Some health plan members may have copays. A copay is a fee you pay when you get certain health care services or prescriptions.
Medicaid copays
|
Service |
Copay |
|---|---|
|
Chiropractic visits Doctor visits Non-emergency and emergency department visits Optometrist and optical visits Outpatient visits Podiatrist visits |
$4 per visit |
|
Generic and brand prescriptions |
$4 per prescription |
There are no Medicaid copays for:
- Members under age 21
- Members who are pregnant
- Members who get hospice care
- Federally recognized tribal members
- North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
- People living in an institution who get coverage for cost of care
- Children/youth in foster care
- Behavioral health, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) services
NC Health Choice copays
|
Service |
Copay |
|---|---|
|
If you do not pay a yearly enrollment fee for your children: |
|
|
Office visits |
$0 per visit |
|
Generic prescriptions Brand prescriptions when no generic is available Over-the-counter (OTC) medicines |
$1 per prescription |
|
Brand prescription when generic is available |
$3 per prescription |
|
Non-emergency and emergency department visits |
$10 per visit |
|
If you do pay a yearly enrollment fee for your children: |
|
|
Office visits Outpatient hospital visits |
$5 per visit |
|
Generic prescriptions Brand prescriptions when no generic is available Over-the-counter (OTC) medicines |
$1 per prescription |
|
Brand prescription when generic is available |
$10 per prescription |
|
Non-emergency and emergency department visits |
$25 per visit |
There are no NC Health Choice copays for:
- Federally recognized tribal members