And when they start having a number of copays because they actually need health care then they will often have the same choices - food/rent vs medical care. That is where it would be prudent to use a network that doesn't cut off care and sue or refuse to see you if you don't pay the copay up front.The question is what beneficiaries can "afford". A premium bill for a supplement is a fixed expense. Paying a monthly premium for many beneficiaries means foregoing other necessities of life. And most beneficiaries would prefer to have food on the table, rather than be free of potential copays.
Don't need your advice...
The Cleveland Clinic just went to if you don't pay the copay in full when you show up for your appointment they will refuse to see you. I have heard that some other systems are doing that as well.