Medicare Part A has a copayment for inpatient care after a person has been in the hospital for a certain amount of time. Medicare Advantage and Medicare Part D also have copayments.
People with enrollment in Medicare will have some out-of-pocket costs for treatments and services. Some individuals may be eligible for help with covering these expenses.
Medicare plans that private medical insurers administer may have differing rules on out-of-pocket expenses, including copayments.
This article discusses which Medicare parts have copayments, the other out-of-pocket costs relating to Medicare, and the financial help available.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare Part A has a copayment. Medicare Part B may also have a copayment in certain cases, such as for hospital visits on an outpatient basis.
People enrolled in Medicare Advantage or Medicare Part D prescription drug plans may pay copayments. However, the amount will depend on the plan provider’s rules.
Each private insurer can determine the amount of copayment they will charge.
Medicare Advantage policies have an out-of-pocket maximum. This means that once a person has paid a certain amount in deductibles, copayments, and coinsurance, their plan will cover all future eligible expenses.
The maximum out-of-pocket limit for Medicare Advantage in 2024 is $8,850. After a person has paid this much in deductibles, copayments, and coinsurance, the plan pays 100% of the costs.
Original Medicare has no yearly out-of-pocket maximum unless a person has Medicare Supplement Insurance, or Medigap.
Medicare Part A provides coverage for inpatient care in hospitals, skilled nursing facilities, and hospices. It also helps with some home healthcare services.
In 2024, Part A has the following costs:
- Premium: Most people will not pay a monthly premium for Part A. For those who do, this will be either $278 or $505.
- Deductible: A person pays $1,632 for every benefit period. A benefit period begins on the day someone’s hospital admittance and ends when they have not received any hospital care for 60 days or more in a row.
- Copayment: Copayments change in relation to how long a person stays in the hospital. There is a $0 copayment for days 1 through 60 of a hospital stay. For days 61 through 90, the copayment is $408 per day. For days 91 to 150, the copayment is $816 per day. After day 150, a person pays all costs.
Learn more about Medicare and hospital stays.
Medicare Advantage, or Medicare Part C, has copayments.
For example, the copay will charge a fixed amount for a doctor’s consultation. This is unlike Original Medicare, where coinsurance helps pay 20% of the costs.
The cost of copayments with Medicare Advantage will differ per plan.
Part D prescription drug plans cover take-home prescription medications.
Costs will depend on whether a person is purchasing generic or brand-name medications.
If a person’s plan reaches the catastrophic coverage phase, they will typically pay between $3,300 and $3,800 toward the $8,000 cap.
In 2025, out-of-pocket costs for prescription medication should not exceed $2,000.
Medicare Part B helps pay for outpatient costs relating to diagnosing and treating a health condition.
It also pays for some preventive services, including cancer screenings.
A person may pay the following costs in 2024:
- Premium: Everyone pays a premium for Part B. The standard premium is $174.70 per month, but this amount could be higher depending on a person’s income.
- Deductible: The 2024 deductible is $240 per year.
- Coinsurance: After a person has paid their deductible, they will be responsible for paying 20% toward eligible healthcare charges. Medicare pays the remaining 80%.
- Copayment: A person may need to pay a copayment for each hospital outpatient service. This is typically no more than the hospital stay deductible amount with Part A.
Medicare usually reviews all charges yearly, meaning that the costs for premiums, deductibles, and copayments may change every year.
Private companies may also change the amounts of their out-of-pocket expenses each year, but Medicare usually limits these expenses.
A person can contact their plan provider to ask about the history of copayment charges. They may also find out whether the company plans to raise the out-of-pocket costs in the future.
A person may be eligible for help paying their healthcare costs, and several options are available.
Medicare Supplement Insurance
Private insurance companies administer Medicare Supplement Insurance, which is also known as a Medigap plan. These help cover gaps in a person’s original Medicare coverage, including premiums and coinsurance.
Medicaid
Medicaid is a federal and state program that helps individuals with limited income and resources with healthcare costs.
The program and its eligibility can vary from state to state.
Learn about the difference between Medicare and Medicaid.
Medicare savings programs
Four state programs help people with limited income and resources pay healthcare costs.
The programs are:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
- Qualified Disabled and Working Individuals (QDWI)
Learn more about Medicare savings programs.
Extra Help
The Extra Help program helps people with limited income and resources pay for their prescription medication costs.
Supplemental Security Income (SSI) benefits:
SSI is a cash benefit that the Social Security Administration (SSA) pays. It is different than Social Security retirement benefits.
People eligible for SSI automatically receive Extra Help and may also qualify for Medicaid.
Medicare parts A, B, and D and Medicare Advantage have copayments. They may also have deductibles and coinsurance.
A copayment is a fixed cost that a person pays toward eligible healthcare claims once they have paid their deductible in full.
If eligible, people may receive help paying their out-of-pocket costs, and benefits are available through state or federal programs to help with medical expenses.