CareSource MyCare Ohio (HMO D-SNP)

Available to residents of Sandusky County, OH for 2027. Contract H6396, plan 017, segment 0.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

Renewed for 2027. CMS carries this plan forward from 2026. Every OH plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$21.10
— medical (Part C) part	$0.00
— drug (Part D) part	$21.10?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,650.00?
Drug deductible	$700.00
Drug out-of-pocket threshold	$2,400.00
Plan type	HMO D-SNP?
Special needs plan	Dual-eligible SNP
D-SNP integration status	Fully Integrated (FIDE)
Zero-dollar cost sharing D-SNP	Yes
Contract / plan	H6396-017-0
Offered by	CareSource MyCare Ohio (HMO D-SNP)
Parent organization	CareSource
Pharmacy search	caresource.com/providers/education/patient-care/pharmacy/
Member services	(844)818-4466TTY (833)711-4711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H6396 shares this rating.

Plan health benefits

Service	In-network
Doctor visits
Primary care doctor	20% coinsurance
Specialist	20% coinsurance
Other health care professional	20% coinsurance
Additional telehealth services	20% coinsurance
Preventive care
Medicare-covered preventive services	$0 copay
Annual physical exam	Not covered
Kidney disease education	20% coinsurance
Glaucoma screening	20% coinsurance
Diabetes self-management training	20% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)
Lab services	$0 copay(authorization required)
Diagnostic radiology (e.g. MRI, CT)	20% coinsurance(authorization required)
Therapeutic radiology	20% coinsurance(authorization required)
Outpatient x-rays	20% coinsurance(authorization required)
Emergency and urgent care
Emergency room	20% coinsurance
Urgent care	20% coinsurance
Worldwide emergency coverage	$0 copay · $10,000 plan limit
Worldwide urgent care	$0 copay · $10,000 plan limit
Worldwide emergency transportation	$0 copay
Hospital care
Inpatient hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient hospital services	20% coinsurance(authorization required)
Outpatient observation	20% coinsurance
Ambulatory surgical center	20% coinsurance(authorization required)
Outpatient blood services	20% coinsurance
Skilled nursing and home health
Skilled nursing facility	Original Medicare cost-sharing(authorization required)
Home health care	$0 copay(authorization required)
Kidney dialysis	20% coinsurance
Rehabilitation
Occupational therapy	20% coinsurance(authorization required)
Physical therapy and speech-language therapy	20% coinsurance(authorization required)
Cardiac rehabilitation	20% coinsurance
Pulmonary rehabilitation	20% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient mental health, individual session	20% coinsurance(authorization required)
Outpatient mental health, group session	20% coinsurance(authorization required)
Psychiatrist, individual session	20% coinsurance
Psychiatrist, group session	20% coinsurance
Partial hospitalization	20% coinsurance(authorization required)
Intensive outpatient program	20% coinsurance(authorization required)
Outpatient substance use, individual session	20% coinsurance(authorization required)
Outpatient substance use, group session	20% coinsurance(authorization required)
Opioid treatment program	20% coinsurance(authorization required)
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)
Air ambulance	20% coinsurance(authorization required)
Transportation to plan-approved locations	Not covered
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)
Medical supplies	20% coinsurance(authorization required)
Diabetes supplies	20% coinsurance(authorization required)
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	20% coinsurance
Routine chiropractic care	Not covered
Acupuncture	Not covered
Foot exams and treatment (Medicare-covered)	20% coinsurance
Routine foot care	Not covered
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)
Preventive dental plan limit	$300 plan limit every month
Oral exams	$0 copay
Cleanings	$0 copay
Fluoride treatment	$0 copay
Dental x-rays	$0 copay
Other diagnostic dental services	$0 copay
Other preventive dental services	$0 copay
Restorative services (fillings, crowns)	$0 copay
Endodontics (root canals)	$0 copay
Periodontics (gum disease)	$0 copay
Dentures and other removable prosthodontics	$0 copay
Maxillofacial prosthetics	Not covered
Implants	$0 copay
Bridges and other fixed prosthodontics	$0 copay
Oral and maxillofacial surgery	$0 copay
Orthodontics	Not covered
Adjunctive general services	$0 copay
Vision?
Eye exam (Medicare-covered)	20% coinsurance
Routine eye exam	$0 copay
Eyewear after cataract surgery (Medicare-covered)	20% coinsurance
Contact lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Eyeglass lenses	$0 copay
Eyeglass frames	$0 copay
Eyewear upgrades	Not covered
Hearing?
Hearing exam (Medicare-covered)	20% coinsurance
Routine hearing exam	$0 copay
Hearing aid fitting and evaluation	$0 copay
Hearing aids (all types)	$0 copay
Hearing aids, inner ear	Not covered
Hearing aids, outer ear	Not covered
Hearing aids, over the ear	Not covered
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(authorization required, step therapy may apply)
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)
Meals after a hospital stay or for a chronic condition	Not covered
Fitness benefit	$0 copay
Health education	Not covered
Nutritional / dietary benefit	Not covered
Extra smoking and tobacco cessation counseling	Not covered
Enhanced disease management	Not covered
Telemonitoring	Not covered
Remote access technologies (web/phone, nurse line)	Not covered
Home and bathroom safety devices	Not covered
Counseling services	Not covered
In-home safety assessment	Not covered
Personal emergency response system (PERS)	Not covered
Medical nutrition therapy	Not covered
Post-discharge in-home medication reconciliation	Not covered
Re-admission prevention	Not covered
Wigs for hair loss from chemotherapy	Not covered
Weight management programs	Not covered
Alternative therapies	Not covered
Therapeutic massage	Not covered
Adult day health services	Not covered
Home-based palliative care	Not covered
In-home support services	Not covered
Support for caregivers	Not covered

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.

Star rating measures

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H6396 shares it.

Benefits in plain text

CareSource MyCare Ohio (HMO D-SNP) (H6396-017-0) is a 2027 HMO D-SNP Medicare Advantage plan offered by CareSource MyCare Ohio (HMO D-SNP), available to residents of Sandusky County, OH.

The monthly premium is $21.10.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,650.00.

The drug deductible is $700.00.

It is a special needs plan (Dual-eligible SNP).

CMS gives the plan's contract (H6396) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.