CareSource is a Medicaid managed care plan, not Medicare
CareSource is a private insurance company that manages Medicaid benefits for may be able to access people in certain states. It is not a Medicare plan. If you are enrolled with CareSource, you have Medicaid coverage, which is a joint federal and state program for people with lower incomes, disabilities, or other may have access to circumstances.
The confusion happens because both Medicaid and Medicare are government health programs with similar names. But they work differently, cover different groups of people, and have different rules. CareSource administers Medicaid in some states — meaning it handles claims, finds doctors in its network, and manages your care — but it does not offer Medicare plans.
If you are unsure which program you have, your insurance card will tell you. A Medicaid card will say "Medicaid" or your state's name with "Medicaid" (like "Ohio Medicaid" or "Kentucky Medicaid"). A Medicare card will say "Medicare" and have a red, white, and blue design with your name and a Medicare number.
Key Takeaways
- CareSource is a Medicaid managed care company that operates in multiple states, not a Medicare plan.
- Your insurance card will clearly state whether you have Medicaid or Medicare coverage.
- Medicaid covers people with lower incomes or disabilities; Medicare covers people 65 and older or with certain disabilities regardless of income.
- If you have CareSource, you have Medicaid, and your benefits and rules are set by your state's Medicaid program.
Which states does CareSource serve?
CareSource operates Medicaid managed care plans in several states, including Ohio, Kentucky, Indiana, Georgia, and others. The company's presence and the specific benefits it offers vary by state because each state runs its own Medicaid program with its own rules, covered services, and payment rates.
If you live in a state where CareSource operates and you are enrolled in Medicaid, CareSource is your managed care plan. This means CareSource coordinates your care, maintains a network of doctors and hospitals, and processes your claims. However, the actual Medicaid benefits — what is covered, what you pay, and who qualifies — come from your state, not from CareSource.
To learn about CareSource serves your state, you can visit CareSource's website or call your state's Medicaid office. Your state Medicaid office can also tell you whether you are currently enrolled with CareSource or with a different managed care plan.
What does it mean to have a Medicaid managed care plan?
A managed care plan is a type of Medicaid insurance that a private company like CareSource runs on behalf of your state. Instead of going to any doctor who accepts Medicaid, you choose doctors and hospitals from CareSource's network. CareSource also assigns you a primary care doctor who coordinates your care and approves referrals to specialists.
The benefit to you is that managed care plans often include extra services that traditional Medicaid does not — things like dental, vision, or transportation to medical appointments. The trade-off is that you must use doctors in the plan's network, or you may have to pay out of pocket (unless it is an emergency).
Your state decides which managed care companies can operate in your area and what benefits they must offer. CareSource follows those state rules. If you have questions about what your CareSource plan covers, your state's Medicaid office and your CareSource member handbook are the official sources.
How CareSource differs from Medicare
Medicare is a federal program run by the Centers for Medicare and Medicaid Services (CMS). It covers people 65 and older, some younger people with disabilities, and people with end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and then you become may be able to access when you turn 65 or meet other criteria.
Medicaid, which CareSource administers in some states, is jointly funded by the federal government and individual states. It covers people with lower incomes, pregnant women, children, people with disabilities, and other groups that each state defines. You do not have to have paid into Medicaid to be covered.
If you are 65 or older and have both Medicare and Medicaid, you are called "dual may be able to access." In that case, Medicare is your primary insurance, and Medicaid fills in gaps. CareSource does not manage Medicare benefits, but some states have CareSource plans that cover Medicaid for dual-may be able to access people.
How to check your CareSource coverage details
Your CareSource member handbook and your insurance card are your first resources. The handbook lists covered services, your copayments, your network doctors, and how to file a claim. You can request a handbook from CareSource by phone or read it from the CareSource website if you have your member ID.
Your member ID appears on your insurance card. You can also call the customer service number on the back of your card to ask about specific services, find a doctor in the network, or report a problem with a claim. CareSource customer service can tell you what your plan covers and what you may owe.
If you have questions about Medicaid rules that explore in your state — such as income limits, what happens if your income changes, or whether you still may have access to — contact your state's Medicaid office directly. They set the rules; CareSource follows them.
What to do if you are unsure about your coverage
Start by looking at your insurance card. It will say "Medicaid" or your state's name with "Medicaid" if you have Medicaid coverage. If it says "Medicare," you have Medicare, not a CareSource Medicaid plan.
If your card is lost or you do not have one, call your state's Medicaid office and give them your name and date of birth. They can tell you whether you are enrolled in Medicaid and, if so, which managed care plan you are in. You can also call CareSource directly if you think you might be a member; they can confirm your enrollment and send you a replacement card.
Keep in mind that your coverage can change if your income changes, if you turn 65, or if you move to a different state. Check your coverage status once a year or whenever your life circumstances change.
Frequently Asked Questions
Can I have both CareSource Medicaid and Medicare at the same time?
Yes. If you are 65 or older and have both Medicare and Medicaid, you are dual may be able to access. Medicare pays first, and Medicaid covers some costs Medicare does not. Some states offer CareSource plans specifically for dual-may be able to access people, but CareSource does not manage your Medicare benefits — only your Medicaid coverage.
Does CareSource work the same way in every state?
No. Each state's Medicaid program is different, so CareSource's benefits, network, and rules vary by state. A CareSource plan in Ohio may cover different services or have different copayments than a CareSource plan in Kentucky. Always check your member handbook or call your state's Medicaid office to understand your specific coverage.
What happens if I move to a state where CareSource does not operate?
Your CareSource coverage will end, and you will need to enroll in your new state's Medicaid program. Contact your new state's Medicaid office to find out how the process works and which managed care plans are available. You may have a short window to choose a new plan, so act quickly.
How do I know if a doctor is in my CareSource network?
Call the customer service number on the back of your CareSource card, visit the CareSource website and use the provider search tool, or ask the doctor's office directly if they accept your CareSource plan. Using an out-of-network doctor may cost you more or may not be covered at all, except in emergencies.
Can I switch from CareSource to a different Medicaid plan?
It depends on your state's rules. Some states allow you to change plans during open enrollment periods or if you have a may have access to life event. Contact your state's Medicaid office or CareSource to ask about your options and important date for switching.