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TennCare Co-payments are effective August 1, 2005. Co-pays are due at the time of service and are collected by the health care provider.
If you do not know your co-pay, call the Family Assistance Service Center at 1-866-311-4287.
Para información acerca de TennCare en español llame al 1-866-311-4290.
Click on the links below for a breakdown of co-pays:
Pharmacy Co-pays
Pharmacy Co-pays shall apply to all TennCare Standard enrollees as well as non-institutionalized Medicaid adults who are eligible to receive pharmacy services in the TennCare program.
The Pharmacy Co-pay amounts are as follows:
Pharmacy Co-payments do not apply to family planning services, pregnant women, enrollees in long term care institutions (including HCBS) or receiving Hospice care.
There are no annual out-of-pocket (OOP) maximums.
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Co-pays other than pharmacy co-pays
Medicaid eligibles are exempt from non-pharmacy co-pays. Preventive services are exempt from co-pay obligations.
Co-pays for TennCare Standard enrollees with incomes at or above 100% of poverty are similar to commercial copays. To encourage good preventive health habits, there will be no co-pays for preventive care visits such as:
- well child visits
- immunizations
- check-ups
- pap smears
- prostate examinations
- mammograms
There are no deductibles or annual out-of-pocket (OOP) maximums which apply to persons with co-pay obligations.
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- $25, Hospital Emergency Room
(waived if admitted)
- $5, Primary Care Provider and Community Mental Health Agency Services Other Than Preventive Care
- $15, Physician Specialists
(including Psychiatrists)
- $100, Inpatient Hospital Admission
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- $50, Hospital Emergency Room
(waived if admitted)
- $10, Primary Care Provider and Community Mental Health Agency Services Other Than Preventive Care
- $25, Physician Specialists
(including Psychiatrists)
- $200, Inpatient Hospital Admission
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Enrollees’ co-pays may change during the year if they have changes in family size or income. Enrollees should report any changes in family size or income to their local Department of Human Services as soon as possible. Enrollees can also call the Family Assistance Service Center at 1-866-311-4287 to
report changes in income or family size.
**TennCare is required to provide advance written notice to enrollees if there are any changes to benefits or co-payments.
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