Q~Medicare copayments

[mickeyd]

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.

 

[kaneohe]

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.

 

[REWahoo]

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.

 

[FIRE'd@51]

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.

 

[kaneohe]

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.

 

[Dudester]

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.

 

[mickeyd]

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.