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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