Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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UPDATED: Sep 11, 2020

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CareSource

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Ohio-based CareSource was created to provide affordable health care options to residents of the area, particularly those qualifying for Medicare and Medicaid. The company now serves five states with a range of individual and government-sponsored plans.

Table of Contents

About CareSource

Originally named Dayton Area Health Plan (DAHP), CareSource was founded as a not-for-proft health insurance company in 1989 in Dayton, Ohio. A $500,000 state grant launched DAHP to provide health insurance plans for underserved populations in the area, particularly low-income families and individuals and those eligible for Medicare and Medicaid.

Expansion beginning in 1996 through acquisitions of other health companies took the company statewide. In 2000 the name change to CareSource re-branded all of those companies under a single name. CareSource continued expansion into four other states: Kentucky, West Virginia, Indiana, and Georgia.

CareSource today is one of the largest HMOs in the nation, and the second largest company headquartered in Dayton. They continue to offer affordable health care options including individual plans via the health care marketplace and Medicare Advantage plans as well.

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CareSource Medicare Advantage

Plan options from this company vary by state, so for the purpose of this review we looked at the options for Ohio. CareSource offers their Medicare plans in a select list of Ohio counties, which can be found on their website. Three plans are available for 2019.

CareSource Advantage Zero Premium is, as the name implies, a zero-premium plan above and beyond your regular Medicare premiums. There is no medical deductible, but a $250 pharmacy deductible applies. Primary care visits have a copay of $9, while specialists are $50. Basic dental, hearing, and vision coverage are all included in this plan. Prescriptions start at $0 for Tier 1 when purchased by mail order pharmacy.

CareSource Advantage is the mid-range plan, with no deductibles either for medical or for pharmacy. There is no copay for primary care visits, and a $49 copay for specialist visits. This plan includes comprehensive dental coverage as well as increased hearing coverage; vision is also included. Prescriptions start at a $4 copay.

The highest level of coverage is provided with the CareSource Advantage Plus plan. Again, there are no deductibles with this plan and no copay for primary care visits. Specialist visits have a $30 copay. This plan includes vision, comprehensive dental, and a higher level of hearing coverage than any other plan. Prescriptions start at $0 for Tier 1.

Rates

The rates for CareSource’s three plans are clearly displayed with the plan overviews and start with the zero premium plan. As with all Medicare Advantage plans, you will still need to pay your regular Part A and Part B premiums.

The mid-range Advantage plan has a monthly rate of $32.90, and the top end Plus plan has a rate of $67 a month.

While these are Ohio rates and not comparable outside the state, they are very affordable for the level of coverage provided based on our experience. HMO plans are usually priced lower than PPO plans, but even so these are on the lower side.

Claims

There is no dedicated claims page for CareSource, which is common to health insurance companies, but they do have a page for various forms and also provide information on appealing a claim decision.

Like most such companies, claims are usually handled directly with the provider and rarely involve the insured.

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Ratings and Consumer Reviews

CareSource has an A+ rating with the Better Business Bureau (BBB), with a total of 192 complaints on file. That is not an especially high volume for such a large company. The 39 customer reviews are mainly negative, with a mixture of various issues including claims being denied and billing problems.

The National Committee for Quality Assurance has not rated CareSource due to a lack of information. Medicare itself has given their Advantage plans a 2.5-star out of 5 rating, which is one of the lower ratings we have seen from Medicare and is considered to be below average.

We were unable to find much else in the way of reviews or ratings of this company, which is a bit unusual given its size.

The Bottom Line

CareSource has good rates for their Medicare plans, but they have a lot of work to do in order to bring their Medicare ratings up to a level that inspires confidence. There is not really enough information on this company’s reputation to form a solid opinion on them, but what is available does raise some concern. Those seeking good Advantage coverage may want to look around at companies that rank higher.

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