1-800-339-4557  Customer Care Line: 1-800-339-4557

How do co-payments work?

Members enrolled in Family Health Plus or Medicaid Managed Care are required to make co-payments when receiving medical services.  Members who cannot afford the co-payment may not be denied a service based on their inability to pay. Your Provider cannot refuse to give you care or services because you are unable to pay. However, you will still owe the unpaid co-pay amounts to the Provider. The Provider may ask you for payment later or send you a bill.  If you have questions contact Customer Care  or call 1-800-339-4557, or call the New York State Department of Health's Co-Pay Hotline at 1-800-541-2831.

 

Members will be responsible for making co-payments to providers for these covered benefits
Brand name prescription drugs $6 for each prescription and each refill
Generic prescription drugs $3 for each prescription and each refill
Clinic visits $5 per visit
Physician visits $5 per visit
Dental service visits $5 per visit up to a total of $25 per year
Radiology services (diagnostic x-rays, ultrasound, nuclear medicine, and oncology services) $1 per radiology service
Lab tests 50¢ per test
Inpatient hospital stays $25 per stay
Non-urgent emergency room visit $3 per visit
Covered over-the-counter medications (stop smoking patches and gum, and insulin) 50¢ per medication
Covered medical supplies (hearing aid batteries,enteral formula, and diabetes test strips, lancets, and syringes) $1 per supply
Co-payments will not apply to these services
  • Emergency services
  • Family planning services and supplies
  • Mental health clinics
  • Chemical dependence clinics
  • Mental illness drugs
  • Tuberculosis drugs
  • Prescription drugs for a resident of an adult care facility
You are not required to pay the co-payments if you:
  • Are under the age of 21
  • Are pregnant
  • Are a permanent resident of a nursing home
  • Are a resident of a community-based residential facility licensed by the Office of Mental Health or the Office of Mental Retardation and Developmental Disability
  • Cannot afford the co-payment at the time of service, tell your provider. The provider must still provide services but can bill you later