When you enroll in Medicare, out-of-pocket costs will apply to certain medical services and prescription drugs. Assistance programs and Medigap plans may help pay for Medicare copays or other costs.

Medicare is one of the most popular health insurance plans for adults aged 65 and older in the United States. When you enroll in Medicare, you must pay various out-of-pocket costs for the services you receive.

A copayment, or copay, is a fixed amount of money that you pay out-of-pocket toward specific services. Copays generally apply to outpatient services and take-home medications. The exact copayment amounts depend on your plan type.

Deductibles, copays, and coinsurance fees all contribute to the out-of-pocket maximums for these plans. Once you reach your out-of-pocket maximum, you will typically pay no more toward medical expenses for the remaining calendar year.

Medicare overview

Medicare is a government-funded health insurance option for Americans age 65 and older and individuals with certain qualifying disabilities or health conditions.

Medicare enrollees are responsible for out-of-pocket costs such as copayments, or copays for certain services and prescription drugs. Financial assistance programs can help pay for copays, among other costs.

Learn more about Medicare

Here’s a quick glance at what the basic copay structure is for Medicare:

  • If you’re enrolled in Original Medicare (parts A and B), you will owe a copay for Part A hospital stays longer than 60 days. Part B does not have copays, but a 20% coinsurance applies to most services.
  • If you are enrolled in a Medicare Advantage (Part C) plan, your plan provider sets the copay amounts for doctor and specialist visits, as well as prescription drugs if they are covered.
  • If you are enrolled in a Medicare Part D prescription drug plan, your plan may charge a copay for prescription drugs. This amount differs depending on the tier your drugs are in within the plan’s formulary.

Let’s look at some of the copays you may come across when you are enrolled in the various parts of Medicare.

Part A

Medicare Part A covers inpatient hospital care. In 2025, you’ll have the following costs for your Part A services:

  • monthly premiums, which vary from $0 up to $518 (depending on how long you or your spouse (if you’re married) worked and paid Medicaid taxes).
  • a $1,676 deductible per year.
  • copayments for inpatient stays longer than 60 days.

Part B

Medicare Part B covers outpatient services for the prevention, diagnosis, and treatment of medical conditions. 2025 Part B costs include:

  • monthly premium of $185. This may be higher depending on your income.
  • an annual deductible of $257
  • a coinsurance of 20% of the Medicare-approved services

These are the only costs associated with Medicare Part B, meaning that you will not owe a copay for Part B services.

Medicare Advantage (Part C)

Medicare Advantage plans provide coverage for all Medicare parts A and B services. However, most plans also cover prescription medications and other benefits, such as dental, vision, or hearing.

You may see the following costs for Medicare Advantage services, depending on your plan:

  • all costs associated with Original Medicare Part A
  • all costs associated with Original Medicare Part B
  • monthly plan premiums
  • annual plan deductible
  • primary doctor visit copays
  • specialist visit copays
  • prescription drug copays

Medicare Advantage costs may vary depending on your location, plan type, or plan provider.

Part D

Medicare Part D prescription drug plans have the following costs, although costs can vary by plan provider and location:

  • monthly premiums.
  • an annual deductible, which in 2025 cannot be higher than $590.
  • after you have paid your deductible, you will pay a 25% coinsurance for all eligible medications until you reach a total of $2,000 in out-of-pocket costs. After you have paid $2,000, you will pay nothing further for your prescriptions for the remaining calendar year.

Part D plans use a formulary structure with different tiers for the medications they cover. Specific drug costs can differ depending on their tier.

Medigap supplement insurance (Medigap)

Medigap plans cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance.

Medigap plans only charge a monthly premium, so you will not owe a copay for Medigap coverage.

The copayment amounts associated with Original Medicare are:

  • Part A: For hospital stays between 61 and 90 days, you will pay $419 per day, and for stays between 91 and 150 days, you will pay $838 per day
  • Part B: There are no copays associated with Part B, but a 20% coinsurance applies to many services.

Since Medicare Part C and Part D plans are administered by private insurance companies, out-of-pocket costs can vary.

Medicare is available to people:

Some people will need to enroll in Medicare independently, but people with qualifying disabilities will be automatically enrolled after 24 months of disability payments.

You can enroll in Original Medicare directly through the Social Security’s website during your initial enrollment period. This period includes the 3 months before, the month of, and the 3 months after your 65th birthday.

If you miss your initial enrollment period or want to change or enroll in a different Medicare plan, here are the additional enrollment periods:

  • Medicare Advantage open enrollment period: from January 1 to March 31
  • Open enrollment period: from October 15 to December 7
  • Special enrollment period: this varies depending on your circumstances

The initial enrollment period is the first time you can enroll in Medicare parts A and B. Once you’re enrolled, you may decide that you would like to enroll in a Medicare Advantage plan instead.

Before you choose a Medicare Advantage plan, you can shop around to compare the different plans available in your area. Comparing benefits, health perks, and plan costs, including copay amounts, can help you choose the best Medicare Advantage plan for your needs.

Help to pay for Medicare

If you’re having difficulty meeting Medicare copays or other costs, you may qualify for financial assistance through various federal- and state-funded programs.

  • Medicare Savings Programs (MSPs). Medicare offers four savings programs to help pay some of the costs associated with Medicare. Most of the programs are aimed at helping pay Medicare premiums. However, the Qualified Medicare Beneficiary (QMB) program can also help cover copays.
  • Extra Help. Medicare Extra Help is a program that offers financial assistance to Medicare beneficiaries for Medicare Part D costs. It can help cover prescription drug coinsurance and copays when refilling your medications.
  • State Health Insurance Assistance Programs (SHIPs). SHIPs are state-run assistance programs that can help Medicare enrollees with questions or concerns about their plans. This may include finding financial assistance that is available to help you pay Medicare costs, such as premiums, deductibles, copays, and more.
  • Medicaid. Medicaid is a federally funded health insurance option for low-income individuals in the United States. Medicare beneficiaries who also qualify for Medicaid can use Medicaid to help cover some of the costs associated with Medicare-covered services, including copays.

When you enroll in Original Medicare, you will pay any associated copays. Part A has copays for inpatient stays longer than 60 days, but Part B has coinsurance, rather than copays.

Medicare Advantage (Part C) plans generally include copays for doctor’s and specialist’s visits and prescription medications.

Medicare Part D prescription drug plans charge either a copay or coinsurance for medication refills, but not both.

If you need financial assistance for copays or other fees associated with your Medicare plan, there are programs available that can help you cover these out-of-pocket costs.

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