Healthcare Defined: “Coinsurance”

Cropped SingleCare logo By | June 7, 2016

Sometimes, healthcare can seem like a whole different language. In this series, we break down some common healthcare terms into plain English.

Coinsurance (noun) — The amount of money you have to pay for your healthcare services after you’ve reached your deductible. This figure is determined by a percentage applied to each medical bill total (usually 80%/20%, 90%/10% or 70%/30%), and your insurance company pays the higher percentage, and you cover the smaller one.

Confused by all these numbers? Let’s break it down.

So you just hit your deductible—let’s call it $2000—which means you’ve spent that much on various medical expenses in a year. Now, your coinsurance kicks in. If your coinsurance is 20%, you pay 20% of each medical bill total, and your insurance covers the remaining 80%.

For example, you visit the doctor for a sore throat, and the bill totals $100.00. Since your coinsurance is 20%, you will be charged $20 for that check-up and then, your insurance will pay $80.

Good news! There’s a limit to your total out-of-pocket expenses. Your insurance company will finally foot the entire bill for a surgery or physical once you’ve reached the out-of-pocket maximum, which includes your deductible and coinsurance fees. So, if you find that you have higher medicals costs each year, choose a higher premium plan as that will have a lower deductible and coinsurance, and your insurance will cover your medical expenses sooner. If you rarely visit the doctor, choose a low premium plan even though it will have a higher deductible and coinsurance to get the most for your money. And remember, deductible and coinsurance will reset when your plan year ends.

Man helping woman with paperwork

[Image: Creatas / Thinkstock]

However, very few people ever meet their out-of-pocket maximum and let alone, their deductible, so you’re probably wondering why you pay for insurance when barely anything is covered…

SingleCare is here to help.

SingleCare allows you to shop for healthcare services without any hidden fees or surprises. We’ve negotiated rates in advance, so you can see the cost for a service upfront and pay only for what you need. What’s more — our rates are lower than our competitors. In fact, we save consumers an average of 36% on dental care, and that’s just for one service! Don’t wait to see a doctor because of the high cost. Hop on SingleCare’s website and get the care you need without sacrificing your sanity or wallet.

[main image credit: monkeybusinessimages / Thinkstock]