Dental, Vision & Hearing

Dental

Don’t worry, CareSource Medicare Advantage also covers your smile. No matter which plan you choose, preventive dental services have $0 copay.

Enhanced coverage for our CareSource Advantage® (HMO) and CareSource Advantage Plus® (HMO) plans also include dentures! No deductible, no waiting period!

2019 Dental Coverage

 CareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) Caresource Advantage Plus® (HMO)
 $1,000 Annual Limit For Comprehensive$1,200 Annual Limit for Comprehensive
 Covered/
Not Covered
Copay/
Coinsurance
Covered/
Not Covered
Copay/
Coinsurance
Covered/
Not Covered
Copay/
Coinsurance
Preventive Dental Visits, including Oral Exams*, Preventive Dental Prophylaxis* and Preventive Dental X-Rays**Covered$0 copayCovered$0 copayCovered$0 copay
Preventive Dental Fluoride TreatmentNot CoveredNot CoveredNot Covered
Comprehensive Dental (Medicare Covered) Covered$50 copayCovered$50 copayCovered$30 copay
Comprehensive Dental (Non-Medicare Covered)Not CoveredCovered50% coinsurance, $1000 limitCovered50% coinsurance, $1,200 limit
Lab and Other TestsNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Emergency (Palliative)Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Space MaintainersNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Simple ExtractionsNot CoveredCovered$0 / 30.0%Covered$0 / 30.0%
Surgical ExtractionsNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Oral SurgeryNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
AnesthesiaNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Minor Restorations
(e.g., Fillings)
Not CoveredCovered$0 / 30.0%Covered$0 / 30.0%
Major Restorations
(e.g., Crowns)
Not Covered– Covered$0 / 50.0%Covered$0 / 50.0%
Periodontics(e.g., Soft Tissue Procedures)Not CoveredCovered$0 / 30.0%Covered$0 / 30.0%
Endodontics
(e.g., Root Canal)
Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
DenturesNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%

*Limit 1, Every 6 Months
**Limit 1, Every Year

2018 Dental Coverage

 CareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) Caresource Advantage Plus® (HMO)
 $750 Annual Limit For Comprehensive$1,000 Annual Limit for Comprehensive
 Covered/
Not Covered
Copay/
Coinsurance
Covered/
Not Covered
Copay/
Coinsurance
Covered/
Not Covered
Copay/
Coinsurance
Preventive Dental Visits, including Oral Exams*, Preventive Dental Prophylaxis* and Preventive Dental X-Rays**Covered$10 copayCovered$10 copayCovered$10 copay
Preventive Dental Fluoride TreatmentNot CoveredNot CoveredNot Covered
Comprehensive Dental (Medicare Covered) Covered$45 copayCovered$50 copayCovered$30 copay
Comprehensive Dental (Non-Medicare Covered)Not CoveredCovered50% coinsurance, $750 limitCovered50% coinsurance, $1,000 limit
Lab and Other TestsNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Emergency (Palliative)Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Space MaintainersNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Simple ExtractionsNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Surgical ExtractionsNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Oral SurgeryNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
AnesthesiaNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Restorations
(e.g., Fillings and Crowns)
Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Periodontics(e.g., Soft Tissue Procedures)Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
Endodontics
(e.g., Root Canal)
Not CoveredCovered$0 / 50.0%Covered$0 / 50.0%
DenturesNot CoveredCovered$0 / 50.0%Covered$0 / 50.0%

* Limit 1, Every 6 Months

** Limit 1, Every Year

Vision

CareSource has partnered with EyeMed Vision Care® to bring a Medicare Advantage vision benefit solution that offers more…

  • Access to EyeMed’s Insight network, a vision network made up of the right mix of independent providers, national retail and regional retail providers, including:
    • Independent Provider Network, LensCrafters, Pearle Vision, Target Optical, Sears Optical and JCPenney Optical
  • Service that is always open to new patients and without an appointment

  • Locations with extended evening and weekend hours in convenient locations

  • Online solutions that allow members and their caregivers, to evaluate options at 

    home and reduce stress at the provider office

  • Benefit options that offer more flexibility, choice and savings

2019 Vision Benefits

CareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) CareSource Advantage Plus® (HMO)
Routine Exam with Dilation as Necessary$0 copay$0 copay$0 copay
Exam to Diagnose and Treat Diseases and Conditions of the Eye$50 copay$50 copay$30 copay
$100 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses$130 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses$150 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses
Eyeglass Frames (1 every 2 years)$0 copay; 20% off balance over $100 allowance$0 copay; 20% off balance over $130 allowance$0 copay; 20% off balance over $150 allowance
Eyeglass Lenses
in lieu of contact lenses
$25-$135 copay for most lens types$25-135 copay for most lens types$25-135 copay for most lens types
Contact Lenses (conventional)
in lieu of eyeglass lenses
$0 copay, 15% off balance over $100 allowance15% off balance over $130 allowance15% off balance over $150 allowance

Additional Savings…

  • 40% off additional pair discount

  • 20% off non-prescription sunglasses

  • 15% off retail or 5% off promotional price LASIK

2018 Vision Benefits

CareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) CareSource Advantage Plus® (HMO)
Routine Exam with Dilation as Necessary$0 copay$0 copay$0 copay
Exam to Diagnose and Treat Diseases and Conditions of the Eye$50 copay$50 copay$30 copay
$100 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses$130 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses$150 allowance per year toward eyeglass frames, eyeglass lenses or contact lenses
Eyeglass Frames (1 every 2 years)$0 copay; 20% off balance over $100 allowance$0 copay; 20% off balance over $130 allowance$0 copay; 20% off balance over $150 allowance
Eyeglass Lenses
in lieu of contact lenses
$25-$135 copay for most lens types$25-135 copay for most lens types$25-135 copay for most lens types
Contact Lenses (conventional)
in lieu of eyeglass lenses
15% off balance over $100 allowance15% off balance over $130 allowance15% off balance over $150 allowance

Hearing

CareSource has partnered with TruHearing to provide you with high-quality hearing aids and local professional care at a fraction of the cost. Traditional Medicare doesn’t offer a hearing aid benefit, leaving you to pay $2,000–3,000 per hearing aid on the retail market. Your plan covers up to two hearing aids per year.

2019 Benefits

In-NetworkCareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) CareSource Advantage Plus® (HMO)
Routine Hearing Test

$0 copay$0 copay$0 copay 
Exam to diagnose and treat hearing and balance issues$50 copay$50 copay$50 copay
Hearing aid fitting/evaluation$0 copay$0 copay$0 copay
Hearing Aids$699/999 copay per hearing aid, up to 2 per year$499/799 copay per hearing aid, up to 2 per year$199/499 copay per hearing aid, up to 2 per year

2018 Benefits

In-NetworkCareSource Advantage® Zero Premium (HMO)CareSource Advantage® (HMO) CareSource Advantage Plus® (HMO)
Routine Hearing Test

$0 copay$0 copay$0 copay 
Exam to diagnose and treat hearing and balance issues$45 copay$45 copay$45 copay
Hearing aid fitting/evaluation$0 copay$0 copay$0 copay
Hearing Aids$699/999 copay per hearing aid, up to 2 per year$499/799 copay per hearing aid, up to 2 per year$199/499 copay per hearing aid, up to 2 per year

Call TruHearing at 1-855-205-5499 (TTY: 711) to learn more and to find a network provider.

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.

CareSource is an HMO with a Medicare contract. Enrollment in CareSource Advantage® Zero Premium (HMO), CareSource Advantage® (HMO) and CareSource Advantage Plus® (HMO) depends on contract renewal. This information is not a complete description of benefits. Call 1-844-607-2827 (TTY: 1-800-750-0750 or 711) for more information.


Y0119_OHMA-M-0251
Updated 10/1/2018
CMS Accepted 9/25/2018