Plan Member Copays
Some members may be required to pay a copay, or a fee you pay when you get certain health care services from a provider or pick up a prescription from a pharmacy.
Your copays if you have Medicaid*
| Service | Your copay |
|---|---|
| Physicians Outpatient services Podiatrists |
$3 per visit |
| Generic and brand prescriptions | $3 per prescription |
| Chiropractic Optical services/supplies |
$2 per visit |
| Optometrists Non-emergency emergency department visit |
$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 cost of care
- Behavioral health services
A provider cannot refuse to provide services if you cannot pay.
Your copays if your child has NC Health Choice
If you do not pay an annual enrollment fee for your child or children:
| Service | Your copay |
|---|---|
| Office visit | $0 per visit |
| Generic prescription Brand prescription when no generic is available Over-the-counter medicines |
$1 per prescription |
| Brand prescription when generic is available | $3 per 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 visit Outpatient hospital |
$5 per visit |
| Generic prescription Brand prescription when no generic is available Over-the-counter medicines |
$1 per prescription |
| Brand prescription when generic is available | $10 per prescription |
| Non-emergency emergency department visits | $25 per visit |