Coinsurance
Your percentage share of a healthcare service cost after you've met your deductible — usually 10-30%.
Coinsurance is the percentage of the allowed amount you pay for covered services after meeting your deductible. If your plan has 20% coinsurance and your insurer's allowed amount for a service is $200, you owe $40 after the deductible. Coinsurance continues until you hit your out-of-pocket maximum, at which point the insurer pays 100%. Coinsurance differs from copay (which is a fixed dollar amount per visit).
Frequently asked questions
What is coinsurance?
Coinsurance is the percentage of the allowed amount you pay for covered services after meeting your deductible. If your plan has 20% coinsurance and your insurer's allowed amount for a service is $200, you owe $40 after the deductible. Coinsurance continues until you hit your out-of-pocket maximum, at which point the insurer pays 100%. Coinsurance differs from copay (which is a fixed dollar amount per visit).
Related terms
- DeductibleThe amount you pay out of pocket each year before your insurance starts paying. Resets every plan ye
- CopayA fixed dollar amount you pay for a specific healthcare service (e.g., $30 for an office visit).
- Out-of-pocket maximum (OOP max)The most you'll pay out of pocket in a plan year before the insurer covers 100% of covered services.
- Allowed amountThe maximum amount your plan considers payable for a covered service. Calculated cost-sharing is bas
Sources
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