In some situations, members must share in the cost of the service provided.
This is a Copayment (or copay), a set amount members pay when they receive a service.
- If you choose to use a brand-name drug when a generic can be used, you may have a copay.
- You may have a copay if you go to an emergency room when you do not have an emergency.
Please refer to your Member Handbook for complete information about copays.
You can find your copays on your member ID card.
- You must make copays directly to providers at the time of service.
- You may be responsible for paying for non-covered services if you sign a release agreeing to pay before services are received.
- If you do not pay your copay, the provider and/or Iowa Medicaid may use legal action to collect payment from you.
These types of members are always exempt from copays:
- Native American and Alaskan Native members
- Pregnant women
- Members receiving hospice care
Other Client Participation
The other type of cost sharing is when a member must pay a portion of their monthly expense. This is referred to as patient liability.
- These may include members in an institutional setting, or HCBS Waiver enrollees. Please refer to your Member Handbook for more information.