How to Use the Medicaid Copay Calculator
Medicaid copays in the U.S. work differently from Korea's medical aid (uiryo geup-yeo) system, which sets a single national fee schedule by recipient type (Type 1 or Type 2). Medicaid is jointly run by the federal government and each state, so exact copay amounts vary by state plan. What federal rules do set is a nominal maximum a state is allowed to charge for each service type under 42 CFR 447.54 — this calculator shows those federal ceilings, not a guaranteed charge, so you can gauge the highest you might realistically be asked to pay.
Select your income level relative to the Federal Poverty Level (FPL) and a service type to see the applicable nominal maximum. At or below 100% FPL, federal rules cap cost-sharing at flat nominal amounts. Above 100% FPL, the cap switches from a flat dollar figure to a percentage of what Medicaid actually pays for the service — generally up to 10%, or up to 20% for non-preferred drugs once income exceeds 150% FPL — so the exact dollar amount depends on your state's payment rate for that service. Keep in mind several groups are exempt from Medicaid cost-sharing altogether, including children, pregnant women, nursing facility residents, and anyone receiving emergency or preventive pediatric care — and many states voluntarily set copays below the federal maximum or charge nothing at all. Check your specific state Medicaid plan for the actual amount you'll be billed.
Frequently Asked Questions
These are federal nominal maximums states are allowed to charge under 42 CFR 447.54. Many states charge less than the maximum, and some charge nothing at all — your actual copay depends on your state's Medicaid plan and your income level.
Yes. Children, pregnant women, people in nursing facilities, emergency services, family planning services, and preventive care for children are generally exempt from Medicaid cost-sharing under federal rules.