Co-Payments

Below is information about co-payments for Georgia Mediciad members only. Click here for PeachCare for Kids® copayment information.

You may have to make a small co-payment when you get care. This depends on your Medicaid group. But Peach State will pay for most, if not all of your bill. Doctors, hospitals or other providers in the Medicaid program must accept Medicaid as payment. But they may bill you for your co-payment.

Those who do not have co-payments are:

  • Medicaid member under age 21
  • PeachCare for Kids® members under age 6
  • Pregnant women
  • Members with breast and /or cervical cancer
  • Nursing home members
  • Members in hospice care
  • American Indians
  • Alaska Natives

If you can not pay your copay, you will not be denied care for a covered service.

Co-Payments

Cost of Prescribed Drug is: Member Pays:
Less than $ 10.01 $0.50 cents
Between $ 10.01 – $ 25.00 $1.00
Between $ 25.00 – $ 50.00 $2.00
More than $ 50.01 $3.00

Note: Co-payments are not required for the following:

  • Family planning services
  • Services for children under the age of 21
  • Pregnant women
  • Nursing home residents
  • Hospice care members
  • Emergency services
  • Prescriptions for family planning services
  • Emergency Room generated prescriptions
  • Members with breast or cervical cancer

Please call our Member Services Department:

  • For more information about the Preferred Drug List
  • To find out how to get an administrative review on a PA decision
  • To ask if your drug is covered
  • To learn more about health education services at no cost to you

Services

Co-payments are required for the following:

Ambulatory Surgical Centers $3.00
Federally Qualified Health Centers & Rural Health Centers $2.00
Outpatient $3.00 (non-emergency visits)
Inpatient $12.50
Emergency Department Visits for Non Emergency Medical Conditions $3.00
Oral Maxiofacial$10.00 or less$10.01 to $25.00$25.01 to $50.00$50.00 or more $2.00$0.50$1.00$2.00$3.00