Medicare beneficiaries spend a lot on prescription drugs. For instance, medications accounted for $100 billion (14%) of Medicare spending in 2017, which is more than double the $49 billion that was spent in 2007. With many senior citizens on fixed incomes, it is no wonder they are looking for ways to save. There are No Copays Until After the Part B Deductible is Met With a Medigap Plan N, you will pay the Medicare Part B Deductible before any copayment is charged. Once the deductible is met, there is a $50 copay for emergency room visits and a $20 copay per office visit.
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.
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 Waiving Copays
- 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
No Copay For Medicare
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.
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.
As noted above, the average monthly premium for Medicare Advantage plans with drug coverage is $33.57 per month in 2021.
Important vs urgent. 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.
Copay For Medicare Part A
Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.
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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).