In almost every U.S. prison system, incarcerated people do have to pay for medical care they ask for themselves, usually through a small co-payment taken from their commissary account. The federal Bureau of Prisons charges $2.00 per self-initiated visit, and most state fees run between $2.00 and $5.00. No facility can turn someone away for being unable to pay, many kinds of care are exempt from any charge, and a handful of states have dropped co-pays entirely.
How the Co-Payment Works
The fee applies when the inmate is the one asking to be seen. In the federal system, that means $2.00 for each self-requested medical, dental, or mental health appointment.1Federal Register. Inmate Fees for Health Care Services States set their own amounts. Most stay in the $2 to $5 range. Wisconsin charges $7.50, Mississippi charges $6.00, and Texas charges $13.55 per visit with a $100 annual cap.
The money comes out of the inmate’s trust or commissary account, which holds prison wages and any deposits from family. The deduction is automatic. If the balance is too low, the charge does not disappear: most systems carry the debt forward and take a share of future deposits until the balance is cleared.
Prison wages make even a small fee heavy. Regular (non-industry) prison jobs pay somewhere between about $0.14 and $0.63 an hour. A $5.00 co-pay can wipe out a full day’s earnings or more, which is why the fees are widely understood to discourage people from asking to be seen in the first place.
Care That Carries No Fee
Federal regulations exempt a long list of services from any co-pay, no matter who requests them. Under Bureau of Prisons rules, the following are free:2eCFR. 28 CFR Part 549 Subpart F – Fees for Health Care Services
- Emergency services
- Any visit initiated by medical or correctional staff
- Staff-approved follow-ups for chronic conditions like diabetes, hypertension, or HIV
- Preventive care, including intake screenings and annual physicals
- Prenatal care
- Mental health care, including counseling, psychiatric treatment, and crisis intervention
- Substance abuse treatment
- Diagnosis and ongoing treatment for chronic infectious diseases such as hepatitis or tuberculosis
State systems generally follow the same pattern, exempting emergencies and staff-initiated visits at a minimum. Some go further. Colorado and South Dakota, for example, also exempt hospice and end-of-life care.
There is an added protection for people who have essentially no money. The Bureau of Prisons treats an inmate as “without funds” when the trust account has averaged less than $6.00 over the past 30 days. Those individuals can get up to two over-the-counter medications a week through sick call at no charge, even when the same medication would otherwise have to be bought from the commissary.3Federal Register. Over-The-Counter (OTC) Medications
States That Have Eliminated Co-Pays
Not every state charges. California, Illinois, New York, Virginia, and Nevada have dropped medical co-pays for incarcerated people, on the reasoning that even small fees keep people from seeking treatment they need.
What Happens If You Can’t Pay
Being unable to pay is not grounds for refusing care. Every system that charges a co-pay is required to treat the patient regardless of account balance. What changes is the debt: the unpaid amount stays on the account, and the facility takes it out of future deposits or wages as they come in. Someone who never has money on their books can still see medical staff; they just accumulate a running balance.
Whether Prison Medical Debt Follows You Home
Co-pay debts do not necessarily end at the prison gate. Most systems collect what they can from the trust account during the sentence, but outstanding balances can survive release. Some prison and jail systems hire third-party collectors to pursue unpaid medical fees, and outside hospitals that treated incarcerated patients may do the same.
Those collection efforts can turn into lawsuits, wage garnishment, or liens. Medical debt from incarceration can also land on a credit report, which affects jobs, bank accounts, and loans exactly when someone is trying to rebuild after release. The Consumer Financial Protection Bureau finalized a rule in 2024 that would have removed most medical debt from credit reports, but a federal court vacated the rule in July 2025, so medical debt reporting continues under the prior rules for now.4Consumer Financial Protection Bureau. CFPB Finalizes Rule to Remove Medical Bills from Credit Reports
Nevada has enacted legislation discharging prison medical debt at release. That kind of reform is still the exception.
The Constitutional Floor on Prison Medical Care
Charging a co-pay is legal, but denying care is not. The Eighth Amendment’s ban on cruel and unusual punishment reaches prison healthcare through the Supreme Court’s 1976 decision in Estelle v. Gamble. The Court held that because incarcerated people cannot seek out their own doctors, the government has to provide medical care for them. In the opinion’s words, “An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met.”5Legal Information Institute. Estelle v. Gamble, 429 U.S. 97
The legal standard that came out of that ruling is “deliberate indifference to serious medical needs.” A prison violates the Eighth Amendment when officials know about a substantial risk to someone’s health and choose to ignore it. Ordinary negligence does not qualify, and disagreeing with a doctor’s treatment plan does not qualify either. In Farmer v. Brennan (1994), the Court clarified that the test is subjective: officials are liable for ignoring risks they actually knew about, not risks they merely should have known about.6Federal Judicial Center. Eighth Amendment Prison Litigation
How to Challenge a Denial of Care
The first step is the prison’s internal grievance process, and it cannot be skipped. Under the Prison Litigation Reform Act, no lawsuit about prison conditions can go forward in federal court until the prisoner has exhausted every available administrative remedy.7Office of the Law Revision Counsel. 42 U.S. Code 1997e – Suits by Prisoners That means filing a formal grievance, following every step the facility’s procedures spell out, and waiting for a final decision. Most cases that get dismissed lose on this ground rather than on the underlying medical facts.
If the grievance does not resolve things, the next step is a lawsuit in federal court under 42 U.S.C. ยง 1983, which lets anyone whose constitutional rights were violated by a person acting under government authority seek damages and injunctive relief.8Office of the Law Revision Counsel. 42 U.S. Code 1983 – Civil Action for Deprivation of Rights The plaintiff has to show that a specific official or medical provider knew about a serious medical need and deliberately failed to address it. A misdiagnosis, a delayed appointment, or a disagreement about which treatment is best will almost never clear the bar. The evidence has to show that someone with decision-making authority saw a real risk and did nothing.9Ninth Circuit District & Bankruptcy Courts. 9.31 Particular Rights – Eighth Amendment – Convicted Prisoners Claim re Conditions of Confinement/Medical Care