Medicare Copay

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.

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Why Medicare Advantage?

According to the Kaiser Family Foundation, in 2019, more than 34 percent of Medicare beneficiaries will be enrolled in a Medicare Advantage plan.*

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 will be $40 per month in 2019.* 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 the Part B premium (unless your plan helps pay for it).

  • 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 will be $40 per month in 2019.

Note: these costs may be higher (or lower), depending on the plan.

Making the right choice

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. A licensed insurance agent can help you weigh your options and match you with a plan that works for you.

Speak with a licensed insurance agent at TTY Users: 711.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

*Kaiser Family Foundation, “Medicare Advantage 2019 Spotlight: First Look.” Published Oct. 16, 2018. https://www.kff.org/report-section/medicare-advantage-2019-spotlight-first-look-data-note.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.