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Copay Reference Guide

AmeriHealth Caritas Iowa will impose co-payments for the following services:


Pharmacy copays Iowa Wellness Plan Medicaid hawk-i
Brand name prescription $0.00 $0.00 $0.00
Generic prescription $0.00 $0.00 $0.00
Maintenance prescription $0.00 $0.00 $0.00

Non-emergent emergency room visits

Health care visits Iowa Wellness Plan Medicaid hawk-i*
Services from a podiatrist, chiropractor, and for physical therapy $0.00 $0.00 $0.00
Ambulance services, audiology services, hearing aid dealer services, medical equipment, optical services (frames and lenses), orthopedic shoes, prosthetic devices, psychology services, and rehabilitation services $0.00 $0.00 $0.00
Hearing aide(s), physician office visits and lab services, vision exams $0.00 $0.00 $0.00
Non-emergent emergency room visits $8.00 $0.00 $25.00

* hawk-i members whose family income is less than 150% of the federal poverty level will not have to pay copays.

There will be no copay for these services for the following members:

  • Individuals between ages 1 and 18, eligible under 42 C.F.R. §  435.118.
  • Individuals under age 1, eligible under 42 C.F.R. §  435.118.
  • Disabled or blind individuals under age 18.
  • Children for whom child welfare services are made available under Part B of title IV of the Social Security Act on the basis of being a child in foster care and individuals receiving benefits under Part E of that title, without regard to age.
  • Disabled children eligible for Medicaid under the Family Opportunity Act.
  • Pregnant women, during pregnancy and through the postpartum period which begins on the last day of pregnancy and extends through the end of the month in which the sixty (60) day period following termination of pregnancy ends.
  • Any individual whose medical assistance for services furnished in an institution is reduced by amounts reflecting available income other than required for personal needs.
  • An individual receiving hospice care, as defined in Section 1905(o) of the Social Security Act.
  • An Indian (as defined at 42 C.F.R. §  447.51) who is currently receiving or has ever received an item or service furnished by an Indian health care provider or through referral under contract health services.
  • Individuals who are receiving Medicaid by virtue of their breast or cervical cancer diagnosis under 42 C.F.R. §  435.213.

If you have questions about copays, call Member Services at 1-855-332-2440 (TTY 1-844-214-2471) 24 hours a day, 7 days a week.