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  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 under 19 years of age
  • Pregnant women
  • Institutionalized individuals (such as persons in a nursing facility or ICF-MR)
  • Members of a Federally Recognized Indian Tribe (for services rendered by the Catawbas Service Unit in Rock Hill, SC and when referred to a specialist or other medical provider by the Catawba Service Unit)
  • Members of the Health Opportunity Account (HOA) program
The following services are not subject to a co-payment:

  • Medical equipment and supplies provided by DHEC
  • Orthodontic services provided by DHEC
  • Family planning services
  • End Stage Renal Disease (ESRD) services
  • Infusion Center services
  • Emergency services in the hospital emergency room
  • Hospice benefits
  • Waiver services

(per date of service)

(per date of service)

(per date of service)

(per claim)

(per admission)

Chiropractor Services

Doctor's office visits (Physician/Nurse Practitioner)

*Durable Medical Equipment and Supplies

Outpatient Hospital services

Inpatient Hospital  

Podiatrist services

Clinic Visits
(Federally Qualified Health Center(FQHC),
Rural Health Clinic (RHC),
Ambulatory Surgical Center)

Dental Services




Home Health visits

Prescriptions {per prescription/per refill}




Optometrist Services





Effective for dates of service on and after 07/11/11.
*NOTE: Durable Medical Equipment that is under a rent to purchase payment plan will have the $3.40 co-pay split evenly among the 10-month rental payment schedule.