Benefits and Services

CareSource plans provide comprehensive, quality coverage that you can afford, understand and use. We offer individual and family plans with optional dental and vision coverage for adults.

Benefits Update

For 2022, CareSource Marketplace Plans feature the following benefits:

  • CSR-eligible Silver plans come in three different packages – Low Premium, Standard, or Low Deductible
  • Active&Fit® Fitness benefit included with all optional Dental, Vision and Fitness plans. It includes access to a network of participating fitness centers, including select LA Fitness®, Snap FitnessTM, Anytime Fitness®, Planet Fitness® – and more! To get more information about the Active&Fit program, visit www.ActiveandFit.com.
  • TruHearing® provider network for hearing coverage is included with all plans.
  • EyeMed provider network for vision services on all plans for pediatric vision and adults with optional Dental, Vision and Fitness plans.
  • DentaQuest® provider network for pediatric dental coverage for all plans and adult dental coverage for adults with optional Dental, Vision and Fitness plans.
  • HSA Bank partnership for members enrolled in an HSA Eligible Bronze plan.

Benefits

  • Additional Programs, Services, and Rewards

    • Active&Fit® Program † (Adults with Dental, Vision and Fitness plans)
    • Care Management
    • CareSource Mobile App
    • CareSource24® 24 Hour Nurse Advice Line
    • Disease Management
    • Fifth Third Express Banking®
    • Health and Wellness Education Programs
    • Health Savings Accounts through HSA Bank
    • Medication Therapy Management
    • MyHealth Online Tool
    • myStrengthSM Online Mental Health Tool
  • Behavioral Health

    • All Inpatient Services*
    • Electroconvulsive Therapy (ECT)
    • Family Psychotherapy*
    • Group Therapy
    • Individual Psychotherapy*
    • Intensive Outpatient Program (IOP) Services*
    • Medication Assisted Treatment (MAT)
    • Partial Hospitalization Program (PHP) Services*
    • Pharmacological Management
    • Psychiatric Diagnostic Evaluation
    • Psychiatric Residential Treatment* (PRTF)
    • Psychological Testing
    • Substance Use Disorder (SUD) Residential*
    • Transcranial Magnetic Stimulation* (TMS)
  • Dental

    All pediatric members and adults with Dental, Vision and Fitness plans.

    • Accidental Dental Services
    • Dental Exams and Cleanings
    • Dental X-Rays*
    • Dentures*
    • Fluoride Treatments (Pediatric Only)
    • Medically Necessary Orthodontics (Pediatric Only) *
    • Surgeries and Procedures* (Extractions, Restorations, etc.)
  • Diagnostics

    • Blood Work/Lab Testing*
    • Scans (e.g., CT, MRI and PET*.)
    • X-Rays
  • Family Planning and Maternity Services

    • Birth Control and Contraceptive Supplies*
    • Breastfeeding Support, Supplies and Counseling
    • Breast Pumps
    • Folic Acid Supplements
    • Infertility Services (Diagnosis and Treatment)
    • Lactation Classes
    • Maternal Depression Screening
    • Newborn Screenings (Sickle Cell, PKU, etc.)
    • Parent Education
    • Prenatal and Postpartum Doctor and Home Visits
    • STD/STI Screenings and Treatment Sterilization*
  • Health Care Visits

    • Birthing Centers
    • Community Behavioral Health Centers (CBHCs)
    • Convenience Care Clinics inside of stores like CVS®, Kroger® and Walmart® (Excludes WV)
    • Emergency Room (ER)
    • Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC)
    • Hospital (Inpatient* and Outpatient)
    • Telehealth – virtual doctor visits over the phone or online including RelyMD®
    • Primary Care Providers (PCP) like Doctors, OB/GYNs, Physician Assistants and Nurse Practitioners
    • Skilled Nursing Facility* (SNF)
    • Specialists (e.g., Podiatrist, Neurologist and Oncologist.)
    • Urgent Care Center
  • Health Condition Management

    • Chemotherapy and Radiation* Diabetes Education
    • Diabetes Screening
    • Diabetic Services and Supplies
    • Dialysis Treatment
    • Kidney Disease Services and Supplies
    • Pulmonary (Lung) Rehabilitation Services*
  • Heart

    • Abdominal Aortic Aneurysm Screening
    • Cardiac (Heart) Rehabilitation Services*
    • Electrocardiogram* (ECG/EKG)
    • Heart Disease Risk Reduction Visit (Therapy for Heart Disease)
    • Heart Disease Testing
  • Home Health Care*

    Durable Medical Equipment (DME – See Medical Supplies)
    Home Infusion Therapy*
    Home Nursing Services* (e.g., Skilled Nursing and Private Duty.) (Private Duty not available to Georgia plans)
    Physical, Occupational and Speech Therapy*

  • Medical Supplies

    • Cochlear Implants*
    • Diabetic Supplies (Lancets, Test Strips and Monitors)
    • Durable Medical Equipment (DME) and Related Supplies* (e.g., Oxygen Tank, Wheelchair/Walkers and Wound Care.)
    • Nutritional Supplies*
    • Prosthetic Devices and Related Supplies*
  • Other Care

    • ABA therapy* (Applied Behavioral Analysis)
    • Allergy Testing and Treatment
    • Bereavement Services
    • Bone Mass Measurements
    • Chiropractic Services*
    • Hearing Exam and Hearing Aids †
    • Hospice Care*
    • Inhalation Therapy* (Asthma, Breathing, etc.)
    • Medical Nutrition Therapy*
    • Nutritional Counseling
    • Obesity/BMI Screening and Dietary Counseling
    • Occupational Therapy*
    • Pain Management*
    • Physical Therapy*
    • Podiatry (Foot) Services
    • Smoking/Tobacco Cessation (Counseling to quit smoking/tobacco use)
    • Speech Therapy*
    • Surgeries* (General, Reconstructive, etc.)
    • TMJ Services* (Jaw pain or problems with jaw movement)
    • Transplant Services*
  • Pharmacy and Medications

    • Brand, Generic and Specialty* Drugs (Multiple Tiers)
    • Mail Order Drugs
  • Preventive and Early Detection Care/Screenings

    • Annual Well Visit (Physical Exam)
    • Autism Spectrum Disorder Screening
    • Blood Pressure Screening (Adults)
    • Breast Cancer Screening (Mammogram)
    • Cervical and Vaginal Cancer Screening (Pap smear) Cholesterol Screening (Adults)
    • Colorectal Cancer Screening
    • Developmental Screening (Under age three)
    • Diabetes Screening
    • Disease Screening and Treatments (e.g., Hepatitis, HIV and STI/STD.)
    • Domestic/Interpersonal Violence Screening
    • Glaucoma Screening Immunizations (e.g., Flu, Pertussis and Hep B shots.) Lung Cancer Screening Prostate
    • Cancer Screening Sports Physicals
  • Transportation Services

    • Emergency* (Ambulance, Air Flights, etc.)
    • Non-Emergency Transfers* (Non-Network to Network Facility, Hospital to Skilled Nursing Facility, etc.
  • Vision/Eye Care

    All pediatric members and adults with Dental, Vision and Fitness plans.

    • Eye Exams (one comprehensive exam per year)
    • Glasses or Contacts (one per year; selection criteria applies)
    • Low Vision Aids (one per year)
    • Low Vision Evaluation (under 18 years and every five years)
    • Replacement Glasses or Contacts (one per year for damage only)

*Prior authorization may be required.
† Available only for certain Marketplace plans.

Contact your provider for further details on when a prior authorization is required. You can also review our prior authorization list at CareSource.com.

Services

We are here to help you. Your services include:

  • Member Services:  Our Member Services representatives are available toll-free to answer your questions and provide assistance Monday through Friday, from 7 a.m. to 7 p.m. Eastern Standard Time (EST). We also provide TTY access for members who are deaf or hearing impaired. Please call us at 1-800-479-9502 (TTY: 711).
  • CareSource24® Nurse Advice Line – Members may call any time of the day or night to speak to a registered nurse about health and medical concerns. Call the number on your member ID card 24 hours a day, 7 days a week.
  • Care Management Services – CareSource offers care management services to children and adults with special health care needs. Registered nurses, social workers and outreach workers can work with you one-on-one to help coordinate your care.

For more specific information about your benefits and services, please see your Evidence of Coverage and Member Handbook, found on the Plan Documents & Resources page. You can also contact us directly. We are happy to help.

Call for additional information:

  • If you need more information about your health benefits, call CareSource Member Services at 1-800-479-9502 (TTY: 711)
  • For help or more information about your pediatric and optional adult vision benefits, call EyeMed at 1-833-337-3129 or visit www.EyeMedVisionCare.com/csmp
  • For help or more information about the TruHearing discount program, call TruHearing at 1-866-202-2561.
  • For help or more information about your pediatric and optional adult dental services, call DentaQuest at 1-855-388-6252.
  • If you have our optional Dental & Vision coverage and would like more information about Active&Fit®, call 1-877-771-2746 or visit www.ActiveandFit.com