Health insurance basics

What is Coinsurance?

2 minute read · Draft for Owner review

Coinsurance is the percentage of a medical bill that you pay after you have paid your deductible.

Build on the same $20,000 example

Medical bill$20,000

−

Deductible paid$5,000

Amount remaining$15,000

$15,000 × 20% = $3,000. This simplified example assumes the bill is covered by the plan.

Continue the same $20,000 example

The medical bill is $20,000. You already paid the first $5,000 because that was your deductible. That leaves $15,000.

Now the coinsurance percentage is applied to that $15,000.

If your coinsurance is 20%, you pay 20% of the remaining $15,000. That is $3,000.

Your insurance plan pays the other 80%. That is $12,000. Together, $3,000 + $12,000 covers the remaining $15,000.

An 80/20 split means the plan pays 80% and you pay 20%. A 75/25 split means the plan pays 75% and you pay 25%. A 50/50 split means you each pay half.

A deductible is a dollar amount that you pay first. Coinsurance is the percentage that you pay next.

Every Plan is different. This is why HealthPlanNinja customizes a plan specifically for your needs. Our licensed advocates are always free.