Make the most of your plan! Review your CareSource®MyCare Ohio (Medicare-Medicaid Plan) plan documents. Contact us with any questions you have.
Member Handbook
Your member handbook is a guide to your health care benefits. It tells you how our plan works, the covered services you get, services that are not included and your rights and responsibilities. Review the handbook that goes with the plan you have.
2024
- Medicare-Medicaid Member Handbook (NavigateEnglish | NavigateSpanish)
- Medicaid Member Handbook (NavigateEnglish | NavigateSpanish)
- NavigateMyCare Waiver Member Handbook
- NavigateMyCare Benefits at a Glance
Annual Notice of Changes
The Annual Notice of Change outlines the changes to your benefits for the next plan year.
2024
Summary of Benefits
The Summary of Benefits includes a summary of your covered benefits and any limitations. Please read your Member Handbook for the full list of benefits.
2024
Provider/Pharmacy Directory
Use these tools to see a list of the providers and pharmacies you can use as a CareSource MyCare Ohio member. You will see office hours and if a provider is accepting new patients. You will also see if the office is on a bus route and other helpful information.
Use our Find a Doctor/Provider tool for the most up-to-date listing of providers you can see. Find a Doctor/Provider | Use our Find a Pharmacy tool for the most up-to-date listing of pharmacies you can use. |
Provider/Pharmacy Directory (English/Español)
- Navigate2024 Full Provider/Pharmacy Directory (10/17/2023) Last updated on 10/17/2023
Get a directory mailed to you.
Forms
Visit theFormspage to find forms when you need them.
Prior Authorization List
Some services require approval from CareSource MyCare Ohio before you can get them. We call this prior authorization. Your provider will ask for approval from us. Then they will schedule these services for you.
This list shows which services you need approval for before you can get them.
- Navigate2024 Prior Authorization List
Your provider can submit a request for a prior authorization using the Prior Authorization Request Form.
If you are seeing a specialist, he or she will get approval from your PCP. Then your services will be scheduled. If you have questions about the prior authorization process or status, please call 1-855-475-3163 (TTY: 1-833-711-4711 or 711), Monday – Friday, 8 a.m. – 8 p.m.
Prescription Drug Benefit Documents
Below are links to documents covering your prescription drug benefits, including the latest drugs covered by the plan and more.
Comprehensive Formulary – This is a list of all drugs covered under your plan
Notice of Formulary Changes – Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates.
- Navigate2024 Notice of Formulary Changes
Last updated on 05/01/2024
- Navigate2024 Notice of Formulary Changes
Over-the-Counter (OTC) Items and Non-Part D Drug List– This list shows the OTC items and non-Part D drugs you get as part of your plan. You can get the OTC items in this list at your local, participating pharmacy. Look for the abbreviation “ADD” in your formulary. ADD stands for Additional Demonstration Drug. The “ADD” shows which OTC items and non-Part D drugs are covered by the Medicaid benefits of your plan.
- Navigate2024 Over-the-Counter (OTC) Items and Non-Part D Drug List
Coverage Determination Request Form – If you think you should get payment or benefits on a certain drug, you can request a coverage determination. Fill out this form:online or Navigatehard copy.
Coverage Redetermination Request Form – If you are unhappy with the result of a coverage determination request, you can file an appeal. Use this redetermination form:online or Navigatehard copy.
Prior Authorization Criteria – There are some drugs where your provider will need to tell us before you can fill your prescription.
- Navigate2024 Prior Authorization Criteria
Last updated on 05/01/2024
Step Therapy Criteria – Sometimes we will have you try another drug to treat your medical condition before your we will cover the drug your provider initially prescribed.
- Navigate2024 Drugs Requiring Step Therapy
Last updated on 05/01/2024
Drug Transition Policy –Learn about our policy for potentially covering a drug that you currently use is not listed in our formulary.
Need Information in Another Language?
You can get CareSource MyCare Ohio information for free in other languages or alternate formats such as large print, braille or audio. Call 1-855-475-3163 (TTY: 1-833-711-4711 or 711), Monday – Friday, 8 a.m. – 8 p.m. The call is free.
Puede obtener esta información de forma gratuita en otros idiomas. Llame al 1-855-475-3163 (TTY: 1-833-711-4711 o 711), el lunes a viernes, 8 a.m. – 8 p.m. La llamada es gratuita.
We can help! See our NavigateMulti-Language Interpreter Services for information to request plan documents in another language.
Non-Discrimination Notice
View the CareSource notice of non-discrimination.
