Do Medicare Users Pay Co-pays? - Medicare Consumer - Medicare Consumer

Do Medicare Users Pay Co-pays?

In addition to the monthly premium that you pay for Medicare Part B – as well as for Part A for some enrollees – there are also certain copays that are required by Medicare for services that are received. The amount of the copay may differ, based on the type of service that is being received, as well as which part of Medicare covers it.

Medicare Part A Copays

Medicare Part A covers hospital care, along with some skilled nursing facility, home health services, and hospice care. In 2015, Part A requires a deductible of $1,260 for each benefit period.

Medicare Part A also requires hospitalization co-insurance of:

  • $315 per day for each benefit period for Days 61 through 90
  • $630 per each lifetime reserve day after day 90. (This means that as long as you have any lifetime reserve days remaining, you would pay $630 per day. Otherwise, patients are responsible for all costs beyond lifetime reserve days).

For skilled nursing facility care, Medicare enrollees are required to pay the following costs (in 2015):

  • $157.50 per day for Days 21-100
  • All costs for Days 101 and beyond

In most cases, there are $0 charges for home health care services to Medicare enrollees – other than a 20% charge for the Medicare-approved amount for durable medical equipment that is needed.

Typically, Medicare participants are also not required to pay any out-of-pocket costs for hospice care – except for $5 for each prescription drug and other similar products that are used for symptom control and pain relief while they are at home.

However, it may be required that an enrollee pay 5% of the Medicare-approved charges for inpatient respite care. Respite care refers to when a patient requires care in an inpatient facility temporarily because his or her in-home caregiver is taking a break.

Medicare Part B Copays

Medicare Part B covers a variety of services – and because of this, there may be different out-of-pocket charges required. These may include the following:

  • Clinical Research Studies – For clinical research studies, Medicare enrollees may have to pay 20% of the Medicare-approved amount, as well as the Part B deductible. (In 2015, the Part B deductible amount is $147).
  • Durable Medicare Equipment – If your supplier accepts Medicare assignment, you will be required to pay 20% of the Medicare-approved amount, as well as the Medicare Part B deductible for durable medical equipment.
  • Mental Health – Medicare Part B also provides coverage for outpatient mental health services. You are not required to pay anything for an annual depression screening, provided that your health care provider or doctor accepts Medicare assignment. You will be required to pay 20% of the Medicare-approved amount for visits to a doctor or other health care provider in order to treat or diagnose your condition. The Part B annual deductible will also apply. If you obtain your services in a facility, in a hospital outpatient clinic or hospital outpatient department, an additional co-payment or co-insurance amount may be required, depending on the service that is provided.

Medicare Parts C and D

Medicare Part C (Medicare Advantage) and Part D (prescription drug coverage) are both offered via private insurance companies. Because of that, the coverage and the corresponding co-payment that is required may differ significantly, depending on the plan that you choose.

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