource covers all medically necessary Medicaid-covered medications, we use a preferred drug list (PDL).
**If you must travel 30 miles or more from your home to get covered health care services, CareSource will provide transportation to and from the health partner's office. CareSource also offers up to 30 one-way trips or 15 round trips per member per year for transportation less than 30 miles.
CareSource covers all medically necessary Medicaid-covered services. These medical services are available at no charge to you. You should not be billed for these services. If you receive a bill, please call us.
For a complete list of these services, refer to your member handbook. If you have further questions, contact Member Services at 1-800-488-0134 (TTY: 1-800-750-0750 or 711).
Services Not Covered
CareSource will not pay for the following services that are not covered by Medicaid:
- All services or supplies that are not medically necessary
- Experimental services and procedures, including drugs and equipment, not covered by Medicaid
- Abortions except in the case of a reported rape, incest or when medically necessary to save the life of the mother
- Infertility services for males or females, including reversal of voluntary sterilizations
- Voluntary sterilization if under 21 years of age or if legally incapable of consenting to the procedure
- Plastic or cosmetic surgery that is not medically necessary
- Sexual or marriage counseling
- Inpatient treatment to stop using drugs and/or alcohol (In-patient detoxification services in a general hospital are covered.)
- Drugs not covered by the Ohio Medicaid pharmacy program, including drugs for the treatment of obesity
- Services for the treatment of obesity unless determined medically necessary
- Inpatient hospital custodial care or comfort items in the hospital (e.g., TV or phone)
- Acupuncture and biofeedback services
- Services to find cause of death (autopsy) or services related to forensic studies
- Services determined by another third-party payer as not medically necessary
- Paternity testing
This is not a complete list of the services that are not covered by Medicaid or CareSource. If you have a question about whether a service is covered, please refer to your member handbook or call Member Services at 1-800-488-0134 (TTY 1-800-750-0750 or 711).
Out of Country Benefits
As an Ohio Medicaid managed care plan (MCP), CareSource provides benefits and covers emergency services obtained in any hospital or urgent care clinic within the United States. However, CareSource does not provide benefits for or cover emergency services received outside the United States.
In addition, information for services received outside the United States can be found on the benefits grid. Page 8 of the benefits grid states that out-of-country services are not covered by CareSource.
If you need additional assistance or have any further questions, please call Member Services at 1-800-488-0134.