Health Insurance
What is coinsurance in health insurance?
Coinsurance is the percentage of covered healthcare costs you pay after meeting your deductible. For example, with 20% coinsurance, you pay 20% of covered costs and your insurance pays 80% — until you reach your out-of-pocket maximum. Common coinsurance structures: 80/20 (you pay 20%), 70/30 (you pay 30%). After reaching your out-of-pocket maximum, your insurance pays 100% of covered costs for the rest of the year. Coinsurance is different from a copay (a fixed dollar amount per visit).
Key Points
- Coinsurance: the percentage of costs you pay after meeting your deductible
- Common structure: 80/20 — insurance pays 80%, you pay 20%
- Applies after you've met your annual deductible
- After reaching out-of-pocket maximum: insurance pays 100%
- Different from a copay — copay is a fixed dollar amount per visit
- In-network coinsurance is typically lower than out-of-network