Coinsurance
Percentage of medical costs you pay after meeting deductible. 20% coinsurance on $1,000 bill = you pay $200, insurance pays $800.
What You Need to Know
Coinsurance is your share of costs for covered services, expressed as a percentage. Applies after you meet your deductible and continues until you hit out-of-pocket maximum.
Common coinsurance: 80/20, 70/30, 90/10 (insurance/you)
Example with 80/20 coinsurance:
- Deductible: $2,000 (you've met it)
- Surgery bill: $10,000
- You pay: 20% × $10,000 = $2,000
- Insurance pays: 80% × $10,000 = $8,000
Full year example:
- Deductible: $2,000 (paid first)
- Then 20% coinsurance on all services
- Out-of-pocket max: $6,000
- Once you've paid $6,000 total (deductible + coinsurance), insurance pays 100%
Copay vs coinsurance confusion:
- Copay: "Pay $30" (fixed amount)
- Coinsurance: "Pay 20%" (percentage varies by bill)
High-deductible plans often have coinsurance instead of copays. After paying $5,000 deductible, you pay 20% of remaining costs until hitting OOP max.
Sources & References
This information is sourced from authoritative government and academic institutions:
- healthcare.gov
https://www.healthcare.gov/glossary/co-insurance/
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Related Terms in Healthcare
Copay (Copayment)
Fixed dollar amount paid for doctor visits, prescriptions, or services. $30 specialist visit copay means you pay $30, insurance covers rest.
FSA (Flexible Spending Account)
A pre-tax account for medical expenses that must be used within the plan year or you lose the money (use-it-or-lose-it rule).
In-Network
Doctors and hospitals contracted with your insurance for pre-negotiated rates. Lower costs, higher coverage. Always use in-network when possible.
Out-of-Network
Doctors not contracted with your insurance. Higher costs, lower coverage, potential balance billing. Avoid except emergencies.
Out-of-Pocket Maximum
Most you pay for covered services in a year. Includes deductible, copays, coinsurance. Once hit, insurance pays 100% rest of year.