Copayment

Some MC clients are required to make copayment for their benefits. See the chart below for services subject to copayment, the fees and the exceptions to the requirement.

The copayment fee is to be collected by or obligated to the provider at the time the service is rendered. The fee is in addition to the amount the provider receives from MC. This means the amount received by the provider is not reduced by the copayment collected.

The collection of the copayment is:

  • Optional 
  • May be waived entirely at the discretion of the provider.

Note: This section is for information only. No action is required.

MC Copayments

Services Subject to Copayment

Copayment Fee

Copayment Fee

Nonemergency Services Provided in an Emergency Room.

  • A nonemergency service is defined as “any service not required for alleviation of severe pain or the immediate diagnosis and treatment of severe medical conditions which, if not immediately diagnosed and treated, would lead to disability or death.”
  • Such services provided in an emergency room are subject to copayment.

$5.00
  • Persons age 18 or under.
  • Any woman during pregnancy and the postpartum period (through the end of the month in which the 60-day period following termination of pregnancy ends.)
  • Persons who are inpatients in a health facility (hospital, skilled nursing facility or intermediate care facility).
  • Any child in AFDC-Foster care.
  • Any service for which the program's payment is $10.00 or less.

OUTPATIENT SERVICES

Physician, optometric, chiropractic, psychology, speech therapy, audiology, acupuncture, occupational therapy,

$1.00

Related Topics

Determining Usage

Medi-Cal Identification Cards