Average Copay

Posted : admin On 1/3/2022
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.

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.


A Medicare copay is the amount of money you're required to pay for a covered Medicare service or good. A copayment is typically a flat fee.

Why Medicare Advantage?

In 2020, more than 34 percent of Medicare beneficiaries were enrolled in a Medicare Advantage plan.1

You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m. The co-payment amount varies depending on the insurance plan. Typical co-pays for a visit to a primary care physician range from $15 to $25. Co-pays for a specialist will generally be between $30 and $50. Most plans also require that the insured pay a deductible before the insurance provider will take over payments to a physician. A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay. Your copay amount is printed right on your health 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 is $33.57 per month in 2021.2 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

Average Copay For Er

Medicare Advantage out-of-pocket costs can include:

  • Medicare Part B premium
    Even under Medicare Advantage, you must still pay your Part B premium (unless your plan helps pay for it). The standard Part B premium in 2021 is $148.50 per month.
  • 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 is $33.57 per month in 2021.

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Average copay amounts

Average Copay Cost

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

Compare Medicare plan costs

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.

What Does Copay Mean In Health Insurance

Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.

Average Copay For Advair

Or call 1-800-557-60591-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

1 Jacobson, G., et al. (Oct. 24, 2019). Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/medicare-advantage-2020-spotlight-first-look.

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2 MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).