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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.

Coinsurance is a form of cost-sharing between the health plan member and the health insurance company.

Coinsurance differs between different health plans. In many cases, the lower the monthly premium and deductible, the higher the coinsurance.


Example of coinsurance with high medical costs[1]

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.