1. Medicare Specialist List
2. Aetna Medicare Ppo Specialist Copay
3. Aetna Medicare Specialist Copay
4. Copay For Medicare Patients

Medicare Advantage plans offer the ability to receive the same benefits as Original Medicare, but from a private insurer.

However even with the added flexibility that Medicare Advantage plans provide, you may still be responsible for out-of-pocket costs, including copays.

A Medicare copay is the amount of money you're required to pay for a covered Medicare service or good. A copayment is typically a flat fee.

Why Medicare Advantage?

1. The AvMed Medicare Circle (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $2,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,500 out of pocket. This can be a extremely nice safety net. AvMed Medicare Circle (HMO) is a Local HMO.
2. You pay this: $1,484 Deductible glossary for each Benefit period. Days 1–60: $0 Coinsurance for each benefit period. Days 61–90: $371 coinsurance per day of each benefit period. Days 91 and beyond: $742 coinsurance per each 'lifetime reserve day' after day 90 for each benefit period (up to.

In 2020, more than 34 percent of Medicare beneficiaries were enrolled in a Medicare Advantage plan.¹

$0 copay for many services. Inpatient hospital. $300 copay per stay; then 100% covered. Outpatient surgery/services and observation stay. Emergency care (worldwide) $90 copay. Dental coverage. Includes routine dental with optional coverage available. Out-of-network coverage with any provider that accepts Medicare. Medicare Part B pays for outpatient medical care, such as doctor visits, some home health services, some laboratory tests, some medications, and some medical equipment.(Hospital and skilled.

Many are likely drawn to the unique benefits of Medicare Advantage, as compared with Original Medicare:

• Medicare Advantage plans may often include additional benefits for prescription drugs, dental care, and vision care.
  
• The average premium for a Medicare Advantage plan that offers prescription drug coverage is $33.57 per month in 2021.² Some plans may not have a monthly premium, and some may even help pay you back for your Medicare Part B premium.
  
• Medicare Advantage, unlike Original Medicare, comes with an out-of-pocket limit, which means your out-of-pocket spending will be capped.
  
• While plans are offered by private insurers, you are still guaranteed the benefits of Original Medicare.

Medicare Advantage costs

Medicare Advantage out-of-pocket costs can include:

• Medicare Part B premium
  Even under Medicare Advantage, you must still pay your Part B premium (unless your plan helps pay for it). The standard Part B premium in 2021 is $148.50 per month.
  
• Deductibles
  Some plans require you to meet a deductible when seeing doctors, visiting hospitals, or getting your drugs filled.
  
• Medicare copay
  Many Medicare Advantage plans require that you pay a copay when you see a doctor. This is a fixed cost — and an alternative to Original Medicare’s 20 percent coinsurance.
  
• Premiums
  As noted above, the average monthly premium for Medicare Advantage plans with drug coverage is $33.57 per month in 2021.

Note: these costs may be higher (or lower), depending on your plan.

Compare Medicare plan costs

As you compare your options, you should weigh the costs of Medicare Advantage against the additional benefits you may receive, as compared to staying with Original Medicare.

Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.

Or call 1-800-557-60591-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

¹ Jacobson, G., et al. (Oct. 24, 2019). Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/medicare-advantage-2020-spotlight-first-look.

² MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).

Last Updated : 10/06/20185 min read

If you’re on Medicare, you might expect that the program would cover doctor visit costs. Medicare may cover doctor visits if certain conditions are met, but in many cases you’ll have out-of-pocket costs, like deductibles and coinsurance amounts.

Find affordable Medicare plans in your area

Doctor visits: a general rule

No matter what kind of Medicare coverage you may have, it’s important to understand that your doctor must accept Medicare assignment. That’s an agreement the doctor has with Medicare that the doctor will accept the Medicare-approved amount as payment in full for a given service, and won’t charge you more than a coinsurance payment and deductible.

Doctor visits: How does Original Medicare cover them?

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). Generally, Part B covers doctor visits – even when you’re in the hospital, where a lot of your care comes under Part A. A deductible and/or coinsurance amount may apply.

Many services covered under Part B come with a 20% coinsurance amount after you’ve paid your Part B deductible. For example, if the Medicare-approved amount for a doctor visit is $100, and you’ve already paid your Part B deductible, you’d pay $20 in coinsurance (20% of $100). If the doctor orders tests, those may be extra.

Did you know you might be able to buy insurance that may cover these out-of-pocket costs for doctor visits? Read about Medicare Supplement (Medigap) insurance plans below.

Doctor visits and Medicare Supplement insurance

It may be useful to know that Medicare Supplement insurance plans may help pay for Medicare Part A and Part B out-of-pocket costs. Medicare Supplement insurance plans generally pay at least part of your coinsurance amounts for Medicare-covered doctor visits. Most standardized plans typically pay the full Part B coinsurance amount.

For example, suppose you had a doctor visit, and the doctor ordered an MRI (magnetic resonance imaging) screening. Let’s say the Medicare-approved costs were $100 for the doctor visit and $900 for the MRI. Assuming that you’ve paid your Part B deductible, and that Part B covered 80% of these services, you’d still be left with some costs. In this scenario, you’d typically pay $20 for the doctor visit and $180 for the x-rays.

If you had Medicare Supplement Plan M, those Part B out-of-pocket costs might be completely covered so you would pay nothing. Of course, Medicare Supplement plans come with a monthly premium. But if you have many doctor visit costs, you might want to learn more about Medicare Supplement plans.

Medicare Specialist List

Some doctor visits may be free of charge

If you have Medicare Part B, or if you’re enrolled in a Medicare Advantage plan, you may get a number of doctor visits and screenings free of charge.

• “Welcome to Medicare” preventive care visit. During the first 12 months after you enroll in Medicare Part B, Medicare provides full coverage for this preventive care doctor visit. The “Welcome to Medicare” doctor visit may include:
  • A review of your medical history
  • A simple vision test
  • Certain disease prevention/detection screenings
  • A depression screening
  • Certain shots if needed
  • Measurement of your vital signs (such as height, weight, and blood pressure)
  • A written plan outlining what additional screenings, shots and other preventive services you need.
• Annual wellness visit. After the first 12 months of coverage, Medicare covers a wellness doctor visit once a year. The doctor will review your medical history; update your list of medications; measure your height, weight, blood pressure and other vital signs; and discuss your health status with you.

Medicare Part B may cover other doctor visits and preventive screenings. For example, you’ll get a doctor visit every year to evaluate and help reduce your risk of cardiovascular disease. There is no charge for this visit.

Be aware that if your doctor orders other tests or medical services during your doctor visit, you might need to pay a deductible amount or coinsurance. Medicare might not cover certain tests or services at all. You might want to find out ahead of time whether the services are covered.

Doctor visits and Medicare Advantage

Perhaps you chose to enroll in a Medicare Advantage plan as an alternate way to receive your Original Medicare benefits. Your doctor visits may have different out-of-pocket costs than you’d pay under Original Medicare.

Medicare Advantage plans are offered by private insurance companies contracted with Medicare. Some plans have monthly premiums as low as $0, but they generally have other costs. Coinsurance, copayments, and deductibles may vary from plan to plan – as will premiums.

Aetna Medicare Ppo Specialist Copay

You’ll still have to pay your Medicare Part B premium if you sign up for a Medicare Advantage plan – in addition to any premium the plan may charge.

Aetna Medicare Specialist Copay

Are you looking for more information about Medicare coverage and doctor visits? Would you like to learn more about your Medicare coverage options? Please feel free to contact me by using the links below. If you wish to compare some of the Medicare plans where you live, use the Compare Plans button on this page.

Copay For Medicare Patients

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.