Benefits and Services

What is a copayment?

A copayment is an amount that some insurance plans require you to pay as your share of the cost for a medical service like a doctor’s visit or a prescription. If premiums are paid timely, a member can avoid paying copayments. Our benefits that require a copayment are listed below. If you qualify for medically frail, you may be exempt from copayments.  

Please note providers who have a posted policy that requires copayments be made before services rendered can deny service for members who are above 100% of the FPL if they have the inability to pay. For members below 100% FPL they are unable to be denied services.

Service or ItemCopay
Preferred and non-preferred generic drug$1
Brand name preferred on formulary over generic equivalent$1
Brand name drugs$4
Specialty visits (Chiropractor, Dental, Vision, Podiatry (foot))$3
Therapy services (Physical therapy, Speech therapy, Occupational therapy)$3
Officevisit (With a physician, physician’s assistant, advanced registered nurse practitioner, certified pediatric and family nurse practitioner, nurse midwife, or any behavioral health professional)$3
Laboratory, diagnostic, or x-ray service$3
Outpatient hospital service$4
Durable medical equipment$4
Outpatient surgery (ambulatory surgical center)$4
Emergency room visit for a non-emergency service$8
Inpatient services (Hospital admission or Mental health/Substance abuse admission)$50

Covered Services

For a complete list of covered services including information on how to obtain hospital, specialty and behavioral health services, refer to your member handbook (English or Spanish).

You should not be billed for covered services. If you do get a bill, please call us. If you have more questions, call Member Services at 1-855-852-7005 (TTY: 1-800-648-6056 or 711).

Services Not Covered

Humana – CareSource will not pay for the following services that are not covered by Medicaid:

  • All services or supplies that are not medically necessary
  • Experimental services and procedures, including drugs and equipment, not covered by Medicaid
  • Abortions except in the case of a reported rape, incest or when medically necessary to save the life of the mother
  • Infertility services for males or females, including reversal of voluntary sterilizations
  • Voluntary sterilization if under 21 years of age or if legally incapable of consenting to the procedure
  • Plastic or cosmetic surgery that is not medically necessary
  • Sexual or marriage counseling
  • Inpatient treatment to stop using drugs and/or alcohol (In-patient detoxification services in a general hospital are covered.)
  • Drugs not covered by the Kentucky Medicaid pharmacy program, including drugs for the treatment of obesity
  • Services for the treatment of obesity unless determined medically necessary
  • Inpatient hospital custodial care or comfort items in the hospital (e.g., TV or phone)
  • Acupuncture and biofeedback services
  • Services to find cause of death (autopsy) or services related to forensic studies
  • Services determined by another third-party payer as not medically necessary
  • Paternity testing

This is not a complete list of the services that are not covered. To learn more, review your member handbook (English or Spanish). Please call Member Services at 1-855-852-7005 (TTY: 1-800-648-6056 or 711) if you have a question about whether or not a service is covered.

Member Services: 1-855-852-7005 (TTY: 1-800-648-6056 or 711), 7 a.m. – 7 p.m., Monday – Friday