CurrentAlabama MedicaidPolicy N/A

Copayments for Medicaid Services

Defines copayment amounts and exemptions for Alabama Medicaid recipients and lists services that do not require a copayment; affects Alabama Medicaid enrollees and participating providers.

Policy Summary

PayerAlabama Medicaid

PolicyCopayments for Medicaid Services

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders may collect only the specified copayment amount and cannot charge additional amounts for Medicaid-covered services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$50Inpatient hospital copayment per admission

$3.90Common maximum copayment for outpatient visits

65¢Minimum copayment for prescriptions/supplies

7+Services explicitly exempted

Copayment Requirements and Exemptions

Copayment criteria

Copayment requirements and exemptions.

Copayments apply to covered services unless an exemption or specific exclusion applies.

Services with copayments

Doctor visits — $1.30 to $3.90 per visit.
Optometric (eye care) services — $1.30 to $3.90 per visit.
Certified nurse practitioner visits — $1.30 to $3.90 per visit.
Health care center visits — $3.90 per visit.

Policy Summary

PayerAlabama Medicaid

PolicyCopayments for Medicaid Services

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders may collect only the specified copayment amount and cannot charge additional amounts for Medicaid-covered services.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Copayment Amounts and Ranges

Doctor and related visitsmixed

Doctor visits	Copayment Amount = $1.30 to $3.90 per visit
Optometric (eye care) services	Copayment Amount = $1.30 to $3.90 per visit
Certified nurse practitioner visits	Copayment Amount = $1.30 to $3.90 per visit

Health center and clinic visitsmixed

Health care center visits	Copayment Amount = $3.90 per visit
Rural health clinic visits	Copayment Amount = $3.90 per visit
Outpatient hospital	Copayment Amount = $3.90 per visit
Ambulatory surgical centers	Copayment Amount = $3.90 per visit

Inpatient servicesmixed

Inpatient hospital

Copayment Amount = $50 per admission

Pharmacy and suppliesmixed

Prescription drugs	Copayment Amount = 65¢ to $3.90 per prescription
Medical equipment	Copayment Amount = $1.30 to $3.90 per item
Supplies and appliances	Copayment Amount = 65¢ to $3.90 per item

Copayment range (general)

Typical minimum copayment65¢ (prescriptions, some supplies)

Typical maximum copayment for many outpatient visits/items$3.90

Common doctor/optometric/NP visit range$1.30 to $3.90 per visit

Inpatient hospital copayment$50 per admission

Billing and Provider Restrictions

Billing Rule

Do not charge more than the Medicaid copayment

Providers may only collect the specified copayment amount from Medicaid recipients and may not charge any additional fees or amounts for services covered by Alabama Medicaid.

Do not bill members for amounts beyond the copayment listed in the policy.
Collect only the copayment amount applicable to the service; no additional facility or administrative fees may be imposed.

OpenPayer

Copayments for Medicaid Services

Copayment Requirements and Exemptions

Copayment Amounts and Ranges

Billing and Provider Restrictions

Key Terms