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CareSource was founded in 1989 in Dayton, Ohio under the name Dayton Area Health Plan (DAHP). The company is a not-for-profit managed health care system originally providing plans for Medicaid and Medicare eligible residents. The company was founded on a $500,000 state grant to help make health care accessible and affordable for low-income individuals and families.
In 1996, the company began acquisition of other health care plans, expanding beyond Dayton and becoming the largest HMO in Ohio. Up until 2000, all of the plans operated under their original names, but in 2000 DAHP adopted the name CareSource, and brought all of its companies under that single name.
In recent years, CareSource has further expanded to offer plans in Kentucky, Indiana, West Virginia, and Georgia. They are one of the nation’s largest HMOs and remain focused on affordable health care options. The plans available in each state vary.
CareSource is also committed to the city where it was begun; their headquarters remains in Dayton, and in 2016 the company announced plans for a new seven-story building to house its growing workforce. They are the second largest company in Dayton, and support local charities through the CareSource Foundation, which donates millions in grants.
Medicare Advantage plans are offered in three out of the five states where CareSource operates. These are Ohio, Indiana, and Kentucky.
For the purpose of this review, we selected the plans offered in Ohio, where CareSource is headquartered. In Ohio, there are three Medicare Advantage plans to choose from, all of which are HMO plans.
CareSource Advantage Zero Premium carries no additional premium beyond the base cost of Original Medicare. There is a $400 deductible for medical services. This plan has a $10 co pay for office visits and a $50 co pay for specialist visits. Urgent Care has a $65 co pay, and emergency care a $75 co pay. Inpatient hospital visits are covered with a $250 co pay for the first five days.
This plan includes basic dental, vision, and hearing benefits for screenings and other services. As with many Medicare Advantage plans, there is a fitness benefit included as well.
As with all of the plans, Part D coverage is included. Prescription drugs start at a $6 co pay for Tier 1. From there they go up to $15, $47, and $100 and have a 27% coinsurance at Tier 5.
The CareSource Advantage Plan has no deductible in return for a higher monthly cost. Primary care office visits also have no charge. There is a $50 co pay for specialist visits, but Urgent Care is lower at $35 and emergency care the standard $75. Inpatient hospital admissions are more costly, at $279 per day for the first seven days; this is a longer period than we see on most Advantage plans.
As with the Zero Premium plan, this plan includes benefits for dental, vision, and hearing, as well as an included fitness benefit. The Part D coverage starts with a $4 co pay for Tier 1 drugs. Tier 2 has a $10 co pay, and Tiers 3 and 4 are the same as the Zero Premium plan at $47 and $100. Tier 5 has a 33% coinsurance.
The Advantage Plus Plan also has no deductible, and carries lower co pays overall. Primary care office visits have a $0 co pay, while specialists have a $30 co pay. Urgent care is $25, and emergency the same as the other plans. The inpatient hospital co pay is $200 per day for the first seven days.
Like the previous plans, Plus offers dental, hearing, and vision benefits, generally with low co pays and in some cases no charge at all. Annual hearing exams, for example, are covered at 100%.
This plan has no charge for Tier 1 drugs, but the rest of the prescription co pays are the same as the Advantage plan.
Overall, these plans offer solid benefits with generally low co pays. The inclusion of dental, hearing, and vision all make for a good value based on cost to benefits; we will look at the cost next.
As the name implies, the Medicare Advantage Zero Premium plan has no premium attached. Many health insurance companies offer a zero premium plan that provides more benefits that Original Medicare with no added cost. The Advantage plan comes in a $32.30 per month, and the Plus plan is the most expensive at $57.60 per month.
While we are not able compare these rates to our usual sample or on a national level, overall, they are very reasonably priced given the coverage level and benefits. These are HMO plans, which are generally more affordable due to the managed care approach that limits the network of providers available. However, as a large company, CareSource is likely to provide a reasonably large network of care.
Ratings and Reviews
CareSource has an A rating from the Better Business Bureau currently, with 163 complaints filed in the past three years, 89 of which were closed in the past 12 months. That is not a high complaint volume for a company of this size.
While we were unable to find reviews on the sites we usually visit, we did find 49 reviews on birdeye.com, which were a mix of negative and positive, generally leaning towards the negative. Most of the complaints centered on customer services issues and denied claims.
There is no current Medicare star rating for CareSource, as the plans are new and have yet to be measured and rated. We also found that the National Committee for Quality Assurance has not yet rated the CareSource Medicare plans.
The Bottom Line
CareSource is new to the Medicare Advantage market, but has a solid history in Medicaid and individual coverage. They offer affordable HMO plans with low co pays and a lot of benefits for the money. If you do not have a problem with the more limited network of providers of an HMO, they are well worth considering for those seeking a budget-friendly Medicare Advantage plan.
For a list of companies that we recommend, visit our Best Insurance Companies page.