What Is Coinsurance?<\/strong><\/p>\nAs mentioned earlier, coinsurance is the percentage of health care services you\u2019re responsible for paying after you\u2019ve hit your deductible for the year. With coinsurance, you\u2019re sharing the cost of medical services with your health insurance plan until you reach your out-of-pocket maximum.<\/p>\n
When you look at your policy, you\u2019ll see your coinsurance shown as a fraction\u2014something like 80\/20 or 70\/30. Most folks are used to having a standard 80\/20 coinsurance policy, which means you\u2019re responsible for 20% of your medical expenses and your health insurance plan will handle the remaining 80%.<\/p>\n
Health plans with higher coinsurance usually have lower monthly premiums. That\u2019s because you\u2019re taking on more risk. So you\u2019ll find that most health plans with 70\/30 coinsurance have lower premiums than an 80\/20 plan.<\/p>\n
So, if you\u2019re mostly healthy and have a good emergency fund in place, it might be a good idea to look for a health plan with higher coinsurance.<\/p>\n
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How Does Coinsurance Work?<\/strong><\/p>\nIt may help to think of how you pay for health care expenses in phases. How much you\u2019ll pay depends on what phase you\u2019re in.<\/p>\n
Phase 1: The Deductible<\/strong><\/p>\nBefore your insurance kicks in, you\u2019re going to have to pay for all of your medical costs until you hit your deductible. So, if you have an insurance policy with a $1,000 deductible, that\u2019s how much you\u2019ll spend on medical expenses before you get help from insurance.<\/p>\n
That\u2019s why it\u2019s important to have enough money in savings to cover your deductible if you need to. Having a fully funded emergency fund or consistently putting money into a health savings account (HSA) if you have one could help you cover health costs during this deductible phase.<\/p>\n
Phase 2: The Coinsurance<\/strong><\/p>\nAt this point, your health insurance will come in and help you pay for a big chunk of your health expenses for the rest of the year while you pay your coinsurance rate.<\/p>\n
Let\u2019s say you\u2019ve already hit your deductible earlier in the year and, during a flag football game this month, you take that \u201cbreak a leg\u201d advice a little too literally.<\/p>\n
After a visit to the emergency room, you get an X-ray and they put a cast on your broken leg. After all the treatment, the total cost of all the new health services received is $2,500.<\/p>\n
If you have an 80\/20 coinsurance plan, you\u2019ll be responsible for 20% of the $2500 bill ($500) and your health insurance will take care of the rest.<\/p>\n
You\u2019ll keep paying your coinsurance rate of medical expenses for the year until you reach your out-of-pocket maximum.<\/p>\n
Phase 3: The Out-of-Pocket Maximum<\/strong><\/p>\nOnce you hit your out-of-pocket maximum, you\u2019re done. Your insurance plan will pay for 100% of the rest of your covered medical expenses for the year, and all you have to do is keep paying your premiums.<\/p>\n
Remember that your deductible and each of the three phases reset each year, so make sure you consider that with timing any needed treatments.<\/p>\n","protected":false},"excerpt":{"rendered":"
What is Coinsurance? Unlike your car insurance, homeowner\u2019s and renter\u2019s insurance which often cover 100% of your costs once you hit your deductible, health insurance is different – coinsurance. Instead, most health insurance plans split the costs of your medical care between you and your health insurance for a brief period of time after you […]<\/p>\n","protected":false},"author":5,"featured_media":6989,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"mc4wp_mailchimp_campaign":[],"footnotes":""},"categories":[339],"tags":[2043,2042,2045,1971,2044],"class_list":["post-7012","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-small-business-health-insurance","tag-co-insurance","tag-coinsurance","tag-health-coinsurance","tag-health-insurance-deductible","tag-out-of-pocket-maximum"],"yoast_head":"\n
What is Coinsurance? - New York Health Insurance - Affordable Small Business Health Plans<\/title>\n \n \n \n \n \n \n \n \n \n \n \n \n\t \n\t \n\t \n \n \n \n \n \n\t \n\t \n\t \n