What is Co-Insurance?
Co-insurance is the percentage of costs of a covered healthcare service you pay (for example 20%) after you've paid your deductible. Typically the coinsurance is a percentage.
Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.
If you've paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
If you haven't met your deductible: You pay the full allowed amount, $100.
Example of coinsurance with high medical costs
Let's say the following amounts apply to your plan and you need a lot of treatment for a serious condition. Allowable costs are $12,000.
Out-of-pocket maximum: $6,850
You'd pay all of the first $3,000 (your deductible).
You'll pay 20% of the remaining $9,000, or $1,800 (your coinsurance).
So your total out-of-pocket costs would be $4,800 — your $3,000 deductible plus your $1,800 coinsurance.
If your total out-of-pocket costs reach $6,850, you'd pay only that amount, including your deductible and coinsurance. The insurance company would pay for all covered services for the rest of your plan year.
Generally speaking, plans with low monthly premiums have higher coinsurance, and plans with higher monthly premiums have lower coinsurance.
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Disclaimer: Medicare has neither endorsed nor reviewed this information.
Not connected or affiliated with any United States Government or State agency.
Calling this number: 415-994-4121 will direct you to a licensed Agent/Broker. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. <Benefits,formulary, pharmacy network, provider network, premium and/or copayments/coinsurance> may change on January 1 of each year. You must continue to pay your Medicare Part B premium.
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