Affordable Care Act
Coinsurance and Medical Claims
Updated on November 15, 2019
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.
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 .