Understanding your Iowa Medicaid costs
The cost of healthcare can be confusing. We’re here to help you make sense of it all.
Breaking it down
Learn more about copays and how you can track your costs.
What is a copay?
A copay is a set dollar amount paid for certain services or treatment. It’s part of your share of the cost for covered healthcare services. You pay copays directly to a provider.
Copays don’t apply to American Indian, Alaskan Native, Family Planning Waiver, pregnant members, and Medicaid members under age 21.
When do I pay a copay?
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 and you can’t see your regular provider, go to an urgent care center. Learn more about your urgent care options.
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.
For Iowa Health and Wellness Plan members
The Iowa Health and Wellness Plan requires members to complete Healthy Behaviors every year to receive no-cost health services. Check your member handbook for details.
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.