What You Pay

Most people who get NC Medicaid don’t have to pay a monthly premium, which means that you only have to make payments when you need medical care.

Generally, if you are 21 years old or older, you may have to pay small copayments ($4 or less) when you use certain medical services that NC Medicaid covers.

You do not need to make copayments if you are:

• Under 21 years old
• Pregnant
• In hospice care
• An American Indian in a federally recognized tribe
• In foster care
• Living in a nursing home or medical facility, or
• Enrolled in Breast and Cervical Cancer Medicaid through the North Carolina Breast and Cervical Cancer Control Program (NC BCCCP).

Retroactive Coverage

NC Medicaid allows new enrollees to request coverage retroactively. This means that you can ask to have your NC Medicaid coverage begin three months before the month you apply. So if you apply for NC Medicaid in April but have unpaid medical bills from the previous three months (January, February, and March), you could have NC Medicaid pay for those unpaid bills.

Compared to Private Insurance

NC Medicaid’s copayments are much lower than the copayments required by private insurance plans. For example, many private insurance plans can have annual deductibles that require you to pay thousands of dollars before the plan will cover most services and even after the deductible is paid, many private insurance plans require $50 or more copayments for services.