Plans

Ambulance
Per trip - $0

Dental care - $0

Inpatient hospital
Per day - $0
Maximum with limits - $0

Medical centers
Ambulatory surgical center - $0
Federally Qualified Health Center or Regional Health Center - $0
Independent medical/surgical center - $0
Short procedure unit - $0

Medical equipment
Purchase - Sliding scale
Rental - $0

Medical visits
Certified nurse practitioner - $0
Chiropractor - $0
Doctor - $0
Optometrist - $0
Podiatrist - $0

Outpatient hospital
Per visit – outpatient surgical, except maternity - $0
Per visit – non-surgical or diagnostic - $0

Prescriptions
Generic - $1
Brand name - $3

X-rays
Per service - $0

• Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit

• Beyond Medicaid covered vision services, no extra services

• Free Smartphone with 350 minutes of talk and unlimited texts for participants who qualify

• Home provider visits, lab draws and testing for qualified participants
• Video visits with care manager
• Bright Start® maternity program

• In-home supports and services to help participants not approved for LTSS avoid nursing home stay
• Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6000 for rental assistance ($2000 more than the $4000 state limit)
• Caregiver programs offer education, respite services and supports

*There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care
have no co-pays. Some services, items and drugs have no co-pays. For co-pay updates, go to ow.ly/WGQM30hern9.