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PeachCare for Kids



PeachCare for Kids offers comprehensive medical coverage for uninsured children under age 19 living in Georgia. The program includes benefits such as primary, specialist, preventive, dental and vision care, as well as major medical services including hospitalization and emergency care. Care for every PeachCare member is coordinated by a Georgia Families Care Management Organization (CMO), selected based on the region in which you live.

The PeachCare program has been nationally recognized as one of the strongest State Children’s Health Insurance Programs, ranking 8th in 2010 for number of enrolled children. To qualify for PeachCare benefits, you must meet certain criteria, including income in relation to your family size. Children up to age 18 in a family with a total household income at or below 235 percent of the current Federal Poverty Level (FPL) may be eligible if they have no other insurance. PeachCare also has requirements for U.S. citizenship, as members must be official citizens or legal immigrants.

 

PeachCare Income Guidelines

PeachCare members must meet the qualifications for income that is less than or equal to 235 percent of the Federal Poverty Level according to their family size. Below are the current monthly and annual income requirements for families living in Georgia.

Family of 1: $2,188 monthly, $26,252 yearly

Family of 2: $2,963 monthly, $35,556 yearly

Family of 3: $3,739 monthly, $44,868 yearly

Family of 4: $4,515 monthly, $54,180 yearly

When applying for benefits, you will be required to verify your income in several ways, including earned income and unearned income. Acceptable proof of earned income can be one month’s worth of weekly, bi-weekly, semi-monthly, or two monthly pay stubs. These will need to be shown for the most recent month of earnings. Those who are paid in cash must obtain the Verification of Earned Income form 809 and have their employer fill it out, sufficing for 4 weeks of pay stubs.

Proof of unearned income, which anyone in the household receives from parents or relatives, agencies, friends, or any other sources can be given in the following ways.

  • Supplemental Security Income or Social Security Administration beneficiaries must show their current year award letter.
  • Unemployment checks must be backed up by 4 weeks of pay stubs or the award letter.
  • Workman’s Compensation, Long-Term Disability, or Short-Term Disability recipients must provide a letter from their insurance company stating the amount received and frequency.
  • Child Support (paid directly to you) can be verified by a written statement from the parent who gives you money, with their name and contact information, and how much they pay.
  • Child Support (paid through court) can be verified by court papers or a letter stating the amount of income received and how often.
  • Contributions must be verified through a letter from the person who gives you money, with name and contact information provided. Also include the amount you receive and how frequently you do so.
  • Other unearned income must be proven in a letter stating the amount received and how often it is received, including 4 weeks of pay stubs and contact information for the source.

 

PeachCare Benefits

PeachCare provides a full range of health benefits for its members, including preventative care, prescription medications, and hospital care. Every health care service you can expect from Medicaid or a private health plan is covered by PeachCare. A selection of medical services available through PeachCare include the following:

  • Doctor visits for illness or minor injury
  • Preventive care such as shots and routine check-ups
  • Specialist care
  • Dental care
  • Vision care, including screenings and eyeglasses
  • Emergency room services
  • Prescription medications
  • Hospitalization
  • Outpatient hospital care
  • Mental health care

 

Health Plan Options

All PeachCare for Kids members will select a Care Management Organization (CMO) and choose a primary care provider to facilitate their medical care. There are three CMOs in Georgia providing Georgia Families programs such as PeachCare, including Amerigroup Community Care, Peach State Health Plan, and WellCare. Each CMO has case management services in addition to your primary care provider to help you get the most out of your benefits, when necessary, and sort out confusion with your plan.

Amerigroup provides additional benefits for its plan members such as free transportation to medical appointments, a prenatal rewards program for pregnant members, free cell phones with health reminder texts and free minutes, and a free membership to participating Boys & Girls Clubs.

Peach State Health Plan also has a rewards program for its pregnant PeachCare members, which creates an account where you earn money for going to all your recommended prenatal and postnatal checkups, and spend funds on health care services as well as various medical supplies. Peach State Health Plan members are required to pay a copayment for some medical services covered your plan. These range from $0.50 for a service that costs $10 or less, to $3 for a service over $50.

WellCare of Georgia includes free over-the-counter medicines, vitamins, and health supplies to its PeachCare beneficiaries on top of the existing benefits. There are no copayments for WellCare members, though families with a certain income will have to pay a monthly premium.

 

PeachCare Costs

Monthly premiums are assigned to children ages 6 and older. Premiums for PeachCare are $10 to $35 for one child, and a maximum of $70 for two or more children per household. These payments are due on the first of the month before the month of coverage.For instance, premiums for coverage in February are to be submitted on January 1.

Copayments may or may not be required depending on which health plan you have. Certain children are also exempt from copayments, such as children under age 6, foster children Alaskan Natives, and American Indians. Any PeachCare member in the mentioned groups will not have to provide a payment at the time of service.

 

Resources

PeachCare for Kids

Apply for PeachCare benefits

Contact PeachCare: 877-GA-PEACH

Amerigroup Community Care

Peach State Health Plan

WellCare of Georgia

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