Copays

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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