Co-Pays

Services Standard & SSI Plan Co-Pay
*Pharmacy State drug list $.50 - $3 *
Medication given during a healthcare provider visit Full coverage MHS covers
Physician visits Full coverage MHS covers
Inpatient hospital Full coverage MHS covers
Outpatient hospital Full coverage MHS covers
Emergency room Full coverage MHS covers
Nursing home Full coverage MHS covers
Physical therapy Full coverage MHS covers
Home health Full coverage MHS covers
Medical equipment Full coverage MHS covers
Medical supplies Full coverage MHS covers 
*Transportation Routine to & from covered services Full coverage
Ambulance Full coverage MHS covers
*Dental Preventive, restorative, palliative *$1 - $3
Vision One exam & glasses per year MHS covers
Added vision $100 allowance for better frames or $80 toward contact lenses MHS covers
Hearing Full coverage MHS covers
Hospice Full coverage No co-pay
Family planning Full coverage No co-pay
*Chiropractor Full coverage *$3
Podiatrist Full coverage MHS covers
Mental health outpatient Full coverage MHS covers
Mental health inpatient Full coverage for age 0-21. (Stays for ages 22-64 in institutional settings are not covered). MHS covers
Residential treatment Short-term coverage for substance abuse *No co-pay
Health education MHS added benefit Asthma, diabetes, hypertension

*Depending on your county of residence the dental benefit may be provided by MHS or by the state. Pharmacy and chiropractic services are provided by the state in all areas. You may access this care from any provider that will accept your ForwardHealth card. Routine transport is provided by the state through a separate company.

Services Not Covered

  • Medically unnecessary services 
  • Reversal of voluntary sterilization 
  • Infertility treatments 
  • Surrogate parenting and related services 
  • Artificial insemination 
  • Inpatient mental health stays in institutional settings for ages 22 – 64 
  • Experimental procedures and treatments