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CareSource MyCare Ohio (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareSource MyCare Ohio (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareSource MyCare Ohio (HMO D-SNP) in 2026, please refer to our full plan details page.
CareSource MyCare Ohio (HMO D-SNP) is a HMO D-SNP plan offered by CareSource available for enrollment in 2026 to people living in Statewide. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that CareSource MyCare Ohio (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
CareSource MyCare Ohio (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CareSource MyCare Ohio (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For CareSource MyCare Ohio (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8950.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The CareSource MyCare Ohio (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for one-month, two-month, and three-month supplies filled through standard pharmacies or standard mail order. This ensures that essential generic medications are accessible without any upfront copayment costs. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, members pay a 25% coinsurance for one-month, two-month, and three-month supplies. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply. These consistent coinsurance rates apply to both standard retail pharmacy and standard mail-order options.
Additional Benefits
The CareSource MyCare Ohio (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for almost all covered services. Beneficiaries can access inpatient hospital stays, home health services, and skilled nursing facility care with no copay and no coinsurance. However, many outpatient services, primary care visits, emergency services, and medical equipment carry a 20% coinsurance. For extra benefits, the plan provides fitness programs, eyeglasses, and prescription hearing aids with no copay and no coinsurance. Dental care is also highly covered, offering preventive and comprehensive dental services with no copay and no coinsurance up to a $5,000 annual limit. Routine eye, hearing, and dental exams generally require no copay but are subject to a 20% coinsurance.
Inpatient Hospital See details
CareSource MyCare Ohio (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CareSource MyCare Ohio (HMO D-SNP) covers outpatient services with no copay, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered under the CareSource MyCare Ohio (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
CareSource MyCare Ohio (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
CareSource MyCare Ohio (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered with a 20% coinsurance and no copay, up to a maximum plan benefit of $10,000.
Primary Care See details
CareSource MyCare Ohio (HMO D-SNP) covers primary care, specialist, mental health, podiatry, and therapy services with no copay and a 20% coinsurance, though chiropractic services are not covered. Prior authorization is required for occupational, physical, speech-language, and opioid treatment therapies.
Preventive Services See details
CareSource MyCare Ohio (HMO D-SNP) provides partially covered preventive services, featuring annual physical exams and fitness benefits with no copay and no coinsurance, alongside kidney disease education and select screenings with no copay and 20% coinsurance. Excluded sub-services that are not covered include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services covered by CareSource MyCare Ohio (HMO D-SNP) include one routine hearing exam per year with no copay and a 20% coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
CareSource MyCare Ohio (HMO D-SNP) vision services are partially covered with no deductible, featuring no copay and a 20% coinsurance for routine eye exams and contact lenses. Eyeglasses, lenses, and frames are covered with no copay and no coinsurance, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by CareSource MyCare Ohio (HMO D-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services feature no copay and no coinsurance up to a $5,000 annual limit, though other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
CareSource MyCare Ohio (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
CareSource MyCare Ohio (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
CareSource MyCare Ohio (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
CareSource MyCare Ohio (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. Under this plan, lab services have no coinsurance, while diagnostic procedures, radiological services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by CareSource MyCare Ohio (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
CareSource MyCare Ohio (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
CareSource MyCare Ohio (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under CareSource MyCare Ohio (HMO D-SNP) are partially covered, featuring over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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