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 | $3 per visit |
| Outpatient services | $3 per visit |
| Podiatrists | $3 per visit |
| Generic and brand prescriptions | $3 for each prescription |
| Chiropractic | $2 per visit |
| Optical services/supplies | $2 per visit |
| Optometrists | $3 per visit |
| Non-emergency Emergency Department visits | $3 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
- If you do not pay your copay, the provider and/or North Carolina Medicaid may use legal action to collect payment from you.
- You may be responsible for paying for non-covered services if you sign a release agreeing to pay before services are received. Note, the cost of non-covered services is likely to be more than a copay for a covered service.
Exemptions
These types of members are always exempt from copays:
- Native American
- Pregnant women
- Members receiving hospice care
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.