Loadfone173

1. What Is A Copay
2. Pcp Office Copay
3. 2 Copays For One Office Visit Program

Copay Tips

What Is A Copay

• You are typically required to pay your copay to your doctor’s office at the time of your visit
• The office visit copay is a set dollar amount (e.g. $15 per visit)
• Your deductible may not apply, depending on your health plan design

You will not pay copays for preventive care office visits. Copays are for the office visit only, and do not cover any additional services you might receive during your visit (e.g. lab work or X-rays). Any additional services are subject to your deductible and coinsurance, until you reach your out-of-pocket limit. Here are examples of office visit types and the applicable copays.

The lowest copays will be for office visits to a primary care physician, physician’s assistant or nurse practitioner. If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher. The most expensive copays will come when you visit the emergency room. Notify your local MDHHS office if you have other health insurance or if your insurance changes. You can visit the myHealthPortal website to make updates or call the Beneficiary Help Line at 1-800-642-3195 to report other health insurance.

Pcp Office Copay

2 Copays For One Office Visit Program

Office Visit Type	$15 Primary Care Visit	$25 Specialty Visit
Family Practice	✔
General Practice	✔
Internal Medicine	✔
Gynecology/OB	✔
Midwives (if your plan provides in-network midwives)	✔
Nurse Practitioners	✔
Physician Assistant	✔
Pediatrics	✔
Urgent Care	✔
Chiropractic	✔
Home Health Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Palliative Care Visit	✔ For PCP Only	✔ For Specialist Only
Vision Exam	✔
Pre/Postnatal Visits	✔* For family practice with obstetrics or OB/GYN	✔* For maternal/fetal specialist
Mental Health Visits/Therapy	✔
Physical Therapy	✔
Occupational Therapy	✔
Speech Therapy	✔
Other Practitioner	✔

*If all prenatal visits are billed as a package at the end of pregnancy, then your deductible and 10% coinsurance apply. Check with your doctor’s office for more information.