What is Coinsurance?

Coinsurance – A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.

- Once any deductible amount and coinsurance are paid, the insurer is responsible for the rest of the reimbursement for covered benefits up to allowed charges: the individual could also be responsible for any charges in excess of what the insurer determines to be “usual, customary and reasonable”.

- Coinsurance rates may differ if services are received from an approved provider (i.e., a provider with whom the insurer has a contract or an agreement specifying payment levels and other contract requirements) or if received by providers not on the approved list.

-In addition to overall coinsurance rates, rates may also differ for different types of services.

Basically – Coinsurance is what you’re going to pay after the deductible.  This means, if you have an 80/20 coinsurance plan, you can be liable for up to 20% of your remaining medical bills, up to the maximum out of pocket cost.

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