Coinsurance is the percentage of a covered cost you pay after meeting your deductible — for example, 20% while the plan pays 80%. It keeps applying until you hit your out-of-pocket maximum, after which the plan covers the rest of covered services for the year.
Coinsurance is the cost-sharing that kicks in once your deductible is met. Instead of a flat copay, you pay a set percentage of the covered charge and the insurer pays the rest — a common split is 20% you, 80% the plan. It continues on each covered service until your total spending reaches your out-of-pocket maximum, at which point the plan pays 100% of covered services for the remainder of the plan year. Because it is a percentage, coinsurance on an expensive procedure can be substantial, which is why the out-of-pocket maximum matters as your backstop.
A copay is a fixed dollar amount; coinsurance is a percentage of the cost. Coinsurance can be much larger on expensive care.
Once your out-of-pocket spending reaches your maximum for the year, the plan pays 100% of covered services and coinsurance stops.
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