Authors examined results of a U.S. prison health survey (conducted in 2016, with results released in 2021) to describe common health conditions likely to require care, receipt of care, and association of co-pays and failure to receive care. Data from the 2016 Survey of Prison Inmates and 2004 Survey of Inmates in State and Federal Correctional Facilities were compared: both used computer-assisted in-person interviews to collect self-reported data. Information on prison medical co-pays and state minimum wage was collated by the Prison Policy Initiative. There were 24,848 respondents in 2016 and 18,185 respondents in 2004. Prevalence of most chronic physical conditions and all mental health conditions was higher in 2016 vs. 2004. Current severe psychological distress was present in 13.3% in 2016, and over one-third reported a substance use disorder. Among respondents who were pregnant on incarceration, 9.1% had received no obstetrical examination between incarceration and delivery. 13.8% with one or more chronic physical condition had received no medical visit since incarceration and 33.0% with a chronic mental health condition had received no mental health treatment since incarceration.  34.7% who were receiving pharmacotherapy for a mental health condition at time of offense had not received pharmacotherapy in prison. Of state prison residents, over 90% were in facilities requiring co-payments. Among respondents who were pregnant or had chronic physical conditions and were in prisons with co-pays, 53.8% and 62.4% had a co-payment greater than one week’s prison wage. Among all persons with chronic physical conditions, those in prisons with co-pays greater than one week’s wage had higher odds of having no clinician visit in adjusted analyses (aOR 2.17; 95% CI, 1.61-2.93).