Benefits and Services
Georgia Families covers services that are medically necessary. We also offer rewards and incentives for members. You can learn about rewards and incentives you have as a CareSource member here.
Some medically necessary services have a small member cost, called a copayment or copay. You’ll pay this at the health care provider’s office or facility. They cannot deny treatment if you cannot pay the copay. To learn more about copays, please refer to your member handbook or call Member Services.
Georgia Medicaid Member Copays
Some Georgia Medicaid members pay a copay for services. There are no copays for preventive care, family planning services, emergency services, or dialysis services except as listed below:
| Service | Added Exceptions | Amount You Pay |
|---|---|---|
| Ambulatory Surgery Centers/Birthing Centers | There is a $3 copay deducted from the surgical code billed. Only one $3 copay will be deducted each date of service for multiple surgical procedures. | |
| Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) | There is a $2 copay on all FQHCs and RHCs. | |
| Outpatient service | There is a $3 copay for all non-emergency hospital visits. | |
| Inpatient services | You won’t have this copay if you were admitted or transferred from:
| There is a $12.50 copay on hospital inpatient services. |
| ER services | There is a $3 copay if the condition is not an emergency health issue. |
These Georgia Medicaid members do not have copays for covered care:
- Members under the age of 21
- Pregnant women
- Nursing facility residents
- Members in hospice care (end-of-life care)
- Members in the Breast and Cervical Cancer program
- American Indian or Alaska Natives
PeachCare for Kids® Copays
PeachCare for Kids® members age six and over have a copay. These copays are no more than five percent of family income. Some copays are a set amount and some are cost-based. Cost-based means the copay depends on the cost of the care. PeachCare for Kids® copays are listed below:
| Service | Copay |
|---|---|
| Ambulatory Surgery Centers/Birthing Centers | $3 |
| Durable medical equipment | $2 |
| Federally Qualified Health Centers | $2 |
| Free-Standing Rural Health Clinic | $2 |
| Home health services | $3 |
| Hospital-Based Rural Health Center | $2 |
| Inpatient services | $12.50 |
| Face or jaw surgery | Cost-Based |
| Orthotics and prosthetics | $3 |
| Outpatient services | $3 |
| Pharmacy – preferred drugs | $0.50 |
| Pharmacy – non-preferred drugs | Cost-Based |
| Physician assistant services | Cost-Based |
| Physician services | Cost-Based |
| Foot care | Cost-Based |
| Eye care | Cost-Based |
Cost-Based Copays
| Cost | Copay |
|---|---|
| $10.00 or less | $0.50 |
| $10.01 to $25.00 | $1 |
| $25.01 to $50.00 | $2 |
| $50.01 or more | $3 |
There are no co-payments for emergency services, preventive care services (routine check-ups), immunizations or routine preventive and diagnostic dental services.
These PeachCare for Kids® members do not have copays for covered care:
- Members under age six
- Members in end-of-life care
- Nursing facility residents
- Children in foster care
- American Indian or Alaska Natives
If you have a question about whether a service is covered, please refer to your member handbook or call Member Services.
Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.