Copayments are specified dollar amounts members pay directly to a provider for each item or service they receive. There are federal limits for certain services and populations. Additional information about copayments, including recent changes are provided in the links below.
Note: Information provided in PDF files, unless otherwise noted.
Mandatory Copayments:
Mandatory copayments permit providers to deny services to members who do not pay the copayment. However, certain services (such as emergency services) and specific populations (such as individuals under the age of 19) are exempt from mandatory copayments. AHCCCS members who have mandatory copayments for certain services include:
Optional Copayments (also known as "nominal"):
Optional copayments apply to AHCCCS members who are not required to make the mandatory copayments as noted above. When a member has an optional copayment, providers are prohibited from denying the service when the member is unable to pay the copayment. As with mandatory copayments, there are certain services (such as emergency services) and specific populations (such as individuals under age 19) which are exempt from the optional copayment.
| AHCCCS Copayments Table |
|
Service |
Populations and Copayment
Amounts |
| |
MANDATORY COPAYMENTS |
OPTIONAL (NOMINAL) COPAYMENTS |
| |
AHCCCS Care (Childless Adults) |
TMA |
Other |
| Pharmacy -
Generic and brand name when generic not available |
$4.00
|
$2.30 |
$2.30 |
| Pharmacy - brand name when generic available |
$10.00 |
$2.30 |
$2.30 |
| Office Visits1 |
$5.00 |
$4.00 |
$3.40 |
| Outpatient
professional therapies |
N/A |
$3.00 |
$2.30 |
| Non-emergency use of the ER |
$30.00 |
N/A |
N/A |
| Non-emergency surgery2 |
N/A |
$3.00 |
N/A |
| Taxis for non-emergency medical transportation3 |
$2.00 per one way trip |
N/A |
N/A |
1 Visits to a primary care physician, specialist, or other
health care provider, except not in a hospital or
outpatient setting.
2 Applies to surgeries performed in office, outpatient
non-emergent, and ambulatory surgical centers.
3 Effective 4/1/12 and applies to childless adults
who reside in Maricopa or Pima County.
Information for Members
Information for Members
Members should contact their health plans for additional information about their cost sharing requirements.
