FAQs

Covered Services

  • What doctors and hospitals are covered by CareSource?

    • To see if your doctor is in the CareSource Medicare Advantage network, you can use our online search tool, Find a Doctor/Provider.

      You can also request a copy of our Provider Directories to be sent to you.

  • Does CareSource Medicare Advantage offer a prescription drug benefit?

    • Yes! All of our plans cover prescription medications with or without deductibles, low or no-copays for preferred generic drugs.
  • Do I have to see certain doctors?

    • Yes. CareSource Advantage has a network of doctors, hospitals, specialists and other providers. Use our online search tool, Find a Doctor/Provider to find out if your doctor is in our network. Scroll down to Ohio and filter the results under Medicare by selecting Medicare Advantage from the list.

      If you use providers that are not in our network, the plan may not pay for these services.

  • How can I find out what drugs are covered?

    • You can search for drugs using our online search tool. You can also review our comprehensive formulary on the Plan Documents page.

      If your medication is not on your plan’s drug list, CareSource Medicare Advantage will cover a one-time, temporary supply of your current drug. After that:

      • If the drug list includes other drugs that treat the same condition, CareSource requires you to try those drugs before we cover the drug you already take.
      • If no other options are available on the drug list, your doctor must obtain approval from CareSource before we will cover the prescription. This process is called prior authorization.
  • What is a formulary?

    • A formulary is also known as a drug list.
  • How do I know what tier my drug is on?

  • When will my coverage begin?

    • In general, your coverage is effective on the first day of the month after we receive your completed application. If you enrolled during the Annual Enrollment Period (AEP) between October 15 and December 7, your coverage is effective on January 1. However, it can take some time for Medicare and CareSource to process your application, so be sure to keep temporary proof of membership with you until you receive your CareSource Medicare Advantage member ID card.
  • Does my plan cover out-of-network services?

    • With limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services covered. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services and cases in which CareSource Medicare Advantage authorizes use of out-of-network providers.
  • What if a medication I am taking is not offered on my plan’s drug list?

    • To find out if a medication you are taking is covered, use the online drug search tool or review the comprehensive formulary on the Plan Documents page.

      If your medication is not on your plan’s drug list, CareSource Medicare Advantage will cover a one-time, temporary supply of your current drug. After that:

      • If the drug list includes other drugs that treat the same condition, CareSource requires you to try those drugs before we cover the drug you already take.
      • If no other options are available on the drug list, your doctor must obtain approval from CareSource before we will cover the prescription. This process is called prior authorization.

Medicare Basics

  • What is Medicare?

    • Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. You are typically enrolled in Medicare hospital insurance (Part A) when you apply for and are approved to receive Social Security benefits. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services. The premium you pay for Part B is deducted from your Social Security benefits.
  • What is Medicare Advantage?

    • Medicare Advantage (MA) is a health insurance program of managed care that serves as a substitute for “Original Medicare” Parts A and B Medicare benefits. Medicare Advantage plans include:

      • Medicare Health Maintenance Organization (HMO)
      • Medicare Preferred Provider Organization (PPO)
      • Medicare Private Fee-for-Service (PFFS)

      Medicare Advantage plans feature prescription drug benefits, fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care.

  • What is a Medicare Advantage HMO plan?

    • HMO stands for a Health Maintenance Organization. An HMO is an alternative to “Original Medicare” that features specific lists of doctors, hospitals and other providers that you must use in order to receive benefits. HMOs often provide additional benefits not found in Medicare, including coverage for deductibles, steep reductions in copayments when you see a doctor, a drug benefit plan, and wellness or fitness programs. If you select a CareSource Medicare Advantage HMO plan, it is an alternative to your Medicare coverage.
  • What is a Medicare Advantage Prescription Drug (Part D) plan?

    • A Medicare Advantage Prescription Drug plan is a Medicare Advantage plan that also provides prescription drug benefits.
  • Why should I consider a Medicare Advantage plan?

    • Medicare pays for many health care services and supplies, but it doesn’t cover all of your health care costs. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage plan.
  • Do I need a prescription drug plan?

    • It depends on your medical and financial situation. Think about your needs and what’s important to you. Keep in mind the costs of prescriptions, especially those you are currently prescribed. A prescription drug plan may help control your expenses.  If you did not join Medicare Part D when initially eligible, you may have to pay a penalty for joining the plan later.  The penalty increases with each month you do not enroll. This is known as the Late Enrollment Penalty, or LEP.
  • Am I eligible to enroll in a Medicare Advantage plan?

    • In order to enroll in a Medicare Advantage plan, you must:

      • Have Medicare Part A & B
      • Reside in the plan’s service area

      If you are unsure whether you meet the qualifications to enroll in CareSource Medicare Advantage, please contact a CareSource Medicare Advantage Sales Representative at 1-844-781-1301. We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours.

  • What are the dates for enrollment in Medicare plans?

    • The key Medicare Advantage enrollment dates are October 15 through December 7 each year. This is known as the Annual Enrollment Period, or AEP. At this time, you can enroll in Medicare health benefits, such as a Medicare Advantage plan, for the following year. During this period, you can also change plans or enroll in a separate drug plan.
  • What are enrollment periods?

Medicare Advantage Enrollment PeriodTime Frame

Annual Enrollment Period (AEP)

October 15 – December 7

Initial Coverage Enrollment Period (ICEP/IEP)

The initial enrollment period is the 7-month period that begins 3 months before the month you are eligible and ends 3 months after the month of eligibility. You can only enroll in one Medicare Advantage plan during this period.

Special Enrollment Period (SEP)

There are various types of SEPs. To see if you qualify for an SEP, contact a CareSource Medicare Advantage Sales Representative 1-844-781-1301 from 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

Medicare Advantage Open Enrollment Period (OEP)

January 1 – March 31

  • What is a Special Enrollment Period (SEP)?

    • There are various types of SEPs, including SEPs for those who are eligible for both Medicare and Medicaid (dual eligibles), as well as for individuals whose current plan no longer operates in his/her area, who move out of the plan’s service area and who meet unique conditions. To see if you qualify for a SEP, please call a CareSource Medicare Advantage Sales Representative at 1-844-781-1301 (TTY: 711) from 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.
  • Can a child or guardian enroll a parent into a Medicare Advantage plan?

    • If you have Legal Guardianship or a valid Power of Attorney that allows you to make decisions on someone’s behalf, you can enroll that person into a Medicare Advantage plan. You must have the paperwork documenting Legal Guardianship or Power of Attorney.
  • What is the Late Enrollment Penalty (LEP) and will I have to pay this penalty?

    • If you have Legal Guardianship or a valid Power of Attorney that allows you to make decisions on someone’s behalf, you can enroll that person into a Medicare Advantage plan. You must have the paperwork documenting Legal Guardianship or Power of Attorney.
  • What is the Late Enrollment Penalty (LEP) and will I have to pay this penalty?

    • The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D) or without a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage for any continuous period of 63 days or more after you were first eligible for Medicare Part D.

      In other words, if you were eligible to join Medicare Part D and did not do so, you may have to pay a penalty for joining the plan later; and that penalty increases with each month you do not enroll. The cost of the late enrollment penalty depends on how long you went without Part D or creditable drug coverage. If you owe this penalty, we will tell you what your premium will be. Please call CareSource Member Services at 1-844-607-2827 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours.

  • I currently have a Prescription Drug Plan (PDP)/Medicare Advantage plan. Can I enroll in another Medicare Advantage plan?

    • During the Annual Enrollment Period or a Special Enrollment Period, you can enroll in a Medicare Advantage plan. However, by enrolling in the Medicare Advantage plan, you will be automatically disenrolled from your current plan. You are only permitted to be enrolled in one Medicare Advantage plan at a time.
  • How can I search and compare plans in my area?

    • You can use the Medicare Plan Finder tool online at Medicare.gov. You can also explore the CareSource Medicare Advantage plans in your area on this website.
  • Do I need to keep my Original Medicare card?

    • If you have Medicare Parts A and B, you’ll need to show your Original Medicare card when you receive health care services.

      If you have a Medicare Advantage plan, you should keep your Medicare card in a safe place – but you don’t have to carry it with you. Instead, present your CareSource Medicare Advantage member ID card to doctor’s offices, pharmacies and other health care providers.

  • I will be turning 65 in a few months. When can I enroll in a CareSource Medicare Advantage plan?

    • You may enroll anytime during the first three months immediately preceding the month your enrollment in Medicare Parts A and B becomes effective. This is typically the month you turn 65. This enrollment period is known as the Initial Coverage Enrollment Period (ICEP). It generally coincides with the month you turn 65. This enrollment period typically ends on the last day of your Part B initial enrollment period, which is usually the end of three months after the month you turn 65.

Joining CareSource

  • When can I enroll in a CareSource Medicare Advantage plan?

    • You may enroll anytime during the first three months immediately preceding the month your enrollment in Medicare Parts A and B becomes effective. This is typically the month you turn 65. This enrollment period is known as the Initial Coverage Enrollment Period (ICEP). It generally coincides with the month you turn 65. This enrollment period typically ends on the last day of your Part B initial enrollment period, which is usually the end of three months after the month you turn 65.

      The Annual Enrollment Period (AEP) for Medicare Advantage is October 15 through December 7 each year. At this time, you can enroll in Medicare health benefits, such as a Medicare Advantage plan, for the following year. During this period, you can also change plans or enroll in a separate drug plan. Your coverage begins January 1.

      However, there are other enrollment periods, like your Initial Coverage Enrollment Period and Special Enrollment Periods. For more information, please contact a CareSource Medicare Advantage Sales Representative at 1-844-781-1301 (TTY: 711) from 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

  • What counties does CareSource Medicare Advantage cover?

    • CareSource offers Medicare Advantage plans in the following Ohio counties:

      RegionCounties
      Region 2Ashland, Carroll, Cuyahoga, Geauga, Hancock, Holmes, Lawrence, Licking, Portage, Stark, Summit, Wayne
      Region 3Adams, Athens, Brown, Champaign, Clark, Columbiana, Darke, Defiance, Delaware, Fairfield, Fayette, Fulton, Gallia, Greene, Hamilton, Hocking, Huron, Lake, Lucas, Madison, Mahoning, Medina, Mercer, Miami, Monroe, Morgan, Muskingum, Pickaway, Richland, Sandusky, Seneca, Shelby, Trumbull, Union, Van Wert, Williams, Wood, Wyandot
      Region 4Allen, Auglaize, Butler, Clermont, Clinton, Coshocton, Crawford, Erie, Franklin, Guernsey, Hardin, Harrison, Henry, Highland, Jackson, Jefferson, Logan, Lorain, Marion, Meigs, Montgomery, Morrow, Noble, Ottawa, Paulding, Perry, Pike, Preble, Putnam, Ross, Scioto, Vinton, Warren, Washington
    • Please visit Benefits and Services to explore your CareSource Medicare Advantage options.
  • What CareSource Medicare Advantage Plans are offered?

    • CareSource offers the following Medicare Advantage plans

      Medicare Advantage with Prescription Drugs

      • CareSource Advantage Zero Premium® (HMO)
      • CareSource Advantage® (HMO)

      *Plans vary based on where you live

  • Do I have to take a physical examination when I apply for a CareSource Medicare Advantage plan?

    • No. You do not have to take a physical examination when you apply for a CareSource Medicare Advantage plan.
  • What documents should I review before enrolling?

    • It is important to review all plan documents prior to completing an enrollment. Please review our benefits and plan documentsIt is important to review the benefits and important documents to make sure a CareSource Medicare Advantage plan is right for you.
  • I don’t feel comfortable enrolling online. Can I enroll over the phone?

    • Our online enrollment form is safe and secure. At CareSource, we take the safety and privacy of members and prospective members very seriously.

      However, CareSource also provides an enrollment form that you can complete, print and mail to us.

      After you fill out the enrollment form it its entirety, mail it to us at the following address:

      CareSource Medicare Advantage
      P.O. Box 1294
      Dayton, OH 45401-1294

      If you’d prefer to talk to someone over the phone, our CareSource Medicare Advantage Sales Representatives are ready for your call. To enroll over the phone, please call us at 1-844-781-1301 (TTY: 711) from 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

      You can also request a CareSource Medicare Advantage Sales Representative to come to your home to review plan benefits and help you enroll in person.

      Medicare beneficiaries may also enroll in CareSource Advantage® Zero Premium (HMO) or CareSource Advantage® (HMO) through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov or by calling 1-800-MEDICARE.

  • I’m having trouble completing the online enrollment form. Who should I call?

    • Call 1-844-781-1301 (TTY: 711) to speak to one of our Medicare Advantage Sales Representatives to get help completing your form. We are open from 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

      We can also send a CareSource Medicare Advantage Sales Representative to your home to answer any questions you may have.

  • When will I get my CareSource member ID card?

    • You will receive your CareSource member ID card a few weeks after you enroll.
  • Do I need to keep my Original Medicare card?

    • If you have Medicare Parts A and B, you’ll need to show your Original Medicare card when you receive health care services.

      If you have a Medicare Advantage plan, you should keep your Medicare card in a safe place – but you don’t have to carry it with you. Instead, present your CareSource Medicare Advantage member ID card to doctor’s offices, pharmacies and other health care providers.

  • When will my coverage begin?

    • In general, your coverage is effective on the first day of the month after we receive your completed application. If you enrolled during the Annual Enrollment Period (AEP) between October 15 and December 7, your coverage is effective on January 1. However, it can take some time for Medicare and CareSource to process your application, so be sure to keep temporary proof of membership with you until you receive your CareSource Medicare Advantage member ID card.
  • What is My CareSource®?

    • My CareSource is a secure personal online account for CareSource members. Use My CareSource to change your doctor, request a new CareSource member ID card, view claims and plan details, update your contact information and more. 
  • How can I request my plan information?

    • You can request plan information by calling Member Services at 1-844-607-2827 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours.

Member Services: 1-844-607-2827 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.

Out-of-network/non-contracted providers are under no obligation to treat CareSource members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

This information is not a complete description of benefits. Call 1-844-607-2827 (TTY: 711) for more information.