The percentage of costs you share with your insurer after meeting your deductible. For example, with 80/20 coinsurance, the insurer pays 80% of covered expenses and you pay 20% until you reach your out-of-pocket maximum.
Related Terms
Copay
A fixed dollar amount you pay for a covered health care service at the time you receive it. For example, you might pay a $30 copay for a doctor visit regardless of the total bill. Copays do not usually count toward your deductible but often count toward your out-of-pocket maximum.
Deductible
The amount you must pay out of pocket before your insurance coverage kicks in. A higher deductible generally means a lower premium. For example, if you have a $1,000 deductible and file a $5,000 claim, you pay $1,000 and your insurer pays $4,000.
Out-of-Pocket Maximum
The most you have to pay for covered health care services in a plan year. After you reach this amount through deductibles, copays, and coinsurance, your plan pays 100% of covered services for the rest of the year. This cap protects you from catastrophic medical bills.