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Copay Information

Your health is important — and so is affording your care. That’s why we offer low or no copays for covered services.

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A copay is the amount of money you need to pay to get a service. If you can’t pay the copay when you get care, you’ll still get the health care you need. Your doctor or other provider may ask you to pay the copay later.

These members don't have copays:
  • Children under 19 years of age
  • Pregnant women
  • Members in institutions, like nursing facilities or intermediate care facilities for individuals with intellectual disabilities
  • Members getting emergency care in the emergency room (ER)
  • Members getting Medicaid hospice benefits
  • Members of federally recognized American Indian tribes don’t pay most copays. Tribal members don’t pay for services from the Catawba Service Unit in Rock Hill, South Carolina, or when referred to a specialist or other medical provider by the Catawba Service Unit.
All other members have these copays:
Service Copay Amount
Dental services, unless an emergency $3.40 per visit
Doctor’s office, primary care provider (PCP) and specialist visits $3.30
Chiropractor $1.15
Medical equipment and supplies $3.40
Home health visits $3.30 per visit
Generic or brand-name drugs your doctor orders $3.40 per drug
Inpatient care given during hospital stay $25
Outpatient care given at a hospital, other than ER visits  $3.40
Optometrist (eye doctor) $3.30
Podiatrist (foot doctor) $1.15
Ambulatory surgical centers $3.30
Federally Qualified Health Centers (FQHCs) $3.30
Rural Health Clinics (RHCs) $3.30


There are no copays for these services:
  • Orthodontic services provided by and medical equipment and supplies given by the Department of Health and Environmental Control (DHEC)
  • Family planning care and medicine
  • End-stage renal disease care
  • Infusion center care
  • Preventive care or urgent care visits
  • Rehabilitative behavioral health services
  • Smoking cessation drugs
  • Behavioral health drugs
  • Some diabetic medications
  • Hospice benefits
  • Waiver services
  • Emergency room visits in the U.S.*

*Disclaimer: Visits that are considered nonemergencies that are serviced in the emergency room do have a copay.

Learn more!

For questions about copays, call the Customer Care Center at 1-866-781-5094 (TTY 1-866-773-9634). You can also click the links below for information about: