When you take a look at your benefits, there are a lot of terms to know. Copay, deductible, and…coinsurance? What’s that?
Coinsurance is your share of the cost of a covered healthcare service, calculated as a percent of the allowed amount for the service, after you meet your deductible. If your office visit is $100 and your coinsurance is 20% (and you’ve met your deductible but not your out-of-pocket maximum), your payment would be $20.
In general, plans with low monthly premiums have higher coinsurance while plans with higher monthly premiums have lower coinsurance.
Here’s another example for a high-cost procedure. The allowable costs of the procedure are $12,000.
Out-of-pocket maximum: $6,850
First, you’d pay $3,000 to reach your deductible. Then you’d pay 20% of the remaining $9,000 ($1,800) for the coinsurance. This would make your out-of-pocket costs $4,800 (deductible plus coinsurance). If your costs went over the out-of-pocket maximum of $6,850, the insurance company would pay for all covered services over that amount for the rest of the plan year.
Check your benefits guide to see what your coinsurance is for different services.
Content by Lockton Dunning Benefits with info from https://www.healthcare.gov/glossary/co-insurance/