Copays for Medical Assistance and General Assistance members
Copays for Medical Assistance and General Assistance members Medicaid members 18 years of age and older and in the Medical Assistance or General Assistance categories will have to pay a copay for prescriptions and various medical services. Members who are under the age of 18, pregnant, or in a nursing home do not have to pay the copays. This depends on your Medicaid group. But Peach State Health Plan will pay for most, if not all of your bill. Doctors, hospitals or other providers in the Medicaid program must accept Medicaid as payment. But they may bill you for your co-payment. Those who do not have co-payments are: Medicaid member under age 21; PeachCare for Kids® members under age 6. Deductibles, copayments, coinsurance, tiers, Medicare prescription drug plans, costs, covered prescriptions, generic and brand-name drugs. Have multiple copays? Copays are paid per visit. A visit is defined as an encounter or series of encounters that are performed on the same date of service at the same entity (including telehealth services). Can a provider refuse to see a Medicaid beneficiary if he/she does not pay the copay?
Medicaid members 18 years of age and older and in the Medical Assistance or General Assistance categories will have to pay a copay for prescriptions and various medical services.
Members who are under the age of 18, pregnant, or in a nursing home do not have to pay the copays.
Residents of a long-term care facility or other medical institution, including intermediate care facilities, do not pay copays.
MA recipients, regardless of age, who qualify for benefits under Title IV-B Foster Care and Title IV-E Foster Care and Adoption Assistance do not pay copays.
Medicaid Copay Urgent Care
PCP visits never have a copay.
Medical and General Assistance recipients cannot be denied a prescription if they cannot afford a copayment. If you cannot afford your prescription copayment, please let your pharmacist know. If you have any problems getting your medication from the pharmacist, please contact Member Relations at 1-800-553-0784 or 215-849-9600 (TTY 1-877-454-8477).
Medical Assistance copays
For the following services you will pay $5.00:
- For acupuncture, you will pay $5.00 for each visit (up to 20 visits). Members who are pregnant or under age 21 do not need to pay a copay.
Nc Medicaid Copay Rules
For the following services you will pay $3.00:
- For inpatient hospital care (which includes both general and medical rehabilitation hospitals), you will pay $3.00 for each day you are in the hospital up to $21.00 for the stay
- For Short Procedure Unit (SPU)/Ambulatory Surgical Center (ASC) visits, you will pay $3.00 per admission or visit.
- For brand name prescription drugs, you will pay $3.00 for each prescription or refill.
For the following services, you will pay $1.00:
Medicaid Copay Nc
- For outpatient x-ray services, you will pay $1.00 for the service (not for each x-ray).
- For generic prescription drugs, you will pay $1.00 for each prescription or refill.
- For chiropractor visits, you will pay $1.00 for each visit.
You don’t have to pay a copayment for any of the following if they are part of your benefit package:
Medicaid Copay For Medication
- Any services provided in an emergency
- Birth centers
- Blood and blood products
- Certain drugs for high blood pressure, cancer, diabetes, asthma, epilepsy, heart disease, psychosis, HIV/AIDS, glaucoma, depression, and anxiety, as well as anti-Parkinson agents, anti-manic agents, anti-convulsants, anti-neoplastic agents, oral contraceptives, test strips, lancets, meters, and needles
- CRNP (Certified Registered Nurse Practitioner) services
- Dental visits
- Disposable medical supplies
- Doctor's fee for x-rays, diagnostic tests, nuclear medicine or radiation therapy
- Drugs and vaccines that you get in your doctor’s office
- Family planning services
- Home health agency services
- Hospice services
- Laboratory tests
- Medical examinations for members under age 21 provided through the EPSDT program More than one of a series of specific allergy tests provided in a 24-hour period Non-emergency ambulance services
- Nurse midwife (maternity services)
- Optometrist visits
- Oxygen
- Physician visits
- Podiatrist visits
- Portable x-ray services
- Renal dialysis services
- Rental of Durable Medical Equipment (DME)
- Skilled Nursing Facility
- Targeted case management services
- Tobacco cessation counseling services
- Waiver services