- $0 copay for emergency room, $0 copay for urgent care center Medicare Part D prescription drug coverage $0/$1.25/$3.40 copays for Tier 1 generics, $0/$3.80/$8.50 copays for Tier 1 brand until $5,100 yearly out-of-pocket limit is met, then copays are $0.
- Get the care you need now — for less. When you need care fast, the emergency room (ER) may seem like your only option. But for many situations, urgent care clinics may treat the same conditions — at up to $2,000 less than the ER. Find Network Urgent Care.
“Yet another area where docs are caught in between the devil and the deep blue sea. Not collecting [a copay] upfront and seeing the patient is actually considered Medicare fraud… [but] ethically and medico-legally you are obligated to provide continuity of care for a patient.” – Urology
You pay a Copayment for each emergency department visit and a copayment for each hospital service. You also pay 20% of the Medicare-approved amount for your doctor's services, and the Part B Deductible glossary applies. If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment because your visit is.
Regardless of what insurance a patient has, almost everyone in the United States makes a copay when going to a doctor – but what are doctors to do when a patient cannot afford their copay?
A doctor from the US specializing in Ophthalmology and Genetics recently asked his fellow physicians on Sermo if they had ever encountered a patient who cannot pay the copay:
If a new patient doesn’t want to pay the co-pay, [that] is an easy decision. The patient is not seen.
[But] what if the patient pays the co-pay for the first visit but needs important follow-up and says they have no money for the co-pay until payday? If patients don’t pay the co-pay at the time of the visit, there is a big chance that they will never pay or take up a lot of staff time to collect later.
The follow-up is important enough that rescheduling the patient until after payday is risky from a malpractice standpoint.
Urgent Care Copay Without Insurance
Doctors are struggling to keep their practices afloat, and failure to pay is a serious issue, but at the end of the day physicians are there to practice medicine, support their patients, and put patients first. In response to the question above, many doctors asserted that the posting doctor should see that patient that can’t pay as an exception and just hope the patient pays the copay later:
Humana Medicare Urgent Care Copay
“It can be very frustrating at times. No checks, no cash, no credit cards to pay co-pay. However, if they’re sick, you have no choice.” – Pediatrics
“You just have to hope that most patients pay. Let staff do the best collections they can. Ophthalmology is a high pay specialty; you will eke out a living somehow.”- Family Medicine
“I am assuming you are concerned the patient legitimately cannot pay. Do what is right for the patient’s health, but you can’t always tell who can’t pay.” – Anesthesiology
“I appreciate the patients who at least apologize and promise to pay when they can. I never turn anyone away who seems legit.” – Ophthalmology
“If the patient is legitimate and unable to pay I usually cut them some slack.” – General Practice
“If it’s urgent/emergent, you have no choice but to see patient as you’ve established a patient-doctor relationship. You will be at risk of being blamed for abandonment if u refused to see patient.” – Anesthesiology
“If the patient’s condition really is serious enough to warrant a worry about malpractice, I’d see them. You might be pleasantly surprised, and they pay after payday. If not, it will probably be worth seeing them for free so as not to worry about the patient, or a malpractice lawsuit.” – Emergency Medicine
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| Basic Option | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care | $30 for primary care1 |
| Virtual doctor visits by Teladoc® | $0 for first 2 visits |
| Urgent Care Center | $35 copay |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $10 copay Tier 2 (Preferred brand): $55 copay2 Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2 Tier 4 (Preferred specialty): $65 copay2 Tier 5 (Non-preferred specialty): $90 copay2 Mail Service Pharmacy: Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $20 Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy: Tier 4 (Preferred specialty): $85 copay2 Tier 5 (Non-preferred specialty): $110 copay2 |
| Maternity Care | $175 inpatient $0 outpatient |
| Hospital Care | Inpatient (Precertification is required): $175 per day; up to $875 per admission Outpatient: $100 per day per facility1 |
| Surgery | $150 in an office setting1 $200 in a non-office setting1 |
| ER (accidental injury) | $175 per day per facility |
| ER (medical emergency) | $175 per day per facility |
| Lab work (such as blood tests) | $0 copay1 |
| Diagnostic services (such as sleep studies, CT scans) | Up to $100 in an office1 Up to $150 in a hospital1 |
| Chiropractic Care | $30 per treatment; up to 20 visits per year |
| Dental Care | $30 copay per evaluation; up to 2 per year |
| Rewards Program | Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |