Copays

The table below lists the Absolute Total Care copayment schedule. Copayments for healthcare services or prescription drugs are paid to the healthcare provider at the time of service. For a complete list of services or questions regarding a specific service or copay please contact Member Services at 1-866-433-6041 (TTY: 711).

There are no copays for children under 19 years old, pregnant women and institutionalized individuals (such as a nursing facility). There are no copayments for preventive care such as well-child or well-baby visits or vaccines.

Benefit

Copay

Prescription Drugs (per month)

  • Unlimited/$3.40 copay (starting at age 19)
  • $0 for certain asthma, COPD and diabetes, and smoking cessation medications on the Preferred Drug List (all ages)

Emergency Care Services (in-network and out-of-network)

$0 copay

Office Visits (per year)

Unlimited/$0 copay for office visits (primary care providers, specialists, well-care, EPSDT, sick visits)

Family Planning Services

$0 copay

Lab Work and X-rays

$0 copay

Durable Medical Equipment

$0 copay

Hospital Inpatient Stay

$25 copay (starting at age 19)

Hospital Outpatient/Surgical Center

$3.40 copay (starting at age 19)

Home Health Care (per year)

50 visit limit /$0 copay

24/7 Nurse Line

$0 copay to speak to a Registered Nurse through our Nurse Advice Line

Care Coordinator

$0 copay to receive personalized service from a care coordinator

Education programs for chronic illnesses

$0 copay

Health programs for pregnancy, diabetes, asthma

$0 copay

CentAccount Rewards program (financial rewards earned for healthy behaviors)

Earn money for completing healthy behaviors and use your rewards at stores like Wal-Mart, Dollar General, Rite Aid and more!

$0 copay

Vision Care

Covered for ages 20 and younger:

  • $0 copay for one eye exam every 12 months
  • One pair of eyeglasses every 12 months and one replacement pair every 12 months

State Covered Services 

Absolute Total Care does not cover all of your services. Some services are covered by Medicaid Fee-for-Service and are called “carved-out benefits.”

State covered services include:

  • Routine and emergency dental services – DentaQuest: 1-888-307-6553
  • Long-term institutional care for stays over 90 days
  • Hospice care
  • Transplants (other than corneal transplants)

For a complete list of services provided by either Absolute Total Care or Medicaid Fee-for-Service please contact Member Services at 1-866-433-6041 (TTY: 711).