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:

ServiceAdded ExceptionsAmount 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 servicesYou won’t have this copay if you were admitted or transferred from:
  • an ER
  • urgent care
  • a different hospital
  • a skilled nursing facility or other health facility
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:

ServiceCopay
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 surgeryCost-Based
Orthotics and prosthetics$3
Outpatient services$3
Pharmacy – preferred drugs$0.50
Pharmacy – non-preferred drugsCost-Based
Physician assistant servicesCost-Based
Physician servicesCost-Based
Foot careCost-Based
Eye careCost-Based

Cost-Based Copays

CostCopay
$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 Navigatemember 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.