1. Health

What Is Health Insurance Coinsurance?


Updated May 29, 2014


Even when you have health insurance, you will be responsible for paying for a portion of every instance of care you seek, whether it's a doctor appointment, a test you need, hospitalization or a drug prescription.

One form of this shared payment is called coinsurance. It is usually framed as a percentage, and that percentage is your responsibility for each instance of care. Your insurance may be 80/20, which means insurance company pays 80% and you pay 20%. Coinsurance may be as much as 50% for most insurance plans, although it may be as high as 100% up to the total of your deductible if you have a high deductible or catastrophic health plan.

The higher the percentage you are expected to pay, the (relatively) less expensive your monthly premiums should be.

Here is how the sharing works:

• You visit your doctor and the total bill is $125.

• You may have already paid a $25 copay, which reduces this bill to $100.

• Your coinsurance is 80/20 which means you are now expected to pay 20% of the $100 - or $20. (That means your total cost for the visit was $25 copay plus $20 coinsurance = $45.)

Insurance companies use coinsurance to not only reduce the amount they must pay out on your behalf for your care, but also to discourage you from seeing your doctor or seeking treatment because they know that if you are required to pay for part of it, you are less likely to seek care.

Unlike most copays, coinsurance does contribute to your deductible. Once you have reached your deductible, you may no longer have any responsibility for co-insurance for the rest of the term of your policy (usually through the end of the current fiscal year.)

Be sure to include the cost of coinsurance when you are figuring out which healthcare insurance plan to choose, either as an individual policy, or during open enrollment.

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