The co-insurance is one of the terms found in every health insurance document, referring to your personal expenses for covered medical or health care costs after paying the minimum insurance, which usually renews annually, on your health care plan.
Co-insurance Percentage
Typically, co-insurance amounts are not split evenly between you and the insurance company. The insurance company usually bears a larger share, where it pays the majority of the covered cost (the higher percentage) for the covered health care service. The first number in the co-insurance split is what the insurance company pays and the second number is what you pay. Co-insurance is usually applied to the allowable amount for the health care service covered by the insurance company, which is the maximum amount that the plan will pay for this expense.
Co-insurance When You Have Coverage from Two Plans
If you are fortunate enough to have coverage under two health insurance plans (for example, under a spouse or domestic partner’s plan), usually one of the plans operates as the primary plan when filing a health insurance claim. In most cases, the co-insurance percentage of the primary plan applies to your expenses first, and typically, the co-insurance percentage of the secondary plan applies to anything not covered by the primary plan. The process of using two plans to cover the cost of something is called “coordination of benefits.”
Conclusion
Understanding how co-insurance works, coordination of benefits, and the minimum insurance on your health plan can save you money annually. It is important to read all the terms of the policy carefully before making your decision or signing a health insurance waiver for any document. If you have any questions, talk to your representative to fully understand your options.
Frequently Asked Questions (FAQs)
What does 80% co-insurance mean?
Typically, 80% co-insurance means that once the minimum insurance is met, the insured is responsible for 20% of the covered medical bills, and the insurance company is responsible for 80%. If you have a bill of $2000 and the minimum insurance has been met, 80% co-insurance means that the insurance company will pay $1000 and you will pay $400.
Which is better: high or low co-insurance percentage?
It is better to have a low co-insurance percentage because that means you will be responsible for a smaller percentage of your covered medical bills.
Is co-insurance good or bad?
Co-insurance is a good thing because it makes you responsible for a small part of the covered medical bill instead of the entire amount. However, co-insurance amounts vary, and percentages of 20% and 30% are common.
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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts contained in our articles. Read our editorial process to learn more about how we fact-check and maintain the accuracy, reliability, and quality of our content.
Healthcare.gov. “Coinsurance.”
Healthcare.gov. “The Health Plan Categories: Bronze, Silver, Gold, and Platinum.”
FAIR Health Consumer. “Having More Than One Health Plan.”
Government of the District of Columbia. “Understanding Your Health Insurance,” Page 2.
Source: https://www.thebalancemoney.com/health-insurance-coinsurance-2645761
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