Benefits & Services
CareSource covers services that are medically necessary. We also offer rewards and incentives for you.
Some services have a small cost to you. This is called a copayment or copay. You’ll pay this at the health care office. They cannot deny treatment if you cannot pay. Learn more in your member handbook or call us.
Georgia Medicaid Member Copays
There are no copays for preventive care, family planning, emergencies or dialysis. Services with a copay include:
| Service | Copays and Exceptions |
|---|---|
| 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 | There is a $3 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® members age six and over have a copay. These 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. They are listed below:
| Service | Copay |
|---|---|
| Ambulatory surgery centers/birthing centers | $3 |
| Durable medical equipment | $1 and $3 |
| Federally Qualified Health Centers (FQHC) | $2 |
| Home health services | $3 |
| Hospital-based Rural Health Center (RHC) | $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 copays for emergency services, preventive care (routine check-ups), shots (immunizations) or routine preventive and diagnostic dental services.
Copay 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
If you have a questions, please see your member handbook or call us.
Member Services: 1-855-202-0729 (TTY: 711), open Monday through Friday, 7 a.m. to 7 p.m.