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 | Copays as of July 1, 2022 |
|---|---|---|
| Physicians Outpatient services Podiatrists |
$3 per visit | $4 per visit |
| Generic and brand prescriptions | $3 per prescription | $4 per prescription |
| Chiropractic Optical services/supplies |
$2 per visit | $4 per visit |
| Optometrists Non-emergency emergency department visit |
$3 per visit | $4 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. If you have any questions about Medicaid copays, please call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).
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 |
If you have any questions about NC Health Choice copays, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).