Medicare coinsuranceĬoinsurance refers to a percentage of the total cost paid by Medicare or the plan that is the member’s out-of-pocket Medicare cost for the service. You can learn which covered services in your Medicare plan have copayments and the amount of the copayments for various services by reading your plan’s Summary of Benefits and Evidence of Coverage documents, which you receive from the plan each year and may review at any time on the website of the Medicare Advantage plan or Medicare Part D Prescription Drug Plan in which you enroll. Similarly, Medicare Advantage plan may assign a $10 copayment to a primary care physician’s service and a $20 copayment to a specialist’s. Often Medicare plans with prescription drug coverage may have as many as five or more tiers with different copayments assigned to the medications within each tier. Prescription drugs may have different copayments based upon the flat fee the plan assigns to a particular tier, or cost category in which certain covered medications are grouped. But different services may have different copayment amounts.įor example, copayments are typically assigned by Medicare plans offering drug coverage to many of the prescription drugs in a given plan’s formulary, the list of covered medication. The amount you pay is always a flat, pre-specified fee. It is a flat fee a Medicare Advantage plan, with or without prescription drug coverage, or a stand-alone Medicare Part D Prescription Drug Plan assigns to particular covered service or supplies. Medicare copaymentsĪ Medicare copayment refers to an out-of-pocket payment that you are responsible for paying at the time you receive a Medicare-covered service.
Original Medicare Part A and Part B use deductibles and coinsurance rather than copayments to define the out-of-pocket amount, or cost-share that is the member’s responsibility. Medicare Part D Prescription Drug Plans are also offered by private insurance companies approved by Medicare. Medicare Advantage plans, which are required to provide the same amount of coverage as Original Medicare, Part A and Part B (with the exception of hospice care which is covered by Part A), are offered by Medicare-approved private insurance companies. It’s possible you’ll pay both a copayment and coinsurance fee during the course of time as you receive different types of Medicare-covered services, so understanding the two is very important.Ĭopayments are common features of Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans. One of these Medicare costs refers to a flat fee that you pay when you receive a Medicare-covered service or treatment, while the other refers to a percentage amount you’ll pay as a share for a Medicare-covered service or procedure. Both terms refer to out-of-pocket spending, but it’s important to understand the difference between the two. It’s easy to think coinsurance and copayments are the same when it comes to Medicare.
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