Copays
Copays are a set amount the beneficiary is required to pay for medical benefits. The set amount can be as low as $0 or $10 for basic services like primary care visits. While typically there are higher set copays for specialist services, ER visits, ect. Copays are generally fixed for each prescription drug but can change through the various phases of Part D coverage; deductible, intial, gap and catastrophic coverage. Remember that in-network versus out-of-network copays will vary as well depending on play type aquired.
Copays & Deductibles
If the plan you are on has an annual medical deductible, you will be required to pay a copay for your medical visit on top of the deductible amount assessed for the services aquired. For most situations, copays do not count toward the annual deductible but they do count towards your annual out-of-pocket expenses.
Coinsurance
Coinsurance charges typically occur for individuals enrolled in Original Medicare, and will come to fruition after the annual deductible is met. Medicare pays for eighty percent of Part B services while beneficiaries are responsible for the remaining twenty percent not covered for the service. This remaining twenty percent for the service is the coinsurance amount, individuals will be required to pay this until they reach their out of pocket maximum.
Coinsurance & Deductibles
Coinsurance is the percentage amount the beneficiary is required to pay after meeting the annual deductible amount.
Exclusion
Typically, preventative care and services are one hundred percent covered under Medicare absent of any copay or coinsurance charge.
