CareSource is a Medicare Advantage plan, not Medicare itself

CareSource is a private insurance company that offers Medicare Advantage plans (also called Part C plans) in certain states. It is not the government Medicare program — it is an insurance company that contracts with Medicare to provide coverage. If you enroll in a CareSource Medicare Advantage plan, you are still on Medicare, but CareSource becomes the company that processes your claims and manages your benefits.

CareSource operates in a limited number of states, primarily in the Midwest and South. The states where CareSource offers Medicare Advantage plans change from year to year, and not all counties within a state may have CareSource plans available. You can only enroll in a CareSource plan if you live in a county where they operate.

Like all Medicare Advantage plans, CareSource plans include Part A (hospital) and Part B (doctor visits) coverage, and most include prescription drug coverage (Part D) as well. However, the specific benefits, costs, and provider networks differ from Original Medicare and vary between CareSource plans.

Key Takeaways

  • CareSource is a private insurance company offering Medicare Advantage plans, not a government program or a replacement for Medicare.
  • You can only enroll in a CareSource plan if you live in a state and county where CareSource operates, which varies by year.
  • CareSource plans bundle hospital, doctor, and usually prescription drug coverage into one plan with a single deductible and out-of-pocket limit.
  • You must stay within CareSource's provider network for most services, except in emergencies, which differs from Original Medicare's rules.
  • You can switch to a different plan or back to Original Medicare during the Annual Enrollment Period (October 15 to December 7 each year).

How CareSource Medicare Advantage plans differ from Original Medicare

Original Medicare is run by the federal government and lets you see any doctor or hospital that accepts Medicare. CareSource Medicare Advantage plans are run by CareSource and require you to use doctors and hospitals in their network for routine care. If you see an out-of-network provider without a referral, you typically pay more or the full cost yourself.

Original Medicare has separate deductibles for Part A and Part B, and prescription drug coverage (Part D) is a separate policy you buy from another company. CareSource plans combine all three into one policy with one deductible and one annual out-of-pocket spending limit. Once you reach that limit, CareSource covers most services at no cost for the rest of the year.

CareSource plans often have lower or zero monthly premiums than Original Medicare plus a separate Part D plan, but they may have higher copayments or coinsurance when you use services. The trade-off is lower monthly costs in exchange for using their network and potentially higher costs when you need care.

What you need to know about CareSource provider networks

Each CareSource plan has its own network of doctors, hospitals, and specialists. Before you enroll, you should check whether your current doctors are in the plan's network. If your doctor is not in the network, you would need to switch doctors or pay out-of-network costs.

CareSource networks can change during the year. A doctor who was in the network when you enrolled may leave, or new doctors may join. CareSource sends you updates when major network changes happen, but it is your responsibility to check the current network before scheduling appointments.

Emergency care is covered outside the network at in-network rates, so you do not have to worry about network restrictions if you need emergency hospital care. However, routine care, specialist visits, and non-emergency services must use in-network providers to get the lowest cost.

CareSource plan costs and what you pay out of pocket

CareSource Medicare Advantage plans have a monthly premium (the amount you pay to CareSource each month), a deductible (the amount you pay before the plan starts covering services), and copayments or coinsurance (the amount you pay each time you use a service). The exact amounts vary by plan and by year.

Most CareSource plans have a yearly out-of-pocket spending limit. Once you reach that limit, CareSource covers most services at no cost for the rest of the calendar year. This limit protects you from very high medical bills in a single year, which is different from Original Medicare, which has no annual limit.

Prescription drug coverage is usually included in CareSource plans. You pay a copayment for each prescription, and the amount depends on which tier the drug is on (generic drugs usually cost less than brand-name drugs). Some drugs may require prior approval from CareSource before the pharmacy will fill them.

When you can enroll in or change a CareSource plan

You can enroll in a CareSource Medicare Advantage plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage begins on January 1 of the following year. This is the main time period when you can join a new plan or switch between plans.

If you are newly may be able to access for Medicare (turning 65 or becoming may be able to access due to disability), you have a seven-month Initial Enrollment Period to join a plan. This period includes the three months before the month you turn 65, the month you turn 65, and the three months after.

If you experience certain life changes — such as moving out of a CareSource service area, losing other health coverage, or becoming may be able to access for Medicaid — you may be able to make changes outside the Annual Enrollment Period. These are called may have access to Life Events, and you typically have 60 days from the event to make a change.

How to learn about CareSource operates in your area

The easiest way to check whether CareSource offers plans where you live is to visit Medicare.gov and use their plan finder tool. Enter your zip code, and the tool will show you all Medicare Advantage plans available in your area, including CareSource plans if they operate there.

You can also contact CareSource directly to ask whether they offer plans in your county. Their customer service number is on their website. Be ready to provide your zip code so they can tell you whether plans are available and what the plan options are.

If CareSource does not operate in your area, you can still compare other Medicare Advantage plans or Original Medicare through Medicare.gov. The plan finder tool shows all options available to you, along with costs, benefits, and provider networks for each.

Questions to ask before enrolling in a CareSource plan

Before you enroll, make a list of your current doctors and specialists and check whether they are in the CareSource plan's network. Call the doctors' offices directly if you are not sure — the plan's website may not have completely current information. Ask whether they are accepting new CareSource patients.

Ask CareSource about the copayments and coinsurance for the services you use most often. If you take multiple medications, ask about the cost of each drug on the plan's formulary (the list of covered drugs). Some drugs may be expensive or require prior approval, which could affect your total costs.

Ask whether the plan covers services you know you will need, such as physical therapy, mental health care, or durable medical equipment. Not all plans cover these services in the same way, and some may have limits on how many visits you can have per year.

Frequently Asked Questions

Do I have to enroll in a CareSource plan if I am on Medicare?

No. You can stay on Original Medicare and buy a separate Medigap or Part D plan if you prefer. CareSource plans are optional — you choose whether to enroll during the Annual Enrollment Period. If you do not make a choice, you stay on whatever coverage you currently have.

Can I switch back to Original Medicare if I do not like my CareSource plan?

Yes. During the Annual Enrollment Period (October 15 to December 7), you can switch to Original Medicare or a different Medicare Advantage plan. The change takes effect on January 1. If you switch to Original Medicare, you should also enroll in a Part D plan and consider a Medigap plan to cover costs that Original Medicare does not pay.

What happens to my CareSource coverage if I move out of state?

Your coverage ends on the last day of the month you move. You have 60 days from the date you move to enroll in a new plan in your new state. Contact CareSource to report your move, and then use Medicare.gov to find plans available in your new location.

Does CareSource cover care outside the United States?

Most CareSource Medicare Advantage plans do not cover routine care outside the U.S., though emergency care may be covered in some cases. If you travel internationally or spend time outside the country, ask CareSource specifically about coverage before you leave. Original Medicare also has limited international coverage.

Can I use my CareSource plan at any hospital in an emergency?

Yes. Emergency hospital care is covered at in-network rates regardless of which hospital you go to. You do not need to call CareSource first or get approval — go to the nearest emergency room if you believe you are having an emergency. CareSource will process the claim as an emergency, even if the hospital is out of network.