WE GOT YOU.
There’s a lot of noise around health insurance these days. It can be difficult to know what’s true about your coverage and what really matters. But at CareSource, we’ve seen it all. We’ve been around since 1989, and we’re currently providing health coverage to over 2 million members*. We’ve been helping Marketplace insurance shoppers in the Mountain State since 2016 and we never quit. CareSource coverage is here when you need it.
Our plans are simple and affordable with coverage for pre-existing conditions and no annual or lifetime dollar limits for essential health benefits. All plans include pediatric dental and vision. You can choose to include the optional adult dental, vision, and fitness benefits where available. So, if you need health insurance this open enrollment period, CareSource can help. We’ve been helping our members through uncertain times for over 30 years.
CARESOURCE MARKETPLACE PLANS COVER ESSENTIAL HEALTH BENEFITS
With CareSource’s Marketplace plans, you’ll get affordable health insurance that covers what you need, when you need it. All of CareSource’s Marketplace plans are ACA (Affordable Care Act) Compliant with all of the protections afforded by the ACA and coverage for all Essential Health Benefits including pediatric Dental and Vision. If your plan is not ACA compliant, you might not have the coverage you need.
Pregnancy, maternity and newborn care
Mental health and substance use disorder services
Rehabilitative and habilitative services and devices
Preventive and wellness services
Pediatric services, including dental and vision
Pregnancy, maternity & newborn care
Mental health & substance use disorder services
Rehabilitative/habilitative services & devices
Preventive & wellness services
Pediatric services, including dental & vision
Optional Adult Dental, Vision & Fitness benefit plans are also available.
EXTRA WAYS TO SAVE MONEY
Four out of five customers can get a Marketplace plan for under $10 a month with financial help!**
Over 70% of people who enroll in a CareSource Health Insurance Marketplace plan also qualify for a government-funded subsidy that substantially lowers the overall cost of the plan. When you enroll, you’ll see if you qualify. Eligibility for these funds is determined by the Health Insurance Marketplace, and not by CareSource. There are two ways in which 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 which 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 Marketplace plans are available statewide in West Virginia:
Barbour, Berkeley, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Grant, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pendleton, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Wayne, Webster, Wetzel, Wirt, Wood, and Wyoming
Marketplace Plan Benefits
OPTIONAL ADULT DENTAL, VISION AND FITNESS BENEFITS
Need to take a trip to the eye doctor or dentist? Interested in no-cost gym memberships? Adults get enhanced benefits by adding optional Adult Dental, Vision & Fitness Benefits to any Silver, Bronze or Gold plan. The Fitness Benefit provides access to multiple fitness centers and gyms, digital fitness choices with home fitness tools, including one home fitness kit per benefit year with some kits including a wearable device (e.g. Fitbit® or Garmin®), digital workouts and live lifestyle coaching. All plans include pediatric dental and vision coverage.
CareSource plans have some of the lowest in-network primary care or retail clinic copays. Plus, many benefits, including primary and specialist care, telehealth, urgent care, retail generic and retail preferred brand drugs, are available before you satisfy your deductible on most of our plans.
PRESCRIPTION DRUG BENEFITS
Our prescription drug coverage includes copays as low as $0 for generic drugs and an extensive list of brand name drugs.
PREVENTIVE CARE COVERAGE
Health insurance should help you stay healthy. That’s why there are no copays or coinsurance fees for defined preventive health services with CareSource Marketplace plans.
All CareSource Marketplace plans include TruHearing® coverage with hearing aid discounts and $0 copay for routine hearing screenings.
Through our Zero Cost Telehealth Partner Program, you have access to $0 copay telehealth office visits. Other telehealth office visits have the same cost share as your Primary Care Physician and non-office visits have the same cost share as an in person visit. CareSource fully supports your choice to use telehealth and is willing to partner with your Provider. CareSource and our partners provide access to US licensed physicians who can consult, diagnose, and prescribe medications by phone or video for short-term illnesses.
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 many CareSource members are also eligible for helpful government subsidies, which will lower your cost for health care.
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.
Health Care Coverage Your Way. We offer different Bronze plan options so you can choose the one that fits your budget and healthcare needs.
Many of our members find that Silver Plans fit their health care coverage needs and budget best. Silver plans offer the highest value for those eligible for financial assistance†.
Health Care Coverage Your Way. We offer different Silver plan options so you can choose the one that fits your budget and healthcare needs.
Financial Assistance. These are the only plans that offer cost-sharing reductions (CSRs)† in addition to premium tax credits. CSRs help you save money on health insurance by lowering the amount you have to pay for deductibles, copayments, and coinsurance.
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.
SHOPPING FOR 2022 MARKETPLACE COVERAGE?
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 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 (Children’s Health Insurance Plan) 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.)