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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. 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).