Cost Sharing Requirements for Selected Services for ACA Adults or Waiver Expansion Adults
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
As of January 2026
| Location | Cost Sharing | Income at Which Cost Sharing Begins (%FPL) | Cost Sharing Amounts for Selected Services - Non-preventive physician visit | Cost Sharing Amounts for Selected Services - Non-emergency ER visit | Cost Sharing Amounts for Selected Services - Inpatient hospital visit | Cost Sharing Amounts for Selected Services - Outpatient hospital visit | Cost Sharing Amounts for Selected Services - Generic drugs | Cost Sharing Amounts for Selected Services - Preferred brand-name drugs | Cost Sharing Amounts for Selected Services - Non-preferred brand-name drugs | Cost Sharing Amounts for Selected Services - Physical therapy | Cost Sharing Amounts for Selected Services - Occupational therapy | Cost Sharing Amounts for Selected Services - Dental services |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| United States | Yes: 21 | Yes: 11 | Yes: 14 | Yes: 12 | Yes: 14 | Yes: 17 | Yes: 18 | Yes: 17 | Yes: 10 | Yes: 9 | Yes: 10 | |
| Alabama | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Alaska | Yes | 0 | $3 | - | $50/day-$200/discharge | 5% of allowed amount | $0.50-$3 | $0.50-$4 | $0.50-$5 | - | - | - |
| Arizona | - | - | - | - | - | - | - | - | - | - | - | - |
| Arkansas | Yes | 0.21 | $5 | $9 | $5 | $5 | $5 | $9 | $9 | $5 | $5 | $5 |
| California | - | - | - | - | - | - | - | - | - | - | - | - |
| Colorado | Yes | 0.69 | - | $8 | - | - | - | - | - | - | - | - |
| Connecticut | - | - | - | - | - | - | - | - | - | - | - | - |
| Delaware | Yes | 0 | - | - | - | - | $0.50 - $3 | $0.50 - $3 | $0.50 - $3 | - | - | $3 |
| District of Columbia | - | - | - | - | - | - | - | - | - | - | - | - |
| Florida | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Georgia | Yes | 0 | - | $3 | $13 | $3 | $0.50 | $0.50 | $0.50-$3 | $2 | $2 | $2 |
| Hawaii | - | - | - | - | - | - | - | - | - | - | - | - |
| Idaho | Yes | 1 | $4 | $4 | - | - | - | - | - | $4 | $4 | - |
| Illinois | - | - | - | - | - | - | - | - | - | - | - | - |
| Indiana | - | - | - | - | - | - | - | - | - | - | - | - |
| Iowa | Yes | 0 | $3 | $8 | - | $2 | $1 | $1 | $1 | $2 | $2 | $3 |
| Kansas | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Kentucky | - | - | - | - | - | - | - | - | - | - | - | - |
| Louisiana | Yes | 0 | - | - | - | - | $0.50-$3 | $0.50-$4 | $0.50-$5 | - | - | - |
| Maine | Yes | 0 | - | - | $3/day or $30/month | Combined with Inpatient | $3/day or $30/month | $3/drug, and combined with $30/month max. | $3/drug, and combined with $30/month max. | $2/day, $20/month max. | $2/day, $20/month max. | - |
| Maryland | Yes | 0 | - | - | - | - | $1 | $1 | $3 | - | - | - |
| Massachusetts | - | - | - | - | - | - | - | - | - | - | - | - |
| Michigan | Yes | 0 | $2 | $3 | $50 | $2 | $1 | $1 | $3 | - | - | $3 |
| Minnesota | - | - | - | - | - | - | - | - | - | - | - | - |
| Mississippi | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Missouri | - | - | - | - | - | - | - | - | - | - | - | - |
| Montana | - | - | - | - | - | - | - | - | - | - | - | - |
| Nebraska | - | - | - | - | - | - | - | - | - | - | - | - |
| Nevada | - | - | - | - | - | - | - | - | - | - | - | - |
| New Hampshire | Yes | 1 | - | - | - | - | $4 | $4 | $4 | - | - | - |
| New Jersey | - | - | - | - | - | - | - | - | - | - | - | - |
| New Mexico | - | - | - | - | - | - | - | - | - | - | - | - |
| New York | Yes | 1 | - | $3 | $25 | $3 | $1 | $1 | $3 | - | - | - |
| North Carolina | Yes | 0 | $4 | $4 | $4 | $4 | $4 | $4 | $4 | $4 | - | $4 |
| North Dakota | - | - | - | - | - | - | - | - | - | - | - | - |
| Ohio | Yes | 0 | - | $3 | - | - | - | $2 | $3 if prior authorization is required ($2 otherwise) | - | - | $3 |
| Oklahoma | Yes | 0 | $4 | $4 | $10/day for the first 7 days. $5 on the 8th day | $4 | $4 | $4 | - | $4 | $4 | - |
| Oregon | - | - | - | - | - | - | - | - | - | - | - | - |
| Pennsylvania | Yes | 0 | $3.80 | $3.80 | $3/day, up to $21 | $3.80 | $1 | $3 | $3.80 | $3.80 | $3.80 | $3.80 |
| Rhode Island | - | - | - | - | - | - | - | - | - | - | - | - |
| South Carolina | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| South Dakota | - | - | - | - | - | - | - | - | - | - | - | - |
| Tennessee | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Texas | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Utah | Yes | 0 | $4 | $8 | $75 | $4 | $4 | $4 | $4 | $4 | $4 | - |
| Vermont | Yes | 0 | - | - | - | $3 | $1-$3 | $1-$3 | $1-$3 | - | - | $3 |
| Virginia | - | - | - | - | - | - | - | - | - | - | - | - |
| Washington | - | - | - | - | - | - | - | - | - | - | - | - |
| West Virginia | Yes | 0 | $0-$4 based on income tier | $8 | $0-$75 based on income tier | $0-$4 based on income tier | - | - | - | - | - | - |
| Wisconsin | Yes | 0.5 | $0.50-$3 | $8 | $3 | $3 | $1 | $3 | $3 | $0.50-$3 | $0.50-$3 | $0.50-$3 |
| Wyoming | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |