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 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 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. Report any changes in your family size or income to TennCare Connect as soon as possible at 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.