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Georgia Families Medicaid

We’ve served Georgia Families members with Medicaid benefits since 2006. With Amerigroup, you get all your Georgia Families benefits, plus extras like a vision exam and glasses each year and a dental exam every six months.

Benefits Overview
Your health is important to us. That’s why our members get important care and services like:
  • A large network of primary care providers to choose from
  • Vision and dental care for children and adults
  • Free round-trip rides to doctor visits
  • Wellness visits and shots to help keep you healthy
  • Low- and no-cost medicines
  • Specialist services and hospital stays
  • Plus lots of extras you can use to take charge of your health

Visit the Georgia Department of Community Health (DCH) website to learn more about Medicaid and other programs.

Copays

Once your copay is paid, you’ll never be billed for a leftover balance. Copays range from 50 cents to $12.50. They are based on the type of service. Please see your member handbook for more information.

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Extra Benefits

With Amerigroup, you get lots of extra benefits you can really use:

  • A dental exam and cleaning every six months
  • Vision care for members 21 and older
  • Free Boys & Girls Club memberships for kids age 6-18
  • Free over-the-counter medicines from plan pharmacies with a written prescription from your doctor
  • Free 24-hour Nurse HelpLine
  • Case management services
  • Taking Care of Baby and Me®
  • Free flu shots
  • Free weight-management program for age 10 and up

Different eligibility rules apply to each benefit.

Look in your member handbook or call us at 1-800-600-4441 (TTY 711) to learn more.

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Pharmacy & Prescription Drugs

We work with Express Scripts to get you the medicines you need. We cover a wide range of prescriptions and many over-the-counter medicines.

Find a Pharmacy

We have good news! Mosquito repellent is now available as a Medicaid benefit. Get more information below.

Preferred Drug List

We have a list of commonly prescribed drugs your doctor can choose from. It’s called a Preferred Drug List (PDL). Prescription and certain over-the-counter medicines are covered. Your doctor may need to get preapproval for some drugs to be filled. Your request should include why the drug is needed and how much is needed. Requests for brand-name drugs when generics are available also need preapproval.

Searchable formulary

Search for brand-name and generic drugs that are on your medication list.

Search for your drug by:
  • Typing the name (at least first three letters) of the drug in the search box
  • Using the A-Z list to search by the first letter of your drug
    or
  • Clicking on therapeutic class of the drug

Search

Your pharmacy benefits

Over 50,000 pharmacies across the U.S. work with us. And we offer specialty pharmacy services for hard-to-find medicines. To view a list of pharmacies in your plan, use our provider directory.

Have your prescriptions filled easily

Just show the prescription from your doctor to a pharmacy in your plan. Or your doctor can call in the prescription. You’ll need to show the pharmacy your Amerigroup ID card and your Medicaid or PeachCare for Kids® ID card to get your prescription. Try to use the same pharmacy each time so your pharmacist will know about problems that may occur when you’re taking more than one prescription. If you use another pharmacy, tell the pharmacist about any medicines you’re taking.

Helping you manage all the moving pieces

Our new Medication Synchronization program (Med Sync) makes getting all your medicines easier — at no extra cost to you.

Med Sync helps align your refill schedules so you can pick up most of your medicines on just one day each month.

Our Med Sync program can help you:

  • Cut down on trips to the pharmacy
  • Make sure you have your medicines when you need them
  • Work with your pharmacist so you can stick to a medicine routine

Get started with Med Sync today! Talk to your pharmacist about coordinating your prescriptions to get started.

Have more questions about Med Sync? Call 1-800-600-4441 (TTY 711).

Your costs

Prescription cost Your copay
Less than $10.01 $0.50
$10.01-$25.00 $1.00
$25.01-$50.00 $2.00
$50.01 or more $3.00

Drug interactions and side effects

Learn more about drug interactions or side effects on the ESI drug information website.

Preapproval

Your provider can email and ask us for an exception.

Common over-the-counter (OTC) medicines

Pharmacy Change Request Form

Member Reimbursement Form

Express Scripts online registration

Frequently asked questions

What pharmacies work with Amerigroup?

For a list of pharmacies that work with your plan, look in your provider directory. Or call Member Services at 1-800-600-4441 (TTY 711) or ask your local pharmacy for help.

Are over-the-counter (OTC) products covered? Do I need a prescription?

We cover many OTC products, like:

  • Pain relievers
  • Antacids
  • Contraceptives
  • Some vitamins

All OTC products need a written prescription from your doctor and can be filled at any pharmacy in your plan.

How does my doctor request preapproval?

Your doctor can ask for preapproval on medicines by calling the Pharmacy department at 1-800-454-3730.

What if a copay is needed and I can’t pay it?

If you don’t have the copay for your medicine, your pharmacy should still give you the medicine. If the pharmacy lets you take the medicine without paying the copay, you’ll have to pay it at a later time.

What happens if my medicines are lost or stolen?

If your medicines are lost or stolen, call your doctor to approve the pharmacy to refill your prescription early. The pharmacy may have to call us for preapproval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.

What if I paid out of pocket for a medicine and want to be paid back?

If you paid for a medicine, ask your provider for a refund. Your provider will send us a claim.

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Who's Eligible?
The Georgia Families program is for Georgians eligible for Medicaid, including:
  • Children eligible for PeachCare for Kids®
  • Women eligible for Planning for Healthy Babies® (P4HB)
To get Medicaid, you must have meet income limits and be a:
  • Pregnant woman
  • Family with children
  • Child under the age of 19

Families who don’t qualify for Medicaid may still get health care for their children.

To find out more about eligibility, visit Georgia Families.

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Our Case Management and Care Team

Getting you the right care

The Amerigroup Care Team is made up of health care experts who will help you by:

  • Working with you to make healthy life choices
  • Sharing health tips like how to take care of asthma
  • Helping you take control of your health by completing a health risk screening
  • Making sure you get the most out of your health plan
    • Connecting you to health care programs like disease management

If you’d like a Care Team health care expert to call you:

  • Send an email to the Care Team with:
    • Your phone number
    • The best time to reach you
Or call our:
  • Case Management department at 678-587-4758
  • Georgia Families 360° Intake Line at 1-855-661-2021*

Everything we talk to you about is private.

*This number is for Georgia Families 360° members only.

How to enroll in disease case management

  • Call 1-888-830-4300 (TTY 711) toll free or
  • Send an email. Include your:
    • Full name
    • Amerigroup ID number
    • Date of birth
    • Address
    • Phone number
    • Condition(s) for which you’d like case management services

Your case manager will call you within five days to let you know you’re enrolled. If you don’t get a call, call 1-888-830-4300 (TTY 711) toll free Monday through Friday from 8:30 a.m. to 5:30 p.m. Eastern time. Once you’re enrolled, you can leave private messages for your case manager 24 hours a day.

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Specialist Care

There are many kinds of specialists. A specialist is a doctor who gives care for a certain illness or part of the body. One kind of specialist is a cardiologist, or heart doctor. Another kind of specialist is an oncologist. An oncologist is a cancer doctor.

Your PCP may send you to a specialist for care. This is called a referral. If your PCP wants you to go to a specialist, he or she may help set up your visit with the specialist.

You don’t have to see your PCP first to go to a women’s health doctor for well-woman checkups. An obstetrician/gynecologist (OB/GYN) is a women’s health doctor.

You do not have to see your PCP first to see a behavioral health provider for mental health, alcohol abuse or substance abuse services.

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Member Handbook

Your member handbook is your go-to guide for health services. It tells you how you can get the most out of your benefits. Read it to find out about:

  • Your benefits
  • Special programs and services like health education classes, case management and disease management
  • Your rights and responsibilities as an Amerigroup member
  • How to choose a primary care provider
  • How to get help if your doctor’s office is closed
  • Recertifying your benefits
  • How to reach Amerigroup Member Services if you have questions

The electronic version of your member handbook is searchable. Use "Ctrl + F" to search for keywords. If you’re using a Mac, use "Command + F."

Need your handbook mailed to you?

Call Member Services toll free at 1-800-600-4441 (TTY 711).

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Learn when you need a referral or preapproval

A referral is when your primary care provider (PCP) sends you to another provider for care. This care is often from a specialist. As an Amerigroup member, you don’t need a referral to see a provider who’s not your PCP as long as the provider works with your plan.

What is precertification?

Precertification is needed for:

  • Inpatient admissions
  • Certain behavioral health services like skills training
  • Psychological testing
  • Certain prescriptions
  • Rehabilitation therapies (physical, occupational, respiratory, speech)
  • Care from a provider who doesn’t work with your plan

As a member, you don’t make the request. Your PCP, specialist or other provider should send in the request. If your case doesn’t meet the rules for medically needed, we’ll send you a letter. The letter will tell you we could not OK the service and why.

Other benefit details can be found in your member handbook. If you have questions or would like a copy of your member handbook mailed to you, call Member Services at 1-800-600-4441 (TTY 711).

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