Copays
CareSource covers services that are medically necessary. We also offer extra benefits just for being our member.
There are some services that have a small cost to you. This is called a copayment or copay. You pay this copay when you get the services. They cannot deny treatment if you cannot pay.
Georgia Medicaid Member Copays
There are no copays for preventive care, family planning, emergencies, or dialysis.
| Service | Copays | More Information |
|---|---|---|
| Outpatient service | $3 | For all non-emergency hospital visits. |
| Inpatient services | $12.50 | You won’t have this copay if you were admitted or transferred from:
|
| Emergency (ER) services | $3 | You are only charged this copay if the condition is not an emergency health issue. Otherwise, there is no copay for emergency services. |
PeachCare for Kids Copays
PeachCare for Kids® copays are no more than five percent of family income. Some are a set amount, and some are cost-based. Cost-based means the copay depends on the cost of the care. There are no copays for emergency services, preventive care, shots (immunizations) or routine preventive, and diagnostic dental services.
| Service | Copay |
|---|---|
| Ambulatory surgery centers/birthing centers | $3 |
| Durable medical equipment | $1 and $3 |
| Eye care | Cost-Based* |
| Foot care | Cost-Based* |
| Federally Qualified Health Centers (FQHC) | $2 |
| Home health services | $3 |
| Inpatient services | $12.50 |
| Face or jaw surgery | Cost-Based* |
| Orthotics and prosthetics | $3 |
| Outpatient services | $3 |
| Pharmacy – preferred drugs | $0.50 |
| Pharmacy – nonpreferred drugs | Cost-Based* |
| Physician assistant services | Cost-Based* |
| Physician services | Cost-Based* |
| Rural Health Center (RHC) | $2 |
*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 |
Exceptions
These Georgia Medicaid and PeachCare for Kids members do not have copays for covered care:
- Under age six (Peach Care) or under age 21 (Medicaid)
- Pregnant women
- In end-of-life care
- Nursing facility residents
- Children in foster care
- In the Breast and Cervical Cancer Program
- American Indian or Alaska Natives
Learn more in your member handbook. You can also call Member Services at 1-855-202-0729 (TTY: 711).