CareSource Ohio
Plan Overviews
CareSource is a leading non-profit public sector managed care company, meeting the needs of health care consumers for more than 24 years.
Gold Plans
This may be a good choice for you if you expect to have a lot of doctor appointments, need many prescription medicines, or need other health services.
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.
Plan Costs
| Plan Type | Annual Deductible | Out-of-Pocket Limit | Coinsurance | Primary Care Visit Copay | Retail Clinic Visit Copay | Specialist Visit Copay | Emergency Copay |
|---|---|---|---|---|---|---|---|
| Individual | $1,000 | Medical $2,500 Pharmacy $2,000 | 20% | $0 | $0 | $40 | $250 after deductible |
| Family | $2,000 | Medical $5,000 Pharmacy $4,000 | 20% | $0 | $0 | $40 | $250 after deductible |
Prescription Drug Coverage
| Plan Type | Preventive | Generic | Preferred Brand | Non-preferred Brand | Preferred Specialty | Non-preferred Specialty |
|---|---|---|---|---|---|---|
| Individual/ Family | $0 | $0 | $120 | $160 | 40% Coinsurance (up to $300) | 50% Coinsurance (up to $300) |
Coinsurance
| Service/Supply Examples | Coinsurance after Deductible |
|---|---|
| Ambulance Services, Dental Services (related to accident or injury), Laboratory Services, Diagnostic Mammogram,X-Rays, Home Health Care Services, Home Infusion Services, Hospice Services, Inpatient Professional Services, Medical Supplies, Durable Medical Equipment and Appliances, Outpatient Services, Therapy Services, etc. | 20% |
Required Copays
| Service | Copay |
|---|---|
| Outpatient Advanced Imaging (CT/PET Scans, MRI) | $150 after deductible |
| Inpatient Facility Services | $150 copay per day for 5 days, $0 days 6 and beyond |
| Skilled Nursing Facility for Physical Medicine and Rehabilitation | $150 copay per day for 5 days, $0 days 6 and beyond |
| Urgent Care Services | $75 |
| Pediatric Vision Services – an annual exam is provided at no charge. Copayments apply ONLY if additional office visits are needed. | $40 |
Pediatric vision and dental (including orthodontia) is included.
Silver Plans
Silver plans are a good middle of the road option, and also the best value when you qualify for cost-sharing reduction.
Plan Costs
| Plan Type | Annual Deductible | Out-of-Pocket Limit | Coinsurance | Primary Care Visit Copay | Retail Clinic Visit Copay | Specialist Visit Copay | Emergency Copay |
|---|---|---|---|---|---|---|---|
| Individual | $3,300 | $6,400 | 30% | $0 | $0 | $50 | $500 after deductible |
| Family | $6,600 | $12,800 | 30% | $0 | $0 | $50 | $500 after deductible |
Prescription Drug Coverage
| Plan Type | Preventive | Generic | Preferred Brand | Non-preferred Brand | Preferred Specialty | Non-preferred Specialty |
|---|---|---|---|---|---|---|
| Individual/ Family | $0 | $0 | $60 | $130 | 40% Coinsurance (up to $300) | 50% Coinsurance (up to $300) |
Coinsurance
| Service/Supply Examples | Coinsurance after Deductible |
|---|---|
| Ambulance Services, Dental Services (related to accident or injury), Laboratory Services, Diagnostic Mammogram,X-Rays, Home Health Care Services, Home Infusion Services, Hospice Services, Inpatient Professional Services, Medical Supplies, Durable Medical Equipment and Appliances, Outpatient Services, Therapy Services, etc. | 20% |
Required Copays
| Service | Copay |
|---|---|
| Outpatient Advanced Imaging (CT/PET Scans, MRI) | $150 after deductible |
| Inpatient Facility Services | $150 copay per day for 5 days, $0 days 6 and beyond |
| Skilled Nursing Facility for Physical Medicine and Rehabilitation | $150 copay per day for 5 days, $0 days 6 and beyond |
| Urgent Care Services | $75 |
| Pediatric Vision Services – an annual exam is provided at no charge. Copayments apply ONLY if additional office visits are needed. | $40 |
Pediatric vision and dental (including orthodontia) is included.
A health plan in the bronze level may be a good choice for you if you don’t expect to have many doctor appointments or need many prescription drugs.
› Generally, plans in the Bronze category have the lowest premiums (your monthly insurance bill) but the highest deductibles and other out-of-pocket costs.
Plan Costs
| Plan Type | Annual Deductible | Out-of-Pocket Limit | Coinsurance | Primary Care Visit Copay | Retail Clinic Visit Copay | Specialist Visit Copay | Emergency Copay |
| Individual | $6,650 | $6,850 | 40% | $35 | $35 | $75 | $500 after deductible |
| Family | $13,300 | $13,700 | 40% | $35 | $35 | $75 | $500 after deductible |
Prescription Drug Coverage
| Plan Type | Preventive | Generic | Preferred Brand | Non-preferred Brand | Preferred Specialty | Non-preferred Specialty |
| Individual/ Family | $0 | $25 | $100 | $250 | 40% Coinsurance (up to $300) | 50% Coinsurance (up to $300) |
Coinsurance
Service/Supply Examples
Coinsurance
after Deductible
Ambulance Services, Dental Services (related to accident or injury), Laboratory Services, Diagnostic Mammogram,
X-Rays, Home Health Care Services, Home Infusion Services, Hospice Services, Inpatient Professional Services, Medical Supplies, Durable Medical Equipment and Appliances, Outpatient Services, Therapy Services, etc.
40%
Required Copays
| Service | Copay |
| Outpatient Advanced Imaging (CT/PET Scans, MRI) | $200 after deductible |
| Inpatient Facility Services | $250 copay per day for 5 days, $0 days 6 and beyond |
| Skilled Nursing Facility for Physical Medicine and Rehabilitation | $100 copay per day for 5 days, $0 days 6 and beyond |
| Urgent Care Services | $100 |
| Pediatric Vision Services – an annual exam is provided at no charge. Copayments apply ONLY if additional office visits are needed. | $75 |
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CareSource Ohio Coverage Area
In 2016 and 2017, service area includes the following Ohio counties: Adams, Ashland, Ashtabula, Belmont, Brown, Butler, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Defiance, Delaware, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Hamilton, Henry, Highland, Jefferson, Lake, Licking, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Miami, Monroe, Montgomery, Morrow, Pickaway, Pike, Portage, Preble, Ross, Sandusky, Scioto, Stark, Summit, Trumbull, Union, Warren, Washington, Wayne and Wood.
Plan Brochures
| Plan Name | Deductible | Out-Of-Pocket | Coinsurance | Brochures | Summary of Benefits |
| Ambetter Secure Care 1 (2016) with 3 Free PCP Visits (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) + Vision (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision (Zero Cost Share) | $0 | $0 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Secure Care 1 (2016) with 3 Free PCP Visits (Limited Cost Share) | $1,000 | $6,350 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (Limited Cost Share) | $5,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (Limited Cost Share) | $6,500 | $6,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (Limited Cost Share) | $4,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) (Limited Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits (Limited Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (Limited Cost Share) | $5,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (Limited Cost Share) | $6,500 | $6,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (Limited Cost Share) | $4,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) + Vision (Limited Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision (Limited Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Secure Care 1 (2016) with 3 Free PCP Visits (Standard Cost Share) | $1,000 | $6,350 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (Standard Cost Share) | $5,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (Standard Cost Share) | $6,500 | $6,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (Standard Cost Share) | $4,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) (Standard Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits (Standard Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (Standard Cost Share) | $5,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (Standard Cost Share) | $6,500 | $6,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (Standard Cost Share) | $4,500 | $6,500 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 1 (2016) + Vision (Standard Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision (Standard Cost Share) | $6,800 | $6,800 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (73% AV Cost Share) | $3,500 | $5,000 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (73% AV Cost Share) | $4,500 | $4,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (73% AV Cost Share) | $4,000 | $5,000 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (73% AV Cost Share) | $3,500 | $5,000 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (73% AV Cost Share) | $4,500 | $4,500 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (73% AV Cost Share) | $4,000 | $5,000 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (87% AV Cost Share) | $350 | $2,250 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (87% AV Cost Share) | $1,750 | $1,750 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (87% AV Cost Share) | $1,000 | $1,750 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (87% AV Cost Share) | $350 | $2,250 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (87% AV Cost Share) | $1,750 | $1,750 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (87% AV Cost Share) | $1,000 | $1,750 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) (94% AV Cost Share) | $0 | $650 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) (94% AV Cost Share) | $550 | $550 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) (94% AV Cost Share) | $250 | $550 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 1 (2016) + Vision (94% AV Cost Share) | $0 | $650 | 20% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 2 (2016) + Vision (94% AV Cost Share) | $550 | $550 | 0% Coinsurance | View PDF | View PDF |
| Ambetter Balanced Care 10 (2016) + Vision (94% AV Cost Share) | $250 | $550 | 20% Coinsurance | View PDF | View PDF |
Contact Us
Phone: (312) 726-6565
Email: [email protected]
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