Cost sharing is a small portion of a medical bill. A cost share may be charged when you receive a medical service. This is often called a co-insurance or co-pay. Cost sharing is paid directly to your health care provider at the time you receive medical care. You may still receive services even if you are unable to pay the cost share at the time of the service. If you do not pay your cost share, the provider may report you to collections for the amount of the cost share and may decline to schedule future appointments with you until you pay your cost share.
Some individuals do not have a cost share for medical services. Individuals exempt from cost sharing include:
Some medical services do not have a cost share. Services exempt from cost sharing include:
If you are enrolled in the Primary Care Provider Program or the Health Home Program and you see your PCP or another provider selected to cover for your PCP in the same clinic, you will not be charged a cost share. If you see a specialist in the same clinic as your PCP, you will be required to pay the cost share.
The table below contains the cost sharing amounts for covered Medicaid services. The cost sharing amounts are also listed in the Medicaid Recipient Handbook.
Service |
Cost Sharing Amount |
Ambulatory Surgical Centers |
5% up to $50.00 |
Chiropractic Services |
$1.00 for each procedure |
Dental Services |
$3.00 per procedure |
Dentures | $3.00 for each denture or reline of dentures |
Diabetes Education |
$3.00 per unit of service |
Dieticians and Nutritionist Services | $3.00 per visit |
Durable Medical Equipment, Supplies, and Prosthetic Devices |
5% of allowable reimbursement |
Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) |
$3.00 per encounter |
Independent Mental Health Practitioners |
$3.00 per procedure |
Inpatient Hospital Services |
$50.00 for each admission |
Mental Health Clinics |
5% of allowable reimbursement |
Nutrition Services |
$2.00 per day for Enteral |
Optometric Services |
$2.00 per visit |
Optical Supply | $2.00 per procedure |
Outpatient Hospital Services |
5% of allowable reimbursement up to maximum $50.00 |
Physician Services |
$3.00 per visit |
Podiatry Services |
$2.00 per visit |
Prescription Drugs |
$3.30 for each brand name prescription |