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Medicaid

With Anthem Medicaid, you get benefits designed to make a difference in your life.

Focused on health

  • Doctors, hospitals, specialists and other providers to choose from near you
  • Visits with a primary care provider (PCP) you choose
  • 24/7 health advice, even on holidays, with our Care on Call line
  • Immunizations (shots)
  • Behavioral health care and our Behavioral Health Crisis Hotline: 1-855-661-2025 (TTY 711)
  • Pharmacy services

Dental care

Call DentaQuest at 1-855-343-7405 to find a dentist or set up your dental services, including:

Oral cleanings and exams
Fillings, X-rays and extractions
Oral surgery for members under 21

Vision care

All members get:

Eye Exams and screenings
Eyeglasses or a credit for contacts every year as an extra just for Anthem Medicaid members

Members under 21 get:

Glasses

Call eyeQuest at 1-855-343-7405 to set up routine eye care.

Extra benefits

We also offer our members special benefits and services:

  • Free eyeglasses or a credit for contacts for adults age 21 and older
  • Free sports physicals for members ages 6-18
  • Free smartphone with up to 350 free monthly minutes to call your family, friends and doctors, texts and data included
  • Anthem Medicaid’s Prenatal program with:​
    • ​​​​​​Free crib or car seat when you go to your PCP or OB/GYN at least seven times while you are pregnant
    • Free gift card when you get prenatal and postpartum checkups on time
    • Free health resources and coaching
  • Anthem Medicaid gives you the opportunity to enroll with our Resource Navigation program, which helps you with seeking education, job skills, employment opportunities and more! Members actively participating in this program will have access to these extra benefits starting January 1, 2019:
    • Childcare assistance: we will assist with childcare costs for parents or guardians seeking employment and education opportunities
    • Transportation assistance: we will provide transportation assistance to get to employment and education opportunities
    • GED test vouchers: we will provide vouchers that allow you to take your GED test for free at an authorized test center
    • Criminal record expungement: we will assist with application fees associated with  criminal record expungement (as allowed by statue)
  • Free gift cards for getting HbA1c diabetic screenings each year
  • Free 24/7 NurseLine to speak to a nurse about your medical questions or concerns 24 hours a day, seven days a week, 365 days a year
  • Free disease management programs to help you manage difficult health conditions like asthma, diabetes and COPD
  • Free hearing aid batteries in common sizes of 10, 13, 312 or 675

As of January 1, 2019, the Department for Medicaid Services is requiring Medicaid members to pay copays for certain services.

Preventive services DO NOT HAVE COPAYS. Preventive services include screenings, checkups, and patient counseling to prevent illnesses, disease, or other health problems.
This copay policy will begin on January 1, 2019, even if the Kentucky HEALTH program has not started

Copays

A copay is a fee that is charged for some health care services. If you receive a service that requires a copay, you pay the provider at the time¬ of service. You can ask if there is a copay when you schedule an appointment. The list of services that will require a copay are below.

Service or Item Copay
Generic drug $1
Brand-name drug that does not have a generic $1
Brand-name drug that has a generic version available $4
Specialty visits (chiropractor, dental, vision, podiatry (foot)) $3
Therapy services (physical therapy, speech therapy, occupational therapy) $3
Office visit (with a physician, physician’s assistant, advanced registered nurse practitioner, certified pediatric and family nurse practitioner, nurse midwife or any behavioral health professional) $3
Laboratory, diagnostic, or X-ray service $3
Outpatient hospital service $4
Durable medical equipment $4
Outpatient surgery (ambulatory surgical center) $4
Emergency room visit for a nonemergency service $8
Inpatient services (hospital admission or mental health/substance abuse admission) $50

Exemptions

Individuals who are exempt will not be required to pay copays. Exemptions may apply, but are not limited, to:
  • Foster children
  • Children enrolled in Medicaid
  • Pregnant women (includes 60-day period after pregnancy ends)
  • Kentucky Medicaid beneficiaries who have reached their cost sharing limit for the quarter
  • Individuals receiving hospice care

Some services are exempt from copays. Exemptions apply, but are not limited, to:
  • Emergency services
  • Some family planning services
  • Preventive services

Limits on copays

There is a limit on the total amount of copays you will have to pay. You will not have to pay more than 5% of your family’s income each quarter. Quarters are January to March, April to June, July to September, and October to December.

We keep track of the copays you pay. When you reach the limit, you will not have to pay any more copays for the quarter. If you pay a copay after your family has reached the maximum out‑of‑pocket amount, your provider will refund the copay to you. To learn more about the benefits and covered services, please see your member handbook.

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