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VA Medicaid Co-Payments

Some Medicaid recipients must pay a small amount for services. This is called a co-payment.

The following people never have to pay a co-payment for services covered by Medicaid:

·             Children younger than age 21;

·             People needing emergency care;

·             People in nursing facilities and waiver recipients; and

·             People in hospice programs.

Other adults must pay a charge for certain services. This is your co-payment responsibility. If a co-payment is due but you have no money, the provider will still give you the medical care you need, but you will be billed for the co-payment.

The following services are never subject to co-pays:

·             Emergency services (including dialysis treatments);

·             Pregnancy-related services;

·             Family-planning services; and

·             Emergency room services.

Routine co-payment responsibilities include:

·             $100 per inpatient hospitalization

·             $3 per outpatient hospitalization clinic visit

·             $1 per clinic visit

·             $1 per physician office visit

·             $3 per other doctor visit or encounter

·             $1 per eye examination

·             $1 per multi-source generic prescription filled

·             $3 per brand name prescription filled

·             $3 per home health visit

·             $3 per rehabilitation service

See Also:

VA Medicaid Income Limits

VA Medicaid Resource Limits

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Information for this topic was drawn from Section M1850.100 of the Department of Social Services (DSS) Medicaid Manual.

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