Medicare FAQs - Cost Sharing
1. What is cost sharing?
The term cost sharing refers to the costs participants will pay in addition to what Medicare pays for medical services.
2. What is co-insurance?
Co-insurance is an amount you may be required to pay for services after you pay any plan deductible. Co-insurance is usually a percentage of the total cost of the service. In the original Medicare plan, this is a percentage (like 20 percent) of the Medicare-approved amount. You have to pay this amount after you pay the Part A and/or Part B deductible.
3. What is a copayment?
A copayment is a flat fee you pay in some Medicare health and prescription drug plans for each medical service, like a doctor's visit, or prescription. Copayments may be different for services or prescriptions that are more expensive. For example, you may pay $10 to see your regular doctor, while your plan may require you to pay a $20 copayment to see a specialist such as a cardiologist or neurologist.
4. What is a deductible?
The deductible is the amount you must pay for healthcare or prescriptions before the original Medicare plan, your prescription drug plan or other insurance begins to pay. For example, in the original Medicare plan, you pay a new deductible for each benefit period for Part A and each year for Part B. These amounts can change every year.