Paying for Dental Services

Medicaid Members

Members in the Medicaid program do not have to pay for covered dental services.

CHIP Members

If you are a member in the CHIP program, you might have to pay a copayment for certain covered services. This includes non-preventive services. You do not have to pay a copayment for things like exams, x-rays, cleanings, and sealants. If your child gets dental services before dental coverage with CHIP starts, you will have to pay for them.

CHIP copayments vary based on your family's income. The total amount that you have to pay cannot be more than 5% of your family's income during one enrollment period. Your copayment amount is on the back of your child's MCNA member ID card. You can view a list of CHIP Office Visit Copayments according to a family's federal poverty level below.

Enrollment Fees (for 12-month enrollment period)

Level	Charge
At or below 151% of FPL *	$0
Above 151% up to and including 186% of FPL	$35
Above 186% up to and including 201% of FPL	$50

Copayments (per visit)

Level	Service	Charge
At or below 151% of FPL *	Office Visit (non-preventative)	$5
	Non-Emergency ER	$5
	Generic Drug	$0
	Brand Drug	$5
	Facility Copayment, Inpatient (per admission)	$35
	Cost-Sharing Cap	5% (of family's income) **
Above 151% up to and including 186% of FPL	Office Visit (non-preventative)	$20
	Non-Emergency ER	$75
	Generic Drug	$10
	Brand Drug	$35
	Facility Copayment, Inpatient (per admission)	$75
	Cost-Sharing Cap	5% (of family's income) **
Above 186% up to and including 201% of FPL	Office Visit (non-preventative)	$25
	Non-Emergency ER	$75
	Generic Drug	$10
	Brand Drug	$35
	Facility Copayment, Inpatient (per admission)	$125
	Cost-Sharing Cap	5% (of family's income) **

* The federal poverty level (FPL) refers to income guidelines established annually by the federal government.

** Per 12-month term of coverage.