Costs
Copay
Quick answer
A copay (copayment) is a fixed dollar amount you pay for a covered service, like $10 for a primary-care visit or $47 for a Tier 3 drug.
Plain-English definition
Copays are common in Medicare Advantage and Part D plans. You typically pay the copay at the point of service.
Why it matters
Copays are predictable — you know your cost before you go.
A simple example
Your plan lists a $40 specialist copay, so you pay $40 to see a cardiologist.
Common mistakes & misconceptions
Related terms
Coinsurance
Coinsurance is your share of a covered service as a percentage, not a fixed dollar amount. Original Medicare's Part B coinsurance is 20% after the deductible.
Deductible
A deductible is the amount you pay out of pocket for covered services before your plan starts to pay. Part A, Part B, Part D, and many Medicare Advantage plans each have their own deductibles.
MOOP (Maximum Out-of-Pocket)
MOOP stands for Maximum Out-of-Pocket. It's the yearly cap on what you pay for covered in-network medical services in a Medicare Advantage plan. Once you hit it, the plan pays 100% of covered Part A and Part B care for the rest of the calendar year.
Frequently asked questions
Do copays count toward the MOOP?+
Yes — copays for covered in-network services count.
Sources & references
📚 Where this information comes from
- Medicare.gov — official U.S. government site for people with Medicare ↗Primary source for benefits, enrollment periods, and plan comparison.
- CMS.gov — Centers for Medicare & Medicaid Services ↗Federal rulemaking, program updates, and official guidance.
- Social Security Administration — Medicare enrollment & premiums ↗Enrollment, premium withholding, and IRMAA determinations.
When you're ready, compare plans on your own terms
See Medicare Advantage plans from the insurance companies we represent, or walk the course with a licensed agent whenever you'd like a second set of eyes.
We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.
Medicare Caddies is an independent insurance agency. We are not affiliated with, endorsed by, or connected to the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services (CMS). We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.