AHCCCS Copayments

Information about copayments proposed for members in the new adult group beginning January 1, 2015, subject to approval by the Centers for Medicare and Medicaid Services can be found at the following link: Proposed Copay Changes 1/1/15 New Icon

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. Some changes to copayments became effective January 1, 2014. These changes to copayments can be found in the new AHCCCS rule AAC R9-22-711 which started January 2014. For a limited time persons who are eligible in the AHCCCS Care Program and persons who are determined AHCCCS eligible on and after January 1, 2014 in the new Adult Group will not have any co-payments starting January 1, 2014. Co-payments for persons in AHCCCS Care and the new adult group are planned for the future. Members will be told about any changes in copayments before they happen. 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 with mandatory copayments for certain services are:

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 as of 1/1/2014
 Service Populations and Copayment Amounts 
  TMA Other
Pharmacy - Generic and brand name when generic not available $2.30  $2.30 
Pharmacy - brand name when generic available $2.30  $2.30 
Office Visits1  $4.00  $3.40
Outpatient professional therapies  $3.00  $2.30 
Non-emergency use of the ER  N/A N/A 
Non-emergency surgery2 $3.00  N/A 
Taxis for non-emergency medical transportation3 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. Effective 1/1/14, well exams are exempt from copays.
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.