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