What Is a Medicare Copayment?

A Medicare copayment is a fixed, out-of-pocket expense that you have to pay for each medical service or item — such as a prescription you receive if you have a Medicare Advantage plan or a Medicare prescription drug plan. Your Medicare plan pays the rest of the cost for the service.

Copayments are different from coinsurance. If you have Original Medicare, you typically don’t have to pay copayments. But you will have to pay coinsurance after you meet your Medicare deductible.

Medicare Advantage plans and Medicare Part D prescription drug plans are sold by private insurers who have contracted with Medicare.

Because they are private insurers, they are able to set their own amounts for copayments. These amounts are generally based on where you live, the amount of benefits you receive and the type of plan you’ve purchased.

Typically, you will be responsible for a copayment if you have a Medicare Advantage or Part D prescription drug plan. And you will have to pay coinsurance if you have Original Medicare — Medicare Part A and Part B.

There are 10 standardized Medigap plans available in most of the United States. These plans help you pay out-of-pocket costs associated with Original Medicare.

Most Medigap plans cover some or all of the costs of your Medicare Part A and Medicare Part B deductibles, copayments and coinsurance. Two of the 10 plans cover either 50% or 75% of copayment and coinsurance costs.

You cannot, however, buy a Medigap plan if you have a Medicare Advantage plan.