Cost Sharing & Copays
What is Cost Sharing?
Cost sharing means that you and MHS work together to pay for your health care services. MHS pays most of the costs. Hoosier Care Connect members have cost sharing through a small copayment.
What are Copayments?
A copayment (copay) is a set amount of money you pay at the time of a medical service. You might also pay this when you pick up a prescription at the pharmacy. The following grid shows copay amounts for Hoosier Care Connect members:
| Service | Copay Amount |
|---|---|
| Transportation by MHS | $1 one way/$2 round trip |
| Prescription medication | $3 (per prescription) |
| Non-emergent emergency room visit | $3 (this means using the ER when you don’t have an emergency) |
Can My Cost Sharing Change?
Yes. There are limits to what you might have to pay. Your family’s total cost sharing for healthcare can’t be more than 5% of your family’s income per quarter (3 month period). This is looked at over each quarter of the year. If you reach the limit, your cost sharing will be reduced or stopped for that quarter and you will not have to pay a copay for the rest of the quarter.
How Do I Know When I Reach the 5% Limit?
MHS keeps track of your costs for you. You do not need to do anything. If you reach the 5% limit, your copays will be automatically stopped for that quarter. You will not have a copay the next time you pick up a prescription or need transportation.*
Remember, your costs are looked at each quarter. Even if your copays stop in one quarter, you may need to pay copays again in the next quarter.
Calendar quarters are:
- January to March
- April to June
- July to September
- October to December
*MHS tracks cost sharing through pharmacy and medical claims.
Are There Any Exceptions?
Yes. There are no copays for:
- Children under age 18
- Members who are pregnant
- Members of Native American descent
- Members who have already met their 5% cost sharing limit
- Maternity services
- Preventive care services
Medications for family planning (like birth control) do not have a copay. And, you will not have a copay for transportation to MHS member events or Member Advisory Council (MAC) meetings.