Unlike flat-fee copays, coinsurance is a percentage of the price of service you’ll pay. For example, after you have paid the Medicare Part B (medical insurance) deductible for the year ($198 in 2020), you will be required to pay 20 percent of each service covered by Part B, and Medicare pays the remaining 80 percent. Understanding Medicare Deductibles Medicare Part A and Medicare Part B each have their own deductibles and their own rules for how they function. Medicare Part A. The Medicare Part A deductible in 2021 is $1,484 per benefit period. You must meet this deductible before Medicare pays for any Part A services in each benefit period. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. Each year the Medicare premiums, deductibles, and copayment rates are adjusted according to the Social Security Act. If you’re having trouble paying your premiums now or if you have any questions about your Medicare premium bill, call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. If you have limited income and resources, your state may help pay your Medicare premiums. You may also qualify for Extra Help to pay for your Part D drug coverage. In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.

• Medicare Part D Copay Structure
• Medicare Doctor Copay
• Are There Copays For Medicare

NPR’s sites use cookies, similar tracking and storage technologies, and information about the device you use to access our sites (together, “cookies”) to enhance your viewing, listening and user experience, personalize content, personalize messages from NPR’s sponsors, provide social media features, and analyze NPR’s traffic. This information is shared with social media, sponsorship, analytics, and other vendors or service providers. See details.

Medicare Part D Copay Structure

You may click on “Your Choices” below to learn about and use cookie management tools to limit use of cookies when you visit NPR’s sites. You can adjust your cookie choices in those tools at any time. If you click “Agree and Continue” below, you acknowledge that your cookie choices in those tools will be respected and that you otherwise agree to the use of cookies on NPR’s sites.

Medicare Advantage plans offer the ability to receive the same benefits as Original Medicare, but from a private insurer.

However even with the added flexibility that Medicare Advantage plans provide, you may still be responsible for out-of-pocket costs, including copays.

A Medicare copay is the amount of money you're required to pay for a covered Medicare service or good. A copayment is typically a flat fee. Acrobat error 1402.

Why Medicare Advantage?

In 2020, more than 34 percent of Medicare beneficiaries were enrolled in a Medicare Advantage plan.¹

Tum dena saath mera serial life ok episodes. Many are likely drawn to the unique benefits of Medicare Advantage, as compared with Original Medicare:

• Medicare Advantage plans may often include additional benefits for prescription drugs, dental care, and vision care.
  
• The average premium for a Medicare Advantage plan that offers prescription drug coverage is $33.57 per month in 2021.² Some plans may not have a monthly premium, and some may even help pay you back for your Medicare Part B premium.
  
• Medicare Advantage, unlike Original Medicare, comes with an out-of-pocket limit, which means your out-of-pocket spending will be capped.
  
• While plans are offered by private insurers, you are still guaranteed the benefits of Original Medicare.

Medicare Doctor Copay

Medicare Advantage costs

Medicare Advantage out-of-pocket costs can include:

• Medicare Part B premium
  Even under Medicare Advantage, you must still pay your Part B premium (unless your plan helps pay for it). The standard Part B premium in 2021 is $148.50 per month.
  
• Deductibles
  Some plans require you to meet a deductible when seeing doctors, visiting hospitals, or getting your drugs filled.
  
• Medicare copay
  Many Medicare Advantage plans require that you pay a copay when you see a doctor. This is a fixed cost — and an alternative to Original Medicare’s 20 percent coinsurance.
  
• Premiums
  As noted above, the average monthly premium for Medicare Advantage plans with drug coverage is $33.57 per month in 2021.

Note: these costs may be higher (or lower), depending on your plan.

Compare Medicare plan costs

As you compare your options, you should weigh the costs of Medicare Advantage against the additional benefits you may receive, as compared to staying with Original Medicare.

Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.

Or call 1-800-557-60591-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Are There Copays For Medicare

¹ Jacobson, G., et al. (Oct. 24, 2019). Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/medicare-advantage-2020-spotlight-first-look.

² MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).