Benefits and Services
As a CareSource member, you get the same necessary medical services that are covered by other Georgia Families® health plans. And, as a CareSource member, you get more. Learn more about these extra benefits.
CareSource covers all medically necessary Medicaid-covered services. Some of these 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. However, a provider may, upon accepting you as a Medicaid or PeachCare for Kids® patient, charge you for non-covered services. 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 |
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.