Plan Documents

Review your CareSource^® MyCare Ohio (Medicare-Medicaid Plan) plan documents to make sure you get the most from your health plan. You can also contact us with any questions you have about your plan.

Member Handbook

Your member handbook is a reference guide to your health care benefits. It allows you to quickly look up information such as how to contact us, how to contact your care manager and how to file a complaint. It also tells you how our plan works, the covered services you get, services that are not included, and your rights and responsibilities. You’ll want to review the handbook and materials that fit your member status.

2023

• Medicare-Medicaid Member Handbook (Navigate English  |  Navigate Spanish)
• Medicaid-Only Member Handbook (Navigate English |  Navigate Spanish)
• Navigate MyCare Waiver Member Handbook
• Navigate MyCare Benefits at a Glance

Annual Notice of Changes

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

2023

• Annual Notice of Change (ANOC) (Navigate English) | (Navigate Spanish)

Summary of Benefits 

The Summary of Benefits includes your covered benefits and any limitations. It is only a summary. Please read your Member Handbook for the full list of benefits.

2023

• Summary of Benefits (Navigate English) | (Navigate Spanish)

Provider/Pharmacy Directory

These directories are listings of the participating providers, including pharmacies, for CareSource MyCare Ohio. You will find office hours and if a doctor is accepting new patients. You will also see if the office is on a bus route and other helpful information. 

Please see Find a Doctor/Provider for the most current listing.

Please see Find a Pharmacy for the most current listing.

Provider/Pharmacy Directory (English/Español)

• Navigate 2023 Full Provider/Pharmacy Directory (9/02/2023) Last updated on 9/02/2023

You may also request a directory be mailed to you by clicking here.

Forms

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

Prior Authorization List

Some services require prior authorization from CareSource MyCare Ohio before you can get them. This means your provider must get approval from CareSource MyCare Ohio before you can get the service.

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

• Navigate 2023 Prior Authorization List

Usually your provider will ask for prior authorization from us and then schedule these services for you. Your provider can submit a request for a prior authorization using the Prior Authorization Request Form.

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 1-855-475-3163 (TTY: 1-800-750-0750 or 711), Monday – Friday, 8 a.m. – 8 p.m.

Prescription Drug Benefit Documents

Below are links to documents covering your prescription drug benefits, including the latest drugs covered by the plan and more.

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

2023

• Comprehensive Formulary
  • Navigate English (9/07/2023) Last updated on 9/07/2023
  • Navigate Spanish (9/13/2023) Last updated on 9/13/2023

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

• • Navigate 2023 Notice of Formulary Changes (9/07/2023) Last updated on 9/07/2023

The Over-the-Counter (OTC) Items and Non-Part D Drug List outlines additional coverage for certain OTC items and non-Part D drugs included in your plan offering. The below is a detailed list of products payable at your local, participating pharmacy. These products are listed in your MyCare Comprehensive Formulary with the abbreviation “ADD”. ADD stands for Additional Demonstration Drug list. ADD indicates the additional OTC items and non-Part D drugs are covered by the Medicaid benefits of your plan.

• Navigate 2023 Over-the-Counter (OTC) Items and Non-Part D Drug List

Coverage Determination Request Form online or Navigate 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 Navigate 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 primary care provider (PCP) will need to contact us before you can fill your prescription.

• Navigate 2023 Prior Authorization Criteria (9/07/2023) Last updated on 9/07/2023

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 provider initially prescribed.

• Navigate 2023 Step Therapy Criteria (9/07/2023) Last updated on 9/07/2023

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

Newsletters

Stay up to date with CareSource MyCare Ohio’s quarterly newsletters.

Need Information in Another Language? 

You can get CareSource MyCare Ohio information for free in other languages or alternate formats such as large print, braille or audio. Call 1-855-475-3163 (TTY: 1-800-750-0750 or 711), Monday – Friday, 8 a.m. – 8 p.m. The call is free.

Puede obtener esta información de forma gratuita en otros idiomas. Llame al 1-855-475-3163 (TTY: 1-800-750-0750 o 711), el lunes a viernes, 8 a.m. – 8 p.m.  La llamada es gratuita.

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

Non-Discrimination Notice

View the CareSource notice of non-discrimination.