If you’ve ever received a medical bill and wondered why you still owe money after paying your deductible, the answer likely involves coinsurance.
Coinsurance is a key part of how cost-sharing works in health insurance. This guide will break it down in simple terms, with examples to help you understand exactly how much you’ll pay—and when.
🔍 Coinsurance Defined
Coinsurance is the percentage of medical costs you pay after you’ve met your deductible. Your health insurance company pays the remaining percentage.
For example, if your plan has 80/20 coinsurance, your insurer pays 80% of the cost of covered services and you pay 20%—but only after your deductible is paid.
📘 Coinsurance Example: How It Works
Let’s say:
- You have a $1,500 deductible
- Your coinsurance is 80/20
- You get a medical procedure that costs $5,000
Step-by-step:
- You pay the first $1,500 to meet your deductible
- Remaining balance = $3,500
- Your insurance pays 80% of $3,500 = $2,800
- You pay 20% = $700 (coinsurance)
👉 So your total out-of-pocket cost: $1,500 (deductible) + $700 (coinsurance) = $2,200
📊 Coinsurance vs Copay vs Deductible
Here’s a breakdown of how each one works:
| Term | What It Means | When It Applies |
|---|---|---|
| Deductible | The amount you pay before insurance starts sharing costs | At the start of the coverage year |
| Copay | A fixed fee (e.g., $30) for services like doctor visits | Usually applies before deductible for visits |
| Coinsurance | A percentage you pay after deductible is met | Applies to major services like surgery |
⚖️ Common Coinsurance Rates
Most health plans use one of the following coinsurance splits:
- 80/20: You pay 20%, insurer pays 80%
- 70/30: You pay 30%, insurer pays 70%
- 90/10: You pay 10%, insurer pays 90%
The lower your coinsurance, the more protection you have—but expect higher premiums.
💡 Tips to Reduce Coinsurance Costs
- ✅ Use in-network providers – They cost less and are fully covered under your plan
- ✅ Track your deductible – Once it’s met, your coinsurance kicks in
- ✅ Choose the right plan – If you expect frequent care, opt for lower coinsurance
- ✅ Consider an HSA – Health Savings Accounts can pay coinsurance costs tax-free
❓ FAQs: What Is Coinsurance in Health Insurance?
💬 Is coinsurance paid before or after the deductible?
After. Coinsurance only applies once your deductible is fully paid.
💬 What if I can’t afford my coinsurance?
You may qualify for:
- Income-based subsidies (Marketplace plans)
- Charity care programs from hospitals
- Health Savings Accounts (HSA)
💬 Does coinsurance apply to prescriptions?
Sometimes. It depends on the plan—some charge a copay, others use coinsurance.
✅ Conclusion: Coinsurance = Shared Responsibility
Understanding what coinsurance is in health insurance helps you prepare for out-of-pocket costs and avoid surprise bills.
To recap:
- Coinsurance is your percentage share of costs after deductible
- Commonly seen as 80/20 or 70/30
- The higher your coinsurance, the more you pay per service
- Compare coinsurance when shopping for health plans
Smart planning now means fewer surprises later.
