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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.

Copays for Medicaid Services

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.