Plan Documents

Review your CareSource Medicare Advantage plan documents to make sure you get the most from your health insurance plan. You can also contact us with any questions you have about your plan coverage.

Evidence of Coverage (EOC)

The EOC is an important legal document that describes the relationship between CareSource and members of CareSource Advantage® Zero Premium (HMO), CareSource Advantage® (HMO), and CareSource Advantage Plus® (HMO). It serves as your contract with CareSource and describes your member rights, responsibilities and obligations. It also tells you how the plan works, the covered services you are entitled to, any conditions and limits related to covered services, the health care services that are not covered by the plan, and the annual deductible, copayments, and coinsurance you must pay when you receive covered services.

Access the EOC below that corresponds to your plan and plan year:

2019

2018

Annual Notice of Change

The Annual Notice of Change for 2018 outlines changes to your benefits for the upcoming year:

2019

2018

Provider and Pharmacy Directory

The Provider and Pharmacy Directory is a listing of the participating providers, including pharmacies, for CareSource Medicare Advantage plans. You may request a directory be mailed to you by clicking here.

You can also search for a provider or a pharmacy by clicking the links below:

Summary of Benefits

The Summary of Benefits outlines the key features of the plan, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

Forms

We want you to be able to easily locate all the forms you may need for your CareSource Medicare Advantage plan. Visit the Forms page to find any form when you need it. 

Prior Authorization List

Some services require prior authorization from CareSource. This means your doctor or health care provider must get approval from CareSource before you can get the service.

The Prior Authorization List shows which services need a prior authorization before you can get them.

Usually your primary care provider (PCP) will ask for prior authorization from us and then schedule these services for you. If you are seeing a specialist, he or she will get approval from your PCP. Then your services will be scheduled. If you have questions about the prior authorization process or status, please call Member Services.

Your provider can submit a request for a prior authorization using the Prior Authorization Request Form .

Prescription Drug Benefit Documents

Below are links to documents covering your prescription drug benefits, including the latest drugs covered by the plan, a list of pharmacies in your area, and more.

Comprehensive Formulary – The CareSource Medicare Advantage formulary is a list of all drugs covered under your plan.

Notice of Formulary Changes – Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates. 

Coverage Determination Request Form online or hard copy – If you believe you are entitled to payment or benefits on a certain drug, you can request a coverage determination by completing this form.

Coverage Redetermination Request Form online or hard copy – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form.

Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.

Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed.

Drug Transition Policy – Learn about our policy for potentially covering a drug that you currently use that is not listed in our formulary.

Star Ratings

Star Ratings are given to Medicare Advantage plans by the Centers for Medicare & Medicaid Services (CMS). Plans are rated on a 5-point scale. Go to www.medicare.gov to learn more about Star Ratings.

Need Information in Another Language?

We can help! See our Multi-Language Interpreter Services for information to request plan documents in another language.

Non-Discrimination Notice

View CareSource’s notice of non-discrimination.

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. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


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