What is Copay in Medicare?

copay in medicareWhat is Copay in Medicare?

Copay in Medicare is a set fee that you pay to use Medicare services.  This is determined by your insurance plan.  Copay is a cost-sharing technique that the companies use. Copays are usually a dollar amount like a $20 /$50 to go to a doctor or hospital.

Coinsurance, on the other hand is usually described as a percentage.  That is the percentage that you pay before your insurance company starts picking up any costs.  So coinsurance is a percentage.

copay in medicare

There is no Copay in Medicare Supplements (Plan F & Plan G). If you have a Medicare Supplement you don’t have to worry about coinsurance because the most popular  Medicare Supplements Plan F & Plan G pay any coinsurances.  See below for the graph. With Medicare Supplements you choose the premiums that you would like to pay.  You also choose the deductible.

copay in medicareIn 2017 the Part B (doctor) deductible is $183. You choose either the zero deductible plan (Plan F) or the $183 annual deductible plan (Plan G). Plan F (zero deductible plan) will not be available after 2020 for new folks.  But it is available up until January 2020.  Check out our Congress changes Plan F article here.

The reason that we’re talking about copay in Medicare because it’s a way of comparing a Medicare Supplement to Medicare Advantage. Have a look at the major differences between Medicare Advantage and Medicare Supplement.  These are the two general choices that you have when you’re turning 65.

copay in medicare







As you know Medicare is not designed to pay for everything.  As a result folks either choose a Supplement along with the original Medicare or they’ll choose the Medicare Advantage.  Medicare Advantage is the alternative to  original Medicare.  You are NOT on Original Medicare anymore. You must still pay the Part B premium even though you are not on Original Medicare.

Copay in Medicare




The biggest difference Medicare Advantage and Medicare Supplement is the maximum out-of-pocket.  The maximum out-of-pocket for Medicare Advantage is set by Medicare at $6700.  That’s an annual max out of pocket that starts over January 1. Compare that to Medicare Supplement.  You don’t have a maximum out-of-pocket.  It’s structured  differently. You have a stable monthly premium that you pay.

copay in medicare

The 2 most popular plans have options of either the zero deductible plan or $183 annual deductible plan.  There is no one behind the scenes saying “Yes you can have this procedure and No you can’t have this one.” Unlike Medicare Advantage, you do not have to get procedures pre-certified or approved.  As long as it’s Medicare approved  & Medically necessary, you are good to go.

Of course it can’t be  vitamins or acupuncture for example.   You are all set with your Original Medicare and the Supplement.  It is a peace of mind that you won’t be ill in a hospital and worrying about huge bills. You WON’T be receiving any bills.  Just choose your deductible… zero or $183 annually & that’s it.

copay in medicare

Thank you for checking out  Medicare Copays & Coinsurance. Give us a call if we can help you with anything Medicare related.  We’re happy to help.  Give us a call at (888) 506-7510.  Or if you’re like so many folks that have questions about Medicare have a look at our 6-Part Medicare mini course.  You’ll find that at www.GetMedicareSavings.com.