How Coinsurance Works

Coinsurance, a term found in every health insurance policy, is your out-of-pocket expense for a covered medical or health care cost after the deductible has been paid on your health care plan.

The insurance company generally pays more of the coinsurance, expressed as a percentage of the cost of service. Common divisions are 70/30, or 80/20, like the A&M Care Plan.

So if your medical bill is $1,400 and you have a $400 deductible, the portion of the bill to which coinsurance will apply is $1,000. For a plan with 20% coinsurance, you would pay:

$400 deductible + $200 (20% of remaining $1,000) = $600

Copayments do not go toward your deductible. In our A&M Care plan, most office visits have a copay that you pay without having to first meet your deductible.  However, if you have in-office surgery that costs more than $500, expect to pay 20% of the cost after the deductible is met.