Medicare Part B Copay

Medicare Part B Copay
Medicare Part B Copay Amount

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.

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

There is a $198 annual deductible for Medicare Part B in 2020. After the deductible, you’ll pay a 20% copay for most doctor services while hospitalized, as well as for DME and outpatient therapy. There is a 20% copay of the Medicare-approved amount for doctor visits to diagnose a. The standard Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA).

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.

Why Medicare Advantage?

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

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 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.

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