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  Home >> >> Beneficiary Copayment Amounts

  Beneficiary Copayment Amounts 

Some adults may have to pay a small co-payment for some services.
Call 1-888-549-0820 if you have questions about which services require a co-payment.

You can only be required to pay for:

  • Allowed co-payments
  • Services that are not covered
  • Services for which you have already used the limit allowed

The following beneficiaries do not have co-payment requirements:

  • Children, age 0-18 years
  • Institutionalized individuals
  • Home-based and community-based waiver individuals
  • Individuals receiving hospice care
  • Individuals receiving family planning services
  • Individuals receiving pregnancy-related services
  • Individuals receiving emergency services
CURRENT COPAY AMOUNTS

$1.00

$2.00

$3.00

$25.00

Podiatrist services

Optometrist services

Durable Medical Equipment

Inpatient hospital admission 

Doctor's office visits

Dentist Services

 

Home health visits

Prescriptions {per prescription/per refill}

 

FQHC/RHC Health Center visits

Outpatient hospital services

Outpatient surgery services