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Q~Medicare copayments
Old 07-06-2009, 11:10 AM   #1
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Q~Medicare copayments

I've checked the medicare web site, but can't seem to find the answer to my seemingly simple Q~

Is there a copayment requirement for medicare when making a routine visit to a doctors' office. I assumed that there was a $10 or $20 or $?? copay, but it's not clear.
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Old 07-06-2009, 11:17 AM   #2
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Isn't medicare a deductible and then coinsurance (20%) system so no co-payments?
.......and unfortunately a "routine" annual physical isn't covered except for a
one-time "Welcome to Medicare" one in the 1st 6 mos. after you turn 65.
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Old 07-06-2009, 11:20 AM   #3
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Originally Posted by kaneohe View Post
Isn't medicare a deductible and then coinsurance (20%) system so no co-payments?
That's the way I understand it - and how my FIL is charged for his medicare eligible expenses.
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Old 07-06-2009, 11:48 AM   #4
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I believe it depends upon whether you have original Medicare (fee-for-service) or a Medicare Advantage policy.

With original Medicare, the copay is 20% of the Medicare-approved amount. If you have a Medigap (i.e supplemental) policy it will pay some or all of this copay.

I believe the only case where you may have a fixed $ copay is with a Medicare Advantage Policy which operates more like an HMO.
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Old 07-06-2009, 12:49 PM   #5
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Fire'd has the best and most global answer. For some reason, I focused on original Medicare only. There is a really good book you might find at your local library......
either the Idiot's orDummies series (don't remember which) on Medicare.
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Old 07-07-2009, 10:14 AM   #6
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Quote:
Originally Posted by mickeyd View Post
I've checked the medicare web site, but can't seem to find the answer to my seemingly simple Q~

Is there a copayment requirement for medicare when making a routine visit to a doctors' office. I assumed that there was a $10 or $20 or $?? copay, but it's not clear.
I'm on Medicare parts A&B and have a Medigap policy.

I tend to think of a copay as payment that you make at the time when you visit the doctor. With my current insurance I do not have to make a copay as I've just defined it. However, I may still have to pay an additional amount which is billed to me later.
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Old 07-07-2009, 04:41 PM   #7
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Quote:
Originally Posted by FIRE'd@51 View Post
With original Medicare, the copay is 20% of the Medicare-approved amount. If you have a Medigap (i.e supplemental) policy it will pay some or all of this copay.

I believe the only case where you may have a fixed $ copay is with a Medicare Advantage Policy which operates more like an HMO.
Thanks FIRE'd I think that's the answer that I was looking for. The references that I saw referred to a 20% copay for a number of procedures, but I was looking for a flat amount like $20/visit. I will have Tricare For Life when I'm 65 (along w/medicare) so I guess that coverage will act like a medigap policy for me.
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