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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 $50 credit for contacts for adults age 21 and older
  • Free sports physicals for youth ages 5 to 18
  • Free smartphone with texts and data, as well as up to 1,000 free monthly minutes to call your family, friends, and doctors
  • Fresh fruits and vegetables program
  • WW® (formerly called Weight Watchers) membership pays for joining fee and 13 weeks of classes
  • Home-delivered, medically-tailored meals for those with chronic
    health problems
  • Anthem Medicaid’s Prenatal program with:​
    • ​​​​​​Free crib or car seat when you go to your PCP or OB/GYN at least six times while you are pregnant
    • Free gift card when you complete prenatal and postpartum checkups
      on time
    • Mail-order diapers when you complete one postpartum visit
    • Free health support and coaching
    • Baby shower gift (one free stroller organizer)
    • Breastfeeding Support kit offers new moms with an infant support nursing pillow and cover, washable nursing pads, and nursing tip sheets
    • Safe sleep kit for new moms with infants under the age of 1. The kit includes a swaddle sleep sack, pacifier, and infant sleep fact sheets
  • Books for Babies provides a $50 Barnes & Noble gift card for parents or caregivers with children up to age 2 to encourage reading
  • Boys & Girls Club membership for youth ages 6 to 18
  • Family activity coupon book for households with children 12 and under
  • Caregiver tool kit
  • Anthem Medicaid gives you the chance to join our Resource Navigation program, which helps you with seeking schooling, job skills, and work opportunities! Members actively taking part in this program will receive:
    • Transportation assistance: we will give rides to buy groceries, as well as seek employment and training opportunities
    • GED test vouchers: we will provide vouchers that allow you to take your GED test for free at an approved testing center
    • Criminal record expungement: we will help with court and application fees tied to criminal record expungement (as allowed by statute)
  • Jump Start program gives online skills assessment and job search tool
  • No-cost laptop for those who are graduating high school with a 3.0 grade point average or higher
  • Free gift cards for receiving HbA1c diabetic screenings each year
  • Free 24/7 NurseLine to speak to a nurse about your health questions or concerns 24 hours a day, seven days a week, 365 days a year
  • Mail order over-the-counter products
  • Medicine safety kit
  • Choose Healthy program offers over 1,000 resources like videos, articles, and self-care tools
  • Healthy Families program helps families make healthier food choices and improve activity levels
  • Online well-being program for those 13 years and up; helps mental health and wellness through lessons, games, and goal setting
  • Healthy-lifestyle aids like digital scales, hearing aid batteries, and
    lumbar pillows
  • Community Resource Link helps you find programs, benefits, and services near you   
  • Free disease management programs to help you manage difficult health conditions like asthma, diabetes and COPD
  • Smoking distraction kits
  • Substance Use Disorder Recovery Support program provides peer support and counselor advice  
The Department for Medicaid Services now requires 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.

 

Healthy Rewards

Healthy Rewards is a no-cost, optional program for eligible members with Anthem Medicaid as their primary health insurance. The program encourages you to seek the care you need to create a healthy lifestyle.

You can receive these Healthy Rewards through the Benefit Reward Hub for completing these healthy activities:

  • $25 for a new member health screener
  • $25 for childhood, adolescent, and adult wellness visits
  • $25 for breast cancer screenings
  • $40 for cervical cancer screenings
  • $15 for childhood dental visits
  • $25 for a flu shot
  • $10 for following up with your doctor after being hospitalized for a behavioral health condition
  • $10 for receiving a refill for antidepressant medicines based on doctor’s prescription
  • $25 for a chlamydia screening
  • $25 for a colorectal cancer screening
  • $25 for a diabetic retinal eye exam
  • $25 for a diabetic A1c screening
  • Up to $40 for diabetic medication adherence
  • $75 for tobacco cessation session
  • $25 for attending first prenatal care visit during the 1st trimester or within 42 days of joining the plan
  • $50 for attending postpartum care visit between 7–84 days after delivery
  • Up to $50 for attending eight well-child visits between ages of 0–30 months

Enroll and earn rewards

To see what you’re eligible to earn, enroll in Healthy Rewards by logging into your Anthem Medicaid account and visiting the Benefit Reward Hub. You can also enroll in the program or learn more by calling Healthy Rewards at 888-990-8681 (TTY 711) Monday through Friday from 9 a.m. to 8 p.m. Eastern time.

If you need help setting up your Anthem Medicaid online account, call Member Services at 855-690-7784 (TTY 711).

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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