Coinsurance
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Coinsurance refers to the percentage of medical costs paid by the patient after the patient has met their deductible.[1]
Overview
Coinsurance is the percentage of cost the insured must pay for a covered service after they have met their deductible. For example, if an insurance plan had a negotiated rate of $50 for a doctor's office visit, and a coinsurance of 20 percent, the patient would be responsible for paying $10. The rest of the cost would be covered by the insurance company. However, if the patient had not yet met their deductible, they would be responsible for the full $50 cost.[2]
The amount paid in coinsurance cannot exceed the plan's stated limit on out-of-pocket costs. Any costs beyond the out-of-pocket maximum would be paid by the insurance company, regardless of the coinsurance percentage. Plans with high monthly premiums tend to have low coinsurance, and plans with low premiums tend to have high coinsurance. According to the USA Managed Care Organizations, coinsurance is usually about 20 percent after deductibles.[2][1]
Coinsurance differs from copayments. In coinsurance, the insured is responsible for a percentage of the cost of service, rather than a fixed amount.[2]
See also
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Footnotes
