Plan Documents

We want you to easily find the documents you need. Explanations of when and why you may need to use a document are also provided below. You can also find these plan documents in CareSource MyLife.

If you would like a printed copy of these documents, please call Member Services and we can mail it to you.

Evidence of Coverage (EOC) and Member Handbook

These documents are a quick reference guide to your health care benefits. You can find your covered benefits and services, where to get care and your rights and responsibilities as a CareSource member.

Quick Guide

The Quick Guide (coming soon) is mailed to all new members. It has a high-level overview of benefits and services, and the printed version that is mailed also has the member ID card.

Annual Notice of Change

The Annual Notice of Change outlines the changes to your benefits for the next plan year.

Summary of Benefits 

The Navigate Summary of Benefits (Last Updated 10/22/2025) is a summary of your covered benefits and any limitations. Your Evidence of Coverage (EOC) or Member Handbook has more information on the full list of benefits.

Provider Directory

The most up-to-date list of providers is available through our Find a Doctor tool. This tool will show you primary care providers (PCPs), specialists, hospitals, and more that are in the CareSource network. Or search all providers in the Ohio Department of Medicaid’s Provider Directory.

Pharmacy Directory

The most up-to-date list of network pharmacies is available through our Find a Pharmacy tool.

Prior Authorization List

Some services require approval from CareSource MyCare Ohio before you can get them. We call this prior authorization. Your provider will take care of this for you. The Prior Authorization list shows which services you need approval for before you can get them.

Your provider can submit a request for a prior authorization using the Prior Authorization Request Form (coming soon). If you are seeing a specialist, they will get approval from your primary care provider (PCP).

Pharmacy Documents

  • List of Covered Drugs (Formulary) (Navigate English  |  Navigate Spanish) (Updated 10/20/2025): This is a list of all drugs covered under your Medicare Part D plan if you get both your Medicare and Medicaid benefits through CareSource.
    • Navigate Prior Authorization Criteria (Last Updated 10/15/2025): There are some drugs where your provider will need to tell us before you can fill your prescription.
    • Navigate Step Therapy Criteria (Last Updated 10/15/2025): Sometimes we will have you try another drug to treat your medical condition before we will cover the drug your provider initially prescribed.
  • Notice of Formulary Changes: If changes occur to drugs on our Part D formulary, we will update them in this list.
  • Preferred Diabetic Supply List (coming soon): CareSource MyCare Ohio covers these preferred diabetic testing supplies.
  • Navigate Medicaid List of Covered Drugs (Last Updated 10/15/2025): This list shows the OTC items and non-Part D drugs you get as part of your plan.
  • Coverage Determination Request Form – If you think you should get payment or benefits on a certain drug, you can request a coverage determination. Fill out this form: online (coming soon) or Navigate hard copy.
  • Coverage Redetermination Request Form – If you are unhappy with the result of a coverage determination request, you can file an appeal. Use this redetermination form: online (coming soon) or Navigate hard copy.

Star Ratings

Star Ratings are given to the CareSource Dual Advantage plan 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.