CareSource Insurance Review & Complaints: Health Insurance (2023)

Ohio-based CareSource Insurance was created to help provide insurance coverage to low-income individuals and families. Today they offer a range of individual health care plans on the marketplace, and also administer government-sponsored health insurance plans. Even with the publicly-funded plans, it’s important to find the best insurance companies for you.

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What is CareSource?

A $500,000 grant from the state of Ohio created the Dayton Area Health Plan (DAHP) in 1989, a not-for-profit organization designed to provide health insurance options to low-income residents n the Dayton area. The company originally focused on Medicare and Medicaid.

Expansion through the late 90s, including multiple acquisitions of other companies, resulted in DAHP becoming the biggest HMO insurance company in the state. The name change to CareSource in 2000 brought all of the various subsidiary companies together under a single name.

The insurer has since expanded to several other states, offering a range of health care coverage, including preventive care, in Kentucky, Georgia, Indiana, and West Virginia. Providing coverage for medical care in the region, they continue to operate as a not-for-profit focused on providing affordable health insurance. Learn about the average health insurance cost per month so you can compare costs.

The company’s headquarters remain in Dayton, where it has grown to become one of the largest companies in the city and a major employer.

What Health Plans are Available?

For the purpose of this review, we will look at the individual health options offered in Ohio. Plans are offered in three states and may differ from state to state. You can read our review of CareSource’s Medicare options separately here. CareSource offers health insurance coverage through the state marketplace at several levels. Options range from comprehensive coverage to more affordable plans.

Gold Plan

There is one main plan at the Gold level, with the option to add dental and vision coverage. This plan has a $1,500 individual deductible, doubled for a family. The primary care visit copay is $10, and the specialist visit copay is $50. Prescription drugs start at $10 for generics.

Silver Plans

There are four levels at the Silver tier, three of which are only available to those who qualify based on income level. Each plan has the option to add a dental and vision plan.

The base-level Silver Plan is available without income restrictions. CareSource Silver has a $3,900 individual deductible that is doubled for a family. Copays are the same as the Gold plan, at $10 for primary care and $50 for specialists. Prescription drugs again start at $10 for generics.

Federal Simple Choice Silver has a $3,500 individual deductible (doubled for family) as well as a $500 prescription coverage deductible. This plan has copays of $30 for primary care and $65 for specialist visits, with prescriptions starting at $15 after the deductible.

Low Premium Silver is a high deductible plan, with a $6,150 individual deductible. The primary care copay is $20, and the specialist copay is $40. Prescription copays start at $20 for Tier 1 generics.

There are three more Silver levels at Silver 1, Silver 2, and Silver 3. All of these levels offer the same three underlying options, but with adjustments made for cost-sharing reductions based on income level. Silver 3 has the lowest deductibles and out of pocket costs for those with low incomes.

Bronze Plans

There are three options at the Bronze level. One includes an HSA and no dental and vision coverage is offered. Dental and vision can be added to the other two.

The HSA Bronze plan is the only plan that offers the use of a health savings account. The deductible on this plan is $4,000 for individuals and doubled for a family. All services with the exception of preventative care are subject to the deductible and are covered at 50% after it is met.

Federal Simple Choice Bronze has a $6,650 individual deductible, doubled for a family. Copays are $35 for primary care and $75 for specialist visits. Tier 1 prescriptions start at $35.

The final Bronze plan, CareSource Bronze, has a $7,250 deductible for individuals, with the out of pocket maximum being only $100 higher. As usual, both deductible and out of pocket maximums are doubled for a family. There is a $30 copay for primary care visits, with all other health care services – including specialists – subject to the deductible before being covered with a 40% coinsurance.

Are the Company’s Insurance Rates Affordable?

A quick quote for a 30-year-old male living in the county where CareSource’s headquarters is located gave us three cost estimates.

For the lowest monthly cost option, the Bronze plan has an estimated premium of $244 a month. The Silver plan has an estimated $320 a month premium, while the Gold plan came in at $385 a month.

All of these rates are for an applicant who does not qualify for any low-income subsidies, and they are generally on par with what we have seen elsewhere for an HMO. Comparing rates for health coverage is difficult due to the many differences in deductibles and copays, but overall CareSource rates seem reasonable for the coverage offered.

If you are having trouble finding affordable coverage, you should consider shopping for temporary health insurance.

How are Insurance Claims Processed?

Like most health insurers the company does not have much in the way of information regarding claims on their website. In general, claims are processed directly between providers and the insurance company, and most members rarely get involved.

As an HMO, we would expect customer service to be relatively speedy about processing claims due to the limited provider network.

Does the Company Have Positive Ratings and Consumer Reviews?

CareSource has an A- rating with the Better Business Bureau (BBB); the file states that drop is due to known government actions against the company. Our research shows a case against CareSource that resulted in a 2011 settlement of $26 million for false claims made against Medicare. Although the BBB file does not name the government action in question, this is likely the reason for the lowered rating. Due to the time that has passed since the action, CareSource’s rating is still good overall, but it’s worth noting that it was at an A when we reviewed this company for Medicare less than a year prior to this current review.

The company also has a total of 182 complaints on file with the BBB in the past three years, 28 of which were closed in the past twelve months. Compared to similar companies, this is a bit on the high side, rising from the number of complaints we saw in a previous review of this company.

We were unable to find a report from the National Committee for Quality Assurance for the company, which is surprising but may be due to lack of data.

Review site Birdeye has 63 reviews, resulting in an overall 1.5-star rating. The majority of the reviews are negative and cite issues including difficulty finding providers and denial of claims.

Overall, the negative reviews of this company do raise some concern, particularly with a BBB complaint volume that is increasing and a rating that has gone down in a few months’ time.

Is CareSource a Good Insurance Company?

CareSource has some affordable health care coverage options for those who don’t mind the network limitations of an HMO plan. The increasing number of negative reviews, however, is worth a note of caution. With similar rates available elsewhere, consumers may want to shop around for a stronger reputation for quality health care.