What Benefits Will I Get?
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What benefits will I get?
The CMSP covers the medical and dental services most frequently used by children. If you have questions about CMSP coverage, call CMSP Customer Service at 1-800-909-2677.
Medical coverage includes:
- Routine check-ups
- Immunizations
- Office visits when child is sick or hurt
- Lab tests, x-rays, and other diagnostic tests
- Outpatient surgery for tympanostomy ear tubes or for inguinal hernia
- Family planning services
- Prescription medicines (up to $200 per child per year*)
- Rental or purchase of prescribed medical equipment (up to $200 per child per year*; up to $500 per child per year* for asthma, diabetes, or epilepsy)
- Eye exams and hearing tests
- Outpatient mental health and substance abuse visits (up to 20 visits per year*)
Dental coverage includes the following services, up to $750 per child per year*:
- Exams and cleanings (twice per year*)
- X-rays
- Fluoride treatment (twice per year*)
- Sealants (once per year*)
- Fillings, extractions, and root canals
- Crowns
- Space maintainers
*The CMSP program year begins July 1 and ends July 30.
What services are not covered?
The following services are not covered:
- Inpatient hospital care
- Over-the-counter medicine
- Early Intervention
- Ambulance services
- Emergency room care
- Orthodontics
- Removal of wisdom teeth
Note: Children from low-income families may be eligible for the Health Safety Net for hospitalization and other services that are not covered by CMSP. See Health Safety Net.
Do I have to pay for CMSP coverage?
Depending on income, some families pay a monthly premium for CMSP, while other families do not pay a premium. Most services require a small co-payment. Monthly premiums and co-payments are based on income, with the highest income families paying the most.
There is no co-payment for routine check-ups, immunizations, and family planning services. These services are free for CMSP members.
There are four income categories for CMSP, based on percentages of the Federal Poverty Guidelines (FPG):
CMSP Income Categories
Annual Household Income
Before Taxes |
Monthly Premium |
Co-pay Medical |
Co-pay Dental |
Co-pay Pharmacy |
| less than 200% of FPG |
No Charge |
$ 2 |
$ 2 |
$ 3 per generic drug
$ 4 per brand name drug
|
| 200% - 300% of FPG |
$7.80 per child per month
with a maximum of
$23.40 per family per month |
$ 5 |
$ 4 |
| 301% - 400% of FPG |
$33.14 per family per month |
$ 5 |
$ 4 |
| more than 400% FPG |
$64.00 per child per month |
$ 8 |
$ 6 |
The Federal Poverty Guidelines (FPG) for families of different sizes are shown below:
Children's Medical Security Program
Category Income Limits (Gross Monthly Income)
Effective March 1, 2009 to February 28, 2010
| Family Size |
200% of FPG |
300% of FPG |
400% of FPG |
| 1 |
$1806 |
$2709 |
$3612 |
| 2 |
$2430 |
$3645 |
$4860 |
| 3 |
$3052 |
$4578 |
$6104 |
| 4 |
$3676 |
$5514 |
$7352 |
| 5 |
$4300 |
$6450 |
$8600 |
| 6 |
$4922 |
$7383 |
$9844 |
| 7 |
$5546 |
$8319 |
$11092 |
| 8 |
$6170 |
$9255 |
$12340 |
| Each extra person |
+$624 |
+$936 |
+$1248 |
|
