Coinsurance
The percentage of the allowed amount a patient pays for a covered service after the deductible has been met.
Updated
Coinsurance is the patient's share of the cost of a covered health care service, calculated as a percentage of the allowed amount. It applies only after the deductible has been met and typically continues until the out-of-pocket maximum is reached.
For example, a 20% coinsurance means the patient pays 20% of the allowed amount for a service while the plan pays the remaining 80%.
In practice
On a claim, coinsurance appears as a percentage-based patient-responsibility line after the deductible is satisfied. Providers collect the coinsurance amount from the patient, and the payer remits the remainder based on the contracted allowed amount.
Commonly confused with
- Copayment: A copayment is a fixed dollar amount per service; coinsurance is a percentage of the allowed amount.
- Deductible: The deductible is the amount paid before the plan shares cost; coinsurance is the percentage paid after the deductible is met.