What is a Co-Insurance for Health Insurance?

Co-insurance is the percentage split that you have with the health insurance company. Generally, after you hit a deductible, then there's gonna be a type of split and the split is based on the co-insurance. Sometimes it's a 100% co-insurance, 90% all the way down to 50%. Normally we don't see it much lower than 50%. But what that means is that if there's 90% co-insurance, that means that after you hit the deductible, the insurance company is gonna pay 90% of the bill, and the policyholders would only pay 10% of the bill. If it's 80%, it would be the insurance company will pay 80% and policyholders pay 20% down to whatever it is. On a 100% plan, that basically means once you hit your deductible, you don't pay anything else. So your deductible generally is going to be the same as your maximum out-of-pocket. So if your deductible in that situation is $2000 and it's a 100% coinsurance, then your out-of-pocket maximum a lot of times would be the same. But there's a catch, sometimes after you hit deductibles you have copays. So there are some policies that you have a copay. Even though you don't have any more deductibles and coinsurance, you're gonna pay co-pays for certain things until you reach your maximum out-of-pocket amount.

Do you still pay after a co-insurance?

In general, yes you're gonna pay whenever you see a deductible and coinsurance under a coverage type. Usually like a hospital, or for in-patient surgery, or outpatient surgery, or whatever. You'll see that. But, if there's a copay, sometimes after you hit the deductible there's gonna be a copay. So, if you go into a hospital after you hit the deductible and there's a $200 copay for an in-patient stay. If you hit your deductible, then you'll still have to pay the $200 copay or that might be it. You don't pay anything else after that or you pay the copay and you pay your percentage of the out-of-pocket max. Most plans that have a prescription drug plan, are gonna have....

If you have a lot of co-pays during the course of the year, you might not have to pay anything after your deductible, because you already paid those co-pays that go towards the maximum out-of-pocket. It kind of skips over the deductible and starts going in that out-of-pocket max bucket to hit that final total.