This article helps to break down Ohio’s Medicaid plan, CareSource, to make it easier for potential enrollees to apply while ensuring they understand its coverage.
Ohio residents with U.S. citizenship and a social security number who meet the financial requirements can enroll in CareSource and receive medical benefits. As of 2023, 3.55 million Ohioans are enrolled in Medicaid.
Many Ohio residents struggle to find a quality healthcare plan that provides first-class coverage and benefits without surpassing their budget. Ohio’s Medicaid program, CareSource, offers expansive medical coverage and might be the perfect fit for your needs. To help you understand CareSource, we created an overview of the program that includes covered services, eligibility requirements, benefits, and how to enroll in the plan.
Purchasing additional healthcare policies from a private or third-party provider furthers your coverage and helps you avoid high medical costs Ohio Medicaid doesn’t cover. This ensures you receive the benefits you need without jumping through unnecessary hoops or paying outrageous prices.
CareSource is Ohio’s Medicaid plan that provides free or reduced healthcare services to low-income residents. It’s a non-profit medical provider determined to provide quality coverage to Ohioans from all walks of life. Eligible residents can choose between CareSource Advantage Zero Premium plan or CareSource Advantage.
CareSource Advantage Zero Premium features no monthly fees, while CareSource Advantage premiums depend on the region. Below are CareSource Advantage’s premiums for each Ohio region:
Both plans provide exceptional coverage and can make various healthcare services, treatments, and prescriptions more affordable.
A CareSource card is a membership I.D. proving a member’s enrollment. It features an identification number that determines the patient’s coverage and benefits. However, it’s important to note that a CareSource Card doesn’t guarantee benefits or eligibility coverage.
To apply for CareSource, visit one of Ohio’s Department of Job and Family Services centers and inquire about the policy. A staff member will explain how to apply for CareSource, describe the plan, and answer any questions you have about coverage.
Ohio residents can also apply for CareSource using one of the following methods:
CareSource doesn’t allow Ohio residents to apply for policies by mail. You can only apply using one of the methods above.
Ohio residents must meet specific eligibility requirements to enroll in CareSource. These eligibility requirements include:
Although non-citizens can’t enroll in Ohio Medicaid (CareSource), they can apply for other healthcare policies. Non-citizens may be eligible for Refugee Medical Assistance or Alien Emergency Medical Assistance if they meet specific criteria.
To request a new CareSource card, visit the CareSource website and login to your My CareSource account. Click the “Request ID Card” button and follow the instructions to order a new card. Once you have your card, you can access a digital version via the CareSource app that provides the same coverage and medical benefits as a physical card.
You can also obtain a new card by calling the CareSource Member Services hotline at (800) 488-0134. A representative will ask for your information and help you order a new card.
CareSource members will receive a new card within seven to 10 days after paying their first premium.
Members can renew or replace their CareSource card through the process mentioned above. Simply log into your My CareSource account, click the “Request ID Card” button, and fill out and submit the required information. You can also contact the Member Services hotline and file a replacement request.
What is the extent of CareSource coverage?
CareSource covers a wide range of healthcare services and can make numerous medical treatments and prescriptions more affordable. However, coverage often fluctuates between plans, so always examine your policy to see what it includes. Continue reading to learn more about Ohio Medicaid-covered services.
Adult CareSource members can receive one dental cleaning and exam every six months without copays. They also have access to accidental dental services as well as extractions, restorations, and other dental procedures or surgeries with prior authorization. Children have more comprehensive dental coverage and can obtain fluoride treatments and medically necessary orthodontics (with prior authorization) without additional fees.
Adults enrolled in the CareSource Marketplace plan can receive additional dental coverage, including dentures, X-rays, and medically necessary orthodontics (with prior authorization).
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Ohio is advisable.
CareSource covers prescription drugs listed in the Marketplace Drug Formulary. Many policies feature $0 copays for 90-day retail on specific generic prescriptions. CareSource also provides affordable copays for mailed medications, with standard Advantage members paying $4 for 30-day retail and Zero Premium beneficiaries paying $5.
If your prescription isn’t in the Marketplace Drug Formulary, you can request an exception by contacting the Member Services hotline at (800) 488-0134 or completing the online Member Exception Request for Non-Formulary Medication form. Once CareSource receives your request, a representative contacts your medication provider for a written clinical document explaining the reasoning for the exception. The representative then reviews and approves or denies the request within 72 hours.
If CareSource denies the request, you can ask for an external review by contacting the Ohio Member Appeals office at (937) 487-0629 or sending a written request to P.O. Box 1947, Dayton, OH, 45401.
Ohio Medicaid covers multiple extended health care benefits, ranging from yearly comprehensive eye exams and nutritional counseling to TMJ (temporomandibular joint) services. However, each plan offers different extended healthcare benefits, so always check your policy to see what it covers before receiving care. Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
CareSource Marketplace plans cover emergency and non-emergency transportation to medical providers and facilities within the network area. They don’t pay for medical care received outside of your network unless it’s a medical emergency.
If you receive emergency care outside your network or from a non-network medical provider, CareSource recommends contacting a representative or your primary care physician beforehand. However, this is not mandatory.
After receiving out-of-network healthcare services, you may need to submit your bill to CareSource via a claim form. You can download a claim form through CareSource’s Forms page or call the Member Services hotline to request a printed copy.
If you are traveling outside of Ohio for leisure, always invest in proper travelers insurance.
Ohio Medicaid doesn’t offer special services for Ohio students or senior citizens. Every CareSource enrollee receives the same benefits listed in the policy.
However, CareSource does offer several benefits and services that help senior citizens. For example, many CareSource Marketplace plans include at-home nursing services as well as speech, physical, and occupational therapy. They also cover long-term nursing facilities for qualified members.
However, many of these services require prior authorization to obtain.
To apply for residence at a long-term nursing facility, CareSource members must submit the following:
Sometimes, federally and state-funded insurance policies offer special benefits to specific subgroups. However, this isn’t always the case and may require an additional policy from a private or third-party insurance provider. Below are some subgroups and unique benefits provided by CareSource:
CareSource doesn’t provide unique coverage to American Indians or Alaska natives. These groups receive the same services as traditional beneficiaries.
Neither does CareSource offer unique benefits to veterans, active military members, or military families. However, Ohio has several medical programs designed for veterans that provide special benefits to veterans. For example, the Veterans on Medicaid program offers long-term care to Ohio veterans and helps them move into a VA facility or a VA-contracted facility that targets their needs.
Now that you understand what CareSource covers, you can learn about its excluded services and treatments. Below are some healthcare services not covered by Ohio Medicaid:
CareSource excludes domiciliary and custodial care, halfway houses or supervised living, room and board for inpatient stays (unless deemed medically necessary), sexual and marital therapy, or counseling.
Depending on your policy, CareSource may exclude orthodontia for adults and children, dentures, support devices, tooth replacements, services or care deemed medically unnecessary, and more than one dental cleaning and exam within a year. Check your policy to learn more about its provided dental coverage.
CareSource doesn’t cover artificial heart implants, arch supports, garter belts, medical corsets, wigs, penile prosthesis, and any medical device deemed medically unnecessary.
Ohio Medicaid doesn’t pay for ART (Assisted Reproductive Technology) services like artificial insemination and in vitro fertilization, embryo transport, sterilization reversal surgeries, cryo-preservation, and surrogacy-related services unless the member is the surrogate. CareSource excludes out-of-network births when the member is more than 37 weeks pregnant.
CareSource doesn’t cover radial keratotomy, keratoplasty, sexual dysfunction or transformation surgeries, gynecomastia treatments, hyperhidrosis treatments, and other procedures deemed medically unnecessary.
Ohio Medicaid will not put forth any funds towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
To learn more about CareSource’s excluded services and prior authorization requirements, examine its category of service pages. Also, keep in mind that coverage often changes, so try staying up to date with your policy and speak with a representative about plan alterations.
CareSource offers numerous medical treatments and services to qualified enrollees. However, coverage varies from policy to policy, so examine your plan documents or contact a CareSource representative if you don’t know what your policy includes.
|X-Rays and Exams
|CareSource pays for one dental exam every six months and one set of routine bitewing X-rays every year. However, it limits comprehensive dental evaluation and X-rays to one every three years. It also limits problem-focused dental X-rays to two per year.
|Ohio’s Medicaid plan doesn’t offer wisdom teeth removal and other dental surgeries without prior authorization. CareSource will cover some dental surgeries and procedures with prior authorization, but not all. Contact a CareSource representative to learn more about your policy’s dental surgery coverage.
|CareSource covers one comprehensive eye exam per year but doesn’t pay for additional exams within said year.
|Zero Premium members receive a $100 allowance for glasses, while standard Advantage plan enrollees obtain a $130 glasses allowance. Qualified members can also receive one glasses replacement a year, but only if they become damaged. CareSource won’t cover replacement costs if you lose your glasses.
|Laser Eye Surgery
|CareSource Marketplace members receive 15% off per LASIK procedure. However, not all CareSource plans offer this discount or cover vision correction treatments or surgeries.
|Ohio Medicare only covers rhinoplasty procedures with prior authorization. Members won’t receive coverage if they don’t have prior authorization or their primary care provider doesn’t believe it’s medically necessary.
|CareSource covers breast reduction procedures if it deems the surgery medically necessary. It doesn’t cover cosmetic breast reductions or other non-medically necessary procedures. Ohio Medicare has strict qualifications for breast reduction surgeries, requiring patients to meet numerous conditions before qualifying for coverage.
|Ohio Medicare covers most hospital stays but may require prior authorization before providing coverage. It also pays for emergency room, urgent care, primary care, and multiple other healthcare facility visits.
|CareSource provides non-emergency and emergency transportation to network and non-network medical facilities. It offers air flights, ambulance transport, and more to and from hospitals, skilled nursing facilities, etc.
|Ohio Medicare pays for delivery, maternal depression screenings, and prenatal/postpartum home and doctor visits.
Depending on your policy, CareSource covers numerous therapy and counseling sessions for qualified enrollees. This includes ABA (applied behavioral analysis) therapy, electroconvulsive therapy, group therapy, medication-assisted treatment, psychiatric diagnostics evaluations, psychological testing, individual psychotherapy, substance use disorder services, and family psychotherapy.
However, coverage varies from plan to plan, and many of these services require prior authorization to qualify for coverage.
|Enrollees can attend gynecological appointments free of charge with CareSource. It also covers several reproductive services like Pap smears and mammograms.
|CareSource doesn’t cover medications for erectile dysfunction since they aren’t deemed medically necessary.
|Ohio Medicaid covers birth control, IUDs, and contraceptive devices like condoms. It also covers specific sterilization procedures like vasectomies if the member meets specific criteria. They must be at least 21 years of age, mentally competent, not pregnant, not institutionalized, and schedule the procedure at least 30 days but not over 180 days after signing the consent form. Follow the link to learn more about CareSource’s sterilization procedure requirements.
|CareSource doesn’t cover infertility treatments. This includes assisted reproductive technologies, in vitro fertilization, artificial insemination, infertility drugs, infertility surgeries, and sterilization reversal surgeries.
|Ohio Medicare pays for dermatologist appointments if a primary care physician deems it medically necessary. It requires a referral for in-network dermatologists and prior authorization for out-of-network dermatologists.
|CareSource enrollees can access physical therapy once a primary care physician deems it medically necessary and provides a referral. Patients can also receive at-home physiotherapy with prior authorization.
|CareSource views massage therapy as a complementary/alternative medicine and doesn’t cover treatment, even with a referral from a private care physician. Other excluded services include homeopathy, aroma therapy, hypnosis, reiki therapy, thermography, naturopathy, BEST (bioenergetic synchronization technique), ANT (auditory integration therapy), etc.
|Podiatry and Foot Care
|Some CareSource plans may cover medically necessary foot care and podiatrist appointments but require prior authorization from a primary care provider. However, most plans exclude cosmetic and non-medically necessary treatments like calluses and corn removal, nail trimming, foot cleaning and soaking, skin creams, and debriding treatments. It’s best to review your policy and talk to a CareSource representative to determine what your plan covers before receiving service or treatment.
|Ohio Medicaid members can receive free allergy testing from in-network healthcare professionals. They don’t need prior authorization to access an allergist.
|Sleep Physician Services and CPAP Machines
|Ohio Medicaid beneficiaries can visit a sleep physician without charge with prior authorization from their primary care provider. CareSource also covers several DEM (durable medical equipment) devices with prior authorization, including CPAP machines, BiPAP machines, apnea monitors, NPPV machines, and specialty mattresses.
Enrolling in a third-party or private health insurance program is an exceptional way to expand your coverage and access more benefits. Many Ohio residents enroll in CareSource and another policy to have more comprehensive coverage. Having multiple insurance policies provides numerous benefits, including:
However, finding a top-quality private or third-party insurance plan that provides the coverage you need without surpassing your budget isn’t always easy. At Insurdinary, we specialize in helping people find first-class insurance policies that match their needs, budget, and lifestyle. We work with dozens of leading insurance providers and will find the perfect plan for you at a price you can afford. You can use private insurance providers to fill the gaps in your Ohio Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
If you want to enroll in a private or third-party insurance plan and need help finding a quality policy in Ohio, contact Insurdinary. We will find a first-class insurance policy without requiring you to unenroll in Ohio’s Medicaid program, CareSource. Our insurance experts have helped hundreds find quality private and third-party insurance plans, and they can do the same for you.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following: