What is coinsurance?
Coinsurance is the percentage of the cost of healthcare services that are paid by a health plan member. Coinsurance is usually paid after the deductible]] has been paid. A typical coinsurance percentage is 10-50% of the cost of healthcare services.
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.
Deductible: $3,000 Coinsurance: 20% 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.