Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness

CareSource · 2026 plan year

Gold
Ind. deductible
$3,000
Family deductible
$6,000
Ind. OOP max
$8,500
Family OOP max
$17,000

Compare with other Gold plans in OH

Side by side: deductibles, out-of-pocket limits and copays.

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Monthly premiums by age

Rating Area 11 — the lowest-priced of the 17 areas this plan covers. Premiums differ by area.

AgeIndividualIndividual + tobacco
Under 15$460$460
21$601$661
30$682$791
40$768$891
50$1,073$1,267
60$1,631$1,925
64 and over$1,803$2,128

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$10.00

Specialist

BenefitIn-network
Specialist Visit$40.00

Hospital

BenefitIn-network
Emergency Room Services10.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$500.00 Copay per Stay after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$30.00

Pharmacy

BenefitIn-network
Generic Drugs$10.00
Non-Preferred Brand Drugs30.00% Coinsurance after deductible
Preferred Brand Drugs$60.00
Specialty Drugs40.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$500.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services$10.00

Other

BenefitIn-network
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental30.00% Coinsurance after deductible
AcupunctureNot covered
Allergy Testing$40.00
Bariatric SurgeryNot covered
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Chemotherapy30.00% Coinsurance after deductible
Chiropractic Care$10.00
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care$500.00 Copay after deductible
Dental Check-Up for ChildrenNot covered
Diabetes Education30.00% Coinsurance after deductible
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Other Practitioner Office Visit (Nurse, Physician Assistant)$10.00
Habilitation Services$10.00
Hearing AidsNo charge
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infertility Treatment30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Laboratory Outpatient and Professional Services$30.00
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling30.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services30.00% Coinsurance after deductible
Prenatal and Postnatal Care$40.00
Private-Duty Nursing30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$10.00
Rehabilitative Speech Therapy$10.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)No charge
Routine Eye Exam for ChildrenNo charge
Routine Foot CareNot covered
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services$500.00 Copay per Stay after deductible
Substance Abuse Disorder Outpatient Services$10.00
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 1 geographic area.

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