Member Copays
In most situations, members must share the cost of the service provided.
This is a Copayment (or copay), or a set amount members pay when they receive a service.
Please refer to your Member Handbook for complete information about copays.
You can find your copays on your member ID card.
Paying Copays and Other Payments
You must make copays directly to providers at the time of service.
| Service | Your Copay |
|---|---|
| Physicians | $4 per visit |
| Outpatient services | $4 per visit |
| Podiatrists | $4 per visit |
| Generic and brand prescriptions | $4 for each prescription |
| Chiropractic | $4 per visit |
| Optical services/supplies | $4 per visit |
| Optometrists | $4 per visit |
| Non-emergency Emergency Department visits | $4 per visit |
Copays for North Carolina Health Choice (NCHC) Services
If you do not pay an annual enrollment fee for your child or children:
| Service | Your Copay |
|---|---|
| Office visits | $0 per visit |
| Generic prescriptions | $1 for each prescription |
| Brand prescriptions (when no generic available) | $1 for each prescription |
| Brand prescriptions (when generic available) | $3 for each prescription |
| Available Over-the-Counter medications | $1 for each prescription |
| Non-emergency Emergency Department visits | $10 per visit |
If you do pay an annual enrollment fee for your child or children:
| Service | Your Copay |
|---|---|
| Office visits | $5 per visit |
| Outpatient hospital | $5 per visit |
| Generic prescriptions | $1 for each prescription |
| Brand prescriptions (when no generic available) | $1 for each prescription |
| Brand prescriptions (when generic available) | $10 for each prescription |
| Over-the-Counter medications | $1 for each prescription |
| Non-emergency Emergency Department visits | $25 per visit |
There are NO copays for the following members or services:
- Members under age 21
- Members who are pregnant
- Members receiving hospice care
- Federally recognized tribal members
- North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
- Children in foster care
- People living in an institution who are receiving coverage for the cost of care
- Behavioral health services
- Intellectual/developmental disability (I/DD) services
- Traumatic brain injury (TBI) services
A provider cannot refuse to provide services if you cannot pay your copay at the time of service. If you have any questions about Medicaid copays, call Member Services at 1-833-552-3876 (TTY: 711).
Exemptions
* There are NO NC Health Choice copays for the following people or services:
- Federally recognized tribal members
If you have any questions about NC Health Choice copays, call Member Services at 1-833-552-3876 (TTY: 711).
Other Client Participation
The other type of cost-sharing is when a member must pay a portion of their monthly expense. This is referred to as patient liability.
These may include members in an institutional setting, or Home and Community-Based Services (HCBS) Waiver enrollees. Please refer to your Member Handbook for more information.