A copay is a set dollar amount you pay when you get certain services or treatment. It’s part of your share of the cost for covered health care services. You pay copays directly to a provider.
The only time you pay a copay is for nonemergency visits to the emergency room. Check your ID card for the amount you pay.
If it’s not an emergency, you need care right now and can’t see your regular provider, go to an urgent care center, a retail health center, or a walk-in doctor’s office. Learn more about your urgent care options
If you think you paid more than five percent of your family’s income for the quarter on health care (copays and other payments), call Member Services. We can tell you the amount you paid in copays, if any.
Copays do not apply to American Indian, Alaskan Native, Family Planning Waiver, pregnant members and Medicaid members under age 21.
Iowa Health and Wellness Plan members pay nothing or very little for the first year. A small monthly payment may be required based on income after the first year if you don’t complete your Healthy Behaviors.There is an $8 copay for using the emergency room for non-emergency services.
Long-Term Services and Supports (LTSS) Member Liability/Client Participation
If you have LTSS benefits, you may have a member liability, also called client participation. The state decides if you have this. Here’s how it works:
- The state decides your patient liability amount and lets us know.
- We let your providers know your liability amount.
- We pay your providers for covered services, minus your liability amount.
- Your providers collect your liability amount from you, and Medicaid pays the rest of the balance for your covered long-term care claims.
Out-of-Pocket Cost Share
Your out-of-pocket spending is the total of all copays you've paid during a specific quarter. Log in to the secure site to see what you've spent this quarter.
If you have any questions about what you paid or owe, call Member Services at 1-800-600-4441 (TTY 711), Monday through Friday from 7:30 a.m. to 6 p.m. Central time.