Coinsurance
The percentage of costs you pay for covered healthcare services after meeting your deductible.
What is Coinsurance?
Coinsurance is your share of costs for a covered healthcare service, calculated as a percentage after you've met your deductible. If your plan has 20% coinsurance, you pay 20% of the allowed amount and your insurance pays 80%.
For example, if a procedure costs $1,000 and you've met your deductible, you'd pay $200 (20%) and insurance pays $800 (80%). Coinsurance continues until you reach your out-of-pocket maximum, at which point insurance pays 100%.
Common coinsurance rates are 80/20 (you pay 20%), 70/30, or 90/10. Lower coinsurance (higher insurance payment) usually means higher premiums. HDHPs often have coinsurance instead of copays for most services.
Frequently Asked Questions
How is coinsurance different from a copay?
Copays are fixed dollar amounts ($30 for a visit), while coinsurance is a percentage (20% of the bill). Coinsurance costs vary with the price of the service.
When do I pay coinsurance?
You pay coinsurance after meeting your deductible and until you reach your out-of-pocket maximum.
What's a typical coinsurance percentage?
80/20 is common: insurance pays 80%, you pay 20%. Some plans offer 70/30 or 90/10 splits.
Related Terms
Copay (Copayment)
A fixed amount you pay for a covered healthcare service at the time of the visit.
Deductible
The amount you must pay out-of-pocket for healthcare before your insurance starts covering costs.
Out-of-Pocket Maximum
The most you'll pay for covered services in a plan year, after which insurance pays 100%.
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