Coinsurance is your share of a medical bill expressed as a percentage. After you’ve met your deductible, you and your insurance company split the cost of covered services — your portion is the coinsurance.
For example: your plan has 20% coinsurance. You see a specialist and the bill is $400. Your insurance pays $320 (80%) and you pay $80 (20%). That $80 is your coinsurance.
Coinsurance rates vary by plan tier and service type. Typically:
Like copays, your coinsurance payments count toward your out-of-pocket maximum. Once you reach that limit, your plan covers 100% of covered costs for the rest of the year.
A copay is a fixed dollar amount (e.g., $30 per visit). Coinsurance is a percentage of the actual cost (e.g., 20% of a $500 bill = $100 out of pocket). Plans often use both — copays for routine visits and prescriptions, coinsurance for hospital stays, labs, or specialist procedures.
After. You pay 100% of covered costs until you meet your deductible. Once the deductible is met, coinsurance kicks in and you only pay your percentage share. Some services, like preventive care, may have $0 coinsurance even before you meet your deductible.
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