Are there co-pays for this program?

Medicaid has co-pays for certain services they provide. If you are unable to pay these, your provider can bill you, but you are still responsible for them. Children under 21 and pregnant women (until 60 days postpartum) are exempt from paying co-pays.

The following services are subject to a co-pay:

  • Clinic visits (hospital-based and free-standing Article 28 Health Department-certified facilities) - $3
  • Laboratory tests performed by an independent clinical laboratory or any hospital-based/free-standing clinic laboratory - $1 per procedure
  • X-rays - $1 per procedure
  • Medical supplies including syringes, bandages, gloves, sterile irrigation solutions, incontinence pads, ostomy bags, heating pads, hearing aid batteries, nutritional supplements, etc. - $1 per claim
  • Inpatient hospital stays (involving at least one overnight stay - is due upon discharge) - $25
  • Emergency room - for non-urgent or non-emergency services - $3 per visit
  • Pharmacy prescription drugs:
    • $3 brand name non-preferred
    • $1 brand name preferred
    • $1 brand name when less than generic
    • $1 generic
  • Non-prescription (over-the-counter) drugs - $0.50

Co-Pay Maximum

You are responsible to pay a maximum of up to $200 in a co-pay year. Your year begins on April 1 and ends March 31 each year. If you reach your maximum of $200, a letter will be sent to you exempting you from paying Medicaid co-payments until April 1. For more information please call 315-366-2211.

Show All Answers

1. Who is eligible for medical assistance (Medicaid)?
2. What medical services are paid for by Medicaid in New York State?
3. Is Medicaid Managed Care available in Madison County?
4. How can I apply for Medicaid?
5. What do I need to apply?
6. Am I eligible for Medicaid?
7. What is Transitional Medical Assistance?
8. What is Spend Down/Provisional Medicaid?
9. Are there co-pays for this program?