Yes, most Medicare plans charge copays, but the amount depends on which part of Medicare you use

Medicare Part A (hospital insurance) and Part B (medical insurance) do not use copays the way commercial insurance does. Instead, you pay a deductible — a set amount you must pay out of your own pocket before Medicare starts to pay — and then coinsurance, which is your percentage share of the cost after that. Part D (prescription drug coverage) and Medicare Advantage plans do use copays for specific services.

The key difference: a copay is a flat fee you pay at the time of service (like $25 to see your doctor), while coinsurance is a percentage of the total bill. Understanding which you owe, and when, prevents surprise bills and helps you budget for healthcare costs.

Key Takeaways

  • Original Medicare (Parts A and B) uses deductibles and coinsurance, not copays, so you pay a percentage of costs after you meet your deductible.
  • Medicare Advantage plans (Part C) often use copays for doctor visits and other services, similar to private insurance plans.
  • Medicare Part D (prescription drugs) uses copays that vary by drug tier, and you may pay coinsurance instead of a copay for some medications.
  • Your out-of-pocket costs stop once you reach the yearly out-of-pocket maximum, after which Medicare covers 100 percent of covered services.
  • Medigap (supplemental insurance) can cover some or all of the deductibles and coinsurance you would otherwise owe under Original Medicare.

How copays and coinsurance work in Original Medicare

If you have Original Medicare (Part A and Part B), you do not pay copays for most services. Instead, you pay a deductible once per year, then coinsurance on top of that.

For Part B (doctor visits, outpatient care, lab work), the 2024 deductible is $240 per year. After you pay that, you typically pay 20 percent coinsurance for most services — Medicare pays the other 80 percent. For example, if your doctor visit costs $100 and you have already met your deductible, you pay $20 and Medicare pays $80.

Part A (hospital stays) works differently. You pay a deductible of $1,632 per benefit period (not per year) if you are admitted to the hospital. After that, you pay coinsurance only if your stay is longer than 60 days. The amount increases the longer you stay. Skilled nursing facility care, home health, and hospice have their own cost structures under Part A.

These dollar amounts change each year, so check your Medicare Summary Notice or call 1-800-MEDICARE to confirm the current amounts for your situation.

Copays in Medicare Advantage plans

Medicare Advantage (Part C) plans are run by private insurance companies and often work more like the health insurance you may have had before Medicare. Most Advantage plans use copays instead of coinsurance.

You might pay $20 to see your primary care doctor, $40 to see a specialist, or $250 for an emergency room visit. These amounts vary widely by plan and by insurance company. Some Advantage plans have no copay for preventive services like annual wellness visits or cancer screenings. Others charge copays for everything.

Advantage plans also have an out-of-pocket maximum — a yearly limit on what you pay. Once you reach it, the plan pays 100 percent of covered services for the rest of that year. Original Medicare does not have an out-of-pocket maximum, which is why many people add Medigap coverage.

Copays for prescription drugs under Part D

Medicare Part D (prescription drug coverage) uses copays that depend on which "tier" your medication falls into. Tier 1 drugs (usually generic) have the lowest copay, often $5 to $10. Tier 2 (preferred brand-name) might be $25 to $50. Tier 3 and 4 drugs cost more, sometimes $75 or higher per prescription.

Some Part D plans use coinsurance instead of a copay for certain drugs, meaning you pay a percentage of the drug's cost rather than a flat fee. This is common for expensive medications. Your Part D plan documents list which tier each drug is on and what you will pay.

Part D also has a coverage gap (sometimes called the "donut hole"). Once you and your plan have spent $5,380 on covered drugs in 2024, you enter the gap and pay more out of pocket until you reach the catastrophic coverage threshold. After that, you pay a small copay and the plan covers the rest. These dollar amounts change yearly.

When you do not pay copays or coinsurance

Medicare covers certain preventive services with no copay, coinsurance, or deductible. These include annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, diabetes screenings, and most vaccinations.

The catch: you must see an in-network provider and the service must be ordered as preventive care, not diagnostic. If your doctor orders a colonoscopy because you have symptoms, it may be billed as diagnostic and you could owe coinsurance. Ask your doctor or the facility in advance whether the service will be billed as preventive.

How Medigap reduces your out-of-pocket costs

Medigap (supplemental insurance) is sold by private insurance companies and covers some or all of the deductibles, coinsurance, and copays you would owe under Original Medicare. There are ten standardized Medigap plans, labeled A through N, each with a different level of coverage.

Plan G, for example, covers your Part B coinsurance (the 20 percent you would normally pay) and your Part B deductible. Plan F covers nearly everything, including Part A and Part B deductibles and coinsurance. Plans are more expensive if they cover more, but they eliminate most surprise bills.

You cannot use Medigap with a Medicare Advantage plan — you choose either Original Medicare plus Medigap, or an Advantage plan. If you have an Advantage plan and want Medigap later, you may face higher premiums or denial of coverage, depending on your state and how long you wait.

Questions to ask your doctor or Medicare plan

Before a service or procedure, ask your provider or plan: "What will this cost me out of pocket?" Request an estimate in writing. Ask whether the service will be billed as preventive or diagnostic, because that changes what you owe. If you use an out-of-network provider with Original Medicare, ask whether they accept Medicare assignment — if they do, your coinsurance is limited to 20 percent; if not, they can charge up to 15 percent more.

If you receive a bill you do not understand, call the provider's billing department and ask them to explain the charge. You can also call 1-800-MEDICARE to ask whether a service should have been covered.

Frequently Asked Questions

Do I pay a copay every time I see my doctor on Original Medicare?

No. You pay a yearly Part B deductible ($240 in 2024), then 20 percent coinsurance for most services after that. There is no copay per visit. If your doctor visit costs $100 and you have met your deductible, you pay $20.

Can my copay or coinsurance change during the year?

The deductible and coinsurance percentages set by Medicare do not change mid-year. However, if you have a Medicare Advantage plan, your copay amounts are set when you enroll and do not change until the next plan year. Part D copays also stay the same throughout the year unless you switch plans.

What happens if I cannot afford my copays or coinsurance?

Talk to your doctor's office or hospital billing department about payment plans. You may also be may be able to access for programs like Medicaid (if your income is low enough) or the Medicare Savings Programs, which help pay your Part B premiums, deductibles, and coinsurance. Call 1-800-MEDICARE to learn whether you may have access to.

Do I owe copays for emergency room visits on Original Medicare?

Yes. You pay Part B coinsurance (20 percent of the cost after your deductible) for an emergency room visit. If you are admitted to the hospital, the ER visit is usually bundled into your Part A hospital deductible and coinsurance instead.

If I have both Medicare and Medicaid, who pays my copay?

Medicaid typically covers your Medicare copays and coinsurance if you may have access to for both programs. The exact coverage depends on your state's Medicaid rules. Contact your state Medicaid office to confirm what they cover for you.