What is a copay?
A copay is a small part of medical care that may be billed to you as a Medicaid client for doctor’s office visits, prescriptions, and other covered services. Not all Medicaid clients will need to pay a copay. Cost sharing rules prevent Medicaid clients from being assigned more than 5% of family income in cost sharing during a three month period (each quarter).
Who does NOT have a copay under Wyoming Medicaid?
- All individuals under age 21. No children on Medicaid have any copays.
- Individuals on Supplemental Security Income (SSI).
- Individuals on Breast and Cervical Cancer treatment program – Coverage is limited to specific screening and diagnostic services for breast and cervical cancer.
- Individuals enrolled in the Colorectal Cancer Screening Program – Coverage is limited to specific screening and diagnostic services related to colorectal cancer.
- Individuals that answer “Yes” on either of the Indian Health Services (IHS) service questions on the eligibility application or renewal
- Native Americans who are currently receiving or have ever received an item or service furnished by an Indian health care provider (IHS or tribally run 638 facility) or through referral under contract health services.
- Native American individuals on CHIP (note: all other individuals on CHIP have copays)
- Pregnant women enrolled on the Pregnant Woman eligibility group.
- Individuals enrolled under the Nursing Home Program, who already contribute to the cost of their care.
- Individuals in hospice.
- Medicaid Emergency Services for Non-Citizens.
- Individuals enrolled in a Medicaid Waiver Program as part of a Home and Community Based Services plan of care will not pay copays related to the waiver services they receive, but will be required to pay copays for regular Medicaid services and care when applicable.
- Medicaid Care Management Entity (CME) – this plan covers youth with serious emotional disturbance that are eligible.
- Individuals enrolled in the Medicaid Family Planning Waiver, also known as the Pregnant by Choice Program.
- Medicaid Inpatient Psychiatric Services for Individuals age 65 and over and individuals under Title 25.
Copay Amounts
If you qualify for copays, the cost sharing amount will be the same for all income levels.
Services or Items with Cost Sharing (Copays) (for service dates of July 1, 2024 and after) |
|
Office Visits | $2.45 |
Home Visits | $2.45 |
Eye Exams | $2.45 |
Rural Health Center Visits | $3.65 |
Federally Qualified Health Center Visits | $3.65 |
Have a question about copays?
This page was last updated on August 1, 2024.