Is Caresource Medicaid or Medicare? How to Tell Which Program You're In

Caresource is a Medicaid plan, not Medicare

Caresource is a private insurance company that administers Medicaid plans in multiple states. It is not Medicare. If you are enrolled in Caresource, you are receiving Medicaid coverage through a managed care plan — meaning Caresource handles your claims, networks, and referrals on behalf of your state's Medicaid program.

The confusion arises because both Medicaid and Medicare are government health programs, but they serve different populations and work differently. Caresource only offers Medicaid plans. It does not offer Medicare Advantage plans or any Medicare product. If you are over 65 or have been on Social Security Disability Insurance (SSDI) for 24 months, you may be may be able to access for Medicare instead, but that would come from a different insurer or directly from Medicare.

Your Caresource card will say "Medicaid" on it. If you are unsure whether you hold a Caresource Medicaid plan or a different type of coverage, check your insurance card or call the customer service number printed on it.

Key Takeaways

Caresource administers Medicaid plans only; it does not offer Medicare or Medicare Advantage coverage.
If you have a Caresource card, you are enrolled in Medicaid through a managed care plan in your state.
Medicaid and Medicare are separate programs: Medicaid is for low-income individuals and families, while Medicare is for people 65 and older or those with certain disabilities.
Your Caresource card will clearly identify it as a Medicaid plan; check the card itself if you are unsure which program you are in.

How Caresource Medicaid plans work

When you enroll in a Caresource Medicaid plan, Caresource becomes your managed care organization (MCO). This means Caresource manages your health care on behalf of your state's Medicaid program. Your state pays Caresource a monthly fee to cover your medical costs, and Caresource then coordinates your care, maintains a network of doctors and hospitals, and processes your claims.

You will have a primary care doctor through Caresource, and you will typically need a referral from that doctor to see a specialist. Caresource also handles prior authorization — the approval process for certain treatments or medications. Your out-of-pocket costs (copays, coinsurance) depend on your state's Medicaid rules and your specific plan, but many Caresource Medicaid plans have low or zero copays for preventive care and primary care visits.

Caresource operates Medicaid plans in states including Ohio, Indiana, Kentucky, Georgia, and others. The specific benefits and network vary by state because each state designs its own Medicaid program. If you move to a different state, your Caresource coverage does not follow you — you will need to enroll in that state's Medicaid program.

The difference between Medicaid and Medicare

Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Your income and household size determine whether you meet your state's Medicaid income limits. Medicaid is administered by your state, though private companies like Caresource often run the day-to-day operations. There is no age requirement for Medicaid.

Medicare is a federal program for people age 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. Medicare is the same nationwide and is administered by the federal government, though private insurers offer Medicare Advantage and prescription drug plans. You pay into Medicare through payroll taxes during your working years.

In short: Medicaid is based on income and is state-run; Medicare is based on age or disability and is federal. Caresource only works in the Medicaid space.

What your Caresource card tells you

Your Caresource insurance card will display the word "Medicaid" prominently. It will also show your member ID number, your group number, and customer service phone numbers. The card may also list your copay amounts for different types of care (doctor visits, emergency room, urgent care, etc.).

If you have a Caresource card and it says "Medicaid," you are enrolled in a Medicaid managed care plan. You are not in Medicare. If you believe you should be in Medicare instead — for example, because you are over 65 — contact your state's Medicaid office or Social Security to discuss your options. You may be able to enroll in Medicare Part A and Part B while keeping your Medicaid coverage, a situation called "dual may be able to access."

If you think you should be in Medicare instead

If you are age 65 or older, you are generally required to enroll in Medicare Part A and Part B when you turn 65, even if you also have Medicaid. If you are under 65 and have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. If you missed the enrollment window, you may face a late enrollment penalty.

You can have both Medicaid and Medicare at the same time. When you have both, Medicare pays first, and Medicaid covers costs that Medicare does not. This is called "dual coverage." If you are currently in a Caresource Medicaid plan and you become may be able to access for Medicare, contact Social Security or your local Social Security office to enroll in Medicare. Your Medicaid coverage will continue.

If you are unsure whether you are may be able to access for Medicare, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office. They can tell you whether you meet the age or disability requirements.

How to confirm your coverage type

The fastest way to confirm whether you are in Medicaid or Medicare is to look at your insurance card. If it says "Medicaid," you are in Medicaid. If it says "Medicare," you are in Medicare. If you do not have a card or cannot find it, call the customer service number on any recent medical bill or explanation of benefits (EOB).

You can also contact your state's Medicaid office directly. Each state has a Medicaid hotline or website where you can check your enrollment status. Alternatively, call Caresource customer service — the number is on your card — and they can tell you which state's Medicaid program you are enrolled in and answer questions about your plan.

Frequently Asked Questions

Can I have Caresource Medicaid and Medicare at the same time?

Yes. If you are 65 or older or have been on SSDI for 24 months, you are may be able to access for Medicare. You can keep your Caresource Medicaid plan and enroll in Medicare Part A and Part B. When you have both, Medicare pays first, and Medicaid covers remaining costs. This is called dual coverage.

Does Caresource offer Medicare Advantage plans?

Caresource does not offer Medicare Advantage plans. Caresource administers Medicaid plans only. If you are looking for a Medicare Advantage plan, you will need to enroll through a different insurance company during Medicare's annual enrollment period (October 15 to December 7).

What if my Caresource card says something other than Medicaid?

Check the card carefully. It should clearly state "Medicaid." If it lists a different program name or you are unsure, call the customer service number on the card. Caresource may use different brand names for plans in different states, but all Caresource plans are Medicaid plans.

How do I know if I am may be able to access for Medicare instead of Medicaid?

You are may be able to access for Medicare if you are 65 or older, or if you have been receiving SSDI for 24 months. Income does not matter for Medicare may be able to access. Call Social Security at 1-800-772-1213 to confirm your may be able to access or to enroll.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.