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Co-Payments

Preventive care is care that helps you stay well and is always free. You don't have to pay co-pays for care like:

  • check-ups for your or your children
  • shots
  • pregnancy care and childbirth
  • pap smears
  • prostate examinations
  • mammograms

For other care, you may have to pay part of the cost. Co-pays are due at the time of service and are collected by the health care provider.

Not sure if you have a co-pay? Or don't know your co-pays for care? Call the Tennessee Health Connection at 1-855-259-0701.

Pharmacy Co-pays

Pharmacy co-pays are for: 1) adults with TennCare Medicaid who are not in a nursing home, HCBS waiver, or ICF-MR and 2) children with TennCare Standard whose family income is at or above 100% of poverty. If you have pharmacy co-pays, you must pay $3 for each brand name drug and $1.50 for each generic drug.

But, you don't pay pharmacy co-pays for:

  • Birth control
  • Medicine you get in hospice care. You must tell the drug store you're getting hospice care.
  • Medicine you can get in a medical emergency.
  • Medicine you get while you are pregnant (like vitamins). You must tell the drug store you're pregnant.

Co-pays other than pharmacy co-pays

TennCare Medicaid adults have pharmacy co-pays only. You don't pay co-pays for other TennCare services.

But, TennCare Standard members with incomes at or above 100% of poverty do have co-pays for other kinds of services.

Poverty Level Copayment Amounts
  • 0%-99%
  • $0
  • 100% - 199%
  • $10.00, Hospital Emergency Room (waived if admitted)
  • $5.00, Primary Care Provider and Community Mental Health Agency Services Other Than Preventive Care
  • $5.00, Physician Specialists (including Psychiatrists)
  • $5.00, Inpatient Hospital Admission (waived if readmitted within 48 hours for the same episode)
  • 200% and above
  • $50.00, Hospital Emergency Room (waived if admitted)
  • $15.00, Primary Care Provider and Community Mental Health Agency Services Other Than Preventive Care
  • $20.00, Physician Specialists (including Psychiatrists)
  • $100.00, Inpatient Hospital Admission (waived if readmitted within 48 hours for the same episode)

Your co-pays may change during the year if there are changes in your family size or income. Report any changes in your family size or income to the Tennessee Health Connection as soon as possible at 1-855-259-0701.

**TennCare must tell you in writing before we can make any changes to benefits or the amount you must pay (co-pays) for services.