What is a Copayment?

An Original Medicare Part B monthly premium, Medicare Advantage, Medigap, Medicare Part D plans stand-alone prescription drug, or Medigap Supplement List copayment, or "copay," is a fixed amount that a beneficiary is required to pay for a healthcare service or item covered by Medicare. Copays are a form of cost-sharing, which means that the patient is responsible for paying a portion of the cost of their healthcare such as premiums, deductibles,

In the case of Original Medicare, you may have a Medigap and Medicare Supplements premiums and a Medicare Part B deductible and a Medicare Part D prescription drug plans may have a Premium and all of these could be called copayments because they are all forms of cost sharing.

In Medicare terminology, PART D Prescription Drug Co-Payments are typically required for services such as doctor's visits, lab tests, and medical equipment. For example, a Medicare beneficiary may be required to pay a $20 copay for a doctor's visit or a $50 copay for a medical device, such as a wheelchair or oxygen tank.

The amount of the copay can vary depending on the type of service or item being provided as well as the specific Medicare plan the beneficiary is enrolled in. Some Medicare plans may have lower copays for certain services, while others may have higher copays or no copays at all. The dollar amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug, is usually a set amount rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or a prescription drug.

In a Medicare Advantage plan, the annual maximum out of pocket amount is capped. The acronym is called the Moop.