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 some TennCare Standard members with incomes at or above 134% of poverty do have co-pays for other kinds of services.

Poverty Level Copayment Amounts  
  • 0%-133%
  • $0
 
  • 134% - 199%
  • $8.20, Hospital Emergency Room for non-emergency services (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 for non-emergency services (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. Tell Tenncare about changes to your family size or job. To report a change, call TennCare Connect at 855-259-0701 or use your TennCare Connect account at tenncareconnect.tn.gov.

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