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What is a copayment?

Your copayment is a set out-of-pocket dollar amount you are obligated to pay for each medical service you receive, including visits to your doctor and prescriptions.

Copayments are a type of cost-sharing (which means the part of your medical care that you have to pay). The other types are coinsurance and deductibles.

Original Medicare does not use copayments in the same way as other health plans. Instead, enrollees pay a deductible (per year for Medicare Part B, and per benefit period for Medicare Part A), and then coinsurance. For Medicare Part B, the coinsurance is 20 percent of the cost of care. But under Medicare Part A, a patient who is hospitalized for more than 60 days would begin paying a flat-dollar “coinsurance” for each additional day in the hospital. In other types of health coverage, coinsurance refers to a percentage of the claim, whereas copay refers to a flat dollar amount. But with Medicare Part A, the term coinsurance is used to describe a flat-dollar amount — don’t let that confuse you!

Medicare Part D plans can either use coinsurance or copays for prescription drugs. And Medicare Advantage plans can also be designed to cover things like doctor visits and prescription drugs with copays, making them similar to the sort of private plans to which many people are accustomed to prior to enrolling in Medicare.