Coinsurance and Medical Claims

Affordable Care Act

Coinsurance and Medical Claims

Updated on November 15, 2019


What is Coinsurance

Coinsurance refers to the amount that you are required to pay for a medical claim, apart from any copayments or deductible that may also be applicable. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional copayment or deductible requirements), then a $100 medical claim would cost you $20, and the insurance company would pay the remaining $80. Coinsurance, deductibles, and copays constitute out-of-pocket costs for health insurance.

Watch our video on coinsurance

Coinsurance is a cost-sharing measure similar to copays and deductibles.

How Coinsurance works

For a better understanding of what coinsurance is and how it may affect your medical claims and out-of-pocket costs, watch the following video.

The graphic below further explains how coinsurance fits into cost-sharing for health insurance.

Maximum out-of-pocket costs

The Affordable Care Act (ACA or Obamacare) requires all major medical health insurance plans to have an annual out-of-pocket maximum for each beneficiary .

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