As a Qualified Health Plan offered through the Health Insurance Marketplace, CareSource offers coverage for all the essential health benefits required by the Affordable Care Act, including maternity care, prescription drug coverage, and more. Plus, Marketplace plans cover people with pre-existing conditions and don’t carry lifetime coverage caps for most benefits. That’s what real insurance should be. Not all health insurance plans can say that.
ESSENTIAL HEALTH BENEFITS
CareSource Marketplace plans cover:
- Pregnancy, maternity and newborn care
- Prescription drugs
- Outpatient care
- Emergency services
- Mental health and substance use disorder services
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services
- Pediatric Services
Marketplace plans are also the only plans that qualify for government-sponsored funds that help make coverage affordable. Eligibility for these funds is determined by the Health Insurance Marketplace, not by CareSource. There are two ways the funds are distributed:
|Advance Premium Tax Credit (APTC)|
|Tax credit based on income levels, to lower monthly premium payments. This can be used no matter what plan you enroll in.|
|Cost-Sharing Reduction (CSR)|
|CSRs are discounts or “extra savings” that lower the amount you have to pay for deductibles, copayments, and coinsurance. CSRs only apply to Silver plans†, so if you qualify for a CSR, you must enroll in a Silver plan to get it.|
CareSource is pleased to serve the community and our members in the following 35 West Virginia counties. Before beginning your search, please make certain we offer plans in your area. Barbour, Boone, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Hancock, Harrison, Jackson, Kanawha, Lincoln, Logan, Marion, Marshall, Mason,McDowell, Mingo, Monongalia, Ohio, Pleasants, Preston, Putnam, Raleigh, Ritchie, Roane, Taylor, Tyler, Wayne, Wetzel, Wirt, Wood and Wyoming.
Marketplace Plan Benefits
Tools & Resources
Explore helpful tools like Find a Doctor and Find My Prescription, view plan documents and more.
Quickly access your member information, change your doctor, request a new ID card and more.
Marketplace plans are separated into metal level categories of Gold, Silver, and Bronze. The metal level categories are based on how you and CareSource share the cost of your health care. Note that most CareSource members are also eligible for helpful government subsidies, which will lower your out-of-pocket cost for health care.
If you expect to have a lot of doctor appointments, need many prescription medicines, or need other health services, this may be a good choice for you. Gold plans have:
Higher premiums. You pay more each month for a Gold plan than you would for another metal level.
Lower out-of-pocket costs. With a Gold plan, the amount you pay each time you get a health service, such as seeing a doctor or filling a prescription, is less than what you’d pay if you have a Bronze or Silver plan.
CareSource Silver Plans are our most popular plans In fact, over half* of our members find that Silver Plans fit their healthcare coverage needs and budget best. Silver plans offer the highest value for those eligible for financial assistance.
Health Care Coverage Your Way. We offer three different Silver plan options so you can choose the one that fits your budget and healthcare needs – Low Premium, Low Deductible, or balance premium and deductible with the Standard Silver plan.
Financial Assistance. These are the only plans that offer cost-sharing reductions (CSRs)† in addition to premium tax credits. CSR’s are a discount or “extra savings” that lower the amount you have to pay for deductibles, copayments, and coinsurance.
Bronze plans offer the most affordable premiums. If you don’t expect to have many doctor appointments or need many prescription drugs, this may be a good choice for you. Bronze plans have:
Lowest premiums. You pay less each month for a Bronze Plan, but these plans have the highest deductibles and other out-of-pocket costs.
Two Different Bronze Plan Options:
Standard Bronze – This plan reduces your premiums for a higher contribution on your benefit usage. Unlike our HSA Eligible option, CareSource will begin covering certain services before you meet your deductible such as Primary Care Provider visits and retail generic prescription drugs.
HSA Eligible – Our Bronze HSA-eligible plan is a high deductible health plan, compatible with a tax advantaged Health Savings Account (HSA). This plan requires your deductible to be met before we contribute to your benefits, however your pre-tax/tax deductible HSA contributions will offset some of the costs. An HSA account can be opened at most financial institutions.
YOU MAY BE ELIGIBLE FOR A SPECIAL ENROLLMENT PERIOD
Open enrollment for 2019 has ended but you may still be able to enroll! If you have had a qualifying Life Event within the last 60 days, the Health Insurance Marketplace will grant you a Special Enrollment period .
Qualifying life events include (but are not limited to):
- Getting married
- Having a baby
- Moving outside your insurer’s coverage area
- Becoming a U.S. citizen
- Leaving incarceration
- Having a change in income or household status that affects eligibility for advance premium tax credits or cost-sharing reductions if you are already enrolled in coverage through the Marketplace
- Adopting a child or placing a child for adoption or foster care
- Losing other qualifying health coverage due to losing job-based coverage, divorce, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and similar circumstances
To find out if you are eligible for a Special Enrollment Period, give us a call at 1-844-539-1733 (TTY: 711).
*Based on 2018 CareSource Marketplace enrollment.
*Adult Vision and Dental coverage not available for Bronze HSA
† CSRs also applicable on Limited and Zero Plans, available only to members of federally recognized tribes and ANCSA corporation shareholders.
CareSource is a Qualified Health Plan issuer in the Health Insurance Marketplace. This is not a Health Insurance Marketplace website. This website does not display all available plans. To see all available Qualified Health Plan options available, go to www.healthcare.gov.
This website is subject to change at any time without prior notice. This website is intended only as general information and is not an offer or invitation to contract.
Specific policy benefits listed on this website are intended to be a summary of coverage and do not list or describe all the benefits covered under specific policies nor is every limitation, exclusion or reduction of benefits listed. The overview of benefits, coverage and member cost shares are based on benefits being received from an in-network provider. To be eligible for reimbursement, all health care services must be provided by an in-network provider, except when applicable federal and state law or the applicable Evidence of Coverage for each policy provide otherwise.
Rates, benefits, premiums, deductibles, co-payments, co-insurance, and out of pocket expenses may vary based upon a variety of factors, including but not limited to, age, county of residence, smoking status, and level of policy selected.
This is a solicitation for health insurance. All covered health care services must be received by in-network providers, except as otherwise required by applicable law, and subject to policy limitations and exceptions. Benefits, premiums, deductibles and copays may vary based on individual circumstances and plan selection. For complete details of coverage, limitations and exclusions, please review the CareSource Marketplace 2019 Evidence of Coverage and Schedule of Benefits documents at www.caresource.com/marketplace.
References to CareSource pertain to each individual company or other CareSource affiliated companies, such as CareSource, CareSource Kentucky Co., CareSource Indiana Inc., and CareSource West Virginia Co. Each company is a separate entity and is not responsible for another’s financial condition or contractual obligations.
CareSource does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations
Last updated 01/04/2019