What is Co-insurance?

Co-insurance is the portion of the plan where the member and the insurance carrier work together to pay for the cost of the medical claim/bills.  The co-insurance portion comes into play after the member have satified their deductible requirements and any office visits charges. Co-insurance is usually displayed as a percentage. The percentage represents the amount that the member is responsible for. Most plan have 80/ 20 coverage, which means that the insurance carrier pays 80% of the cost and the member pays the remaining 20%. Once the member has reached the plan's co-insurance maximum out of pocket limit, the percentages change.  The insurance carrier will cover the plan at a 100% up to the plan's lifetime maximum. At this period, the member just needs to continue to pay for their monthly premium.

Example: If the plan has 20% co-insurance and the claim is for $1,000.00. You will pay 20% of $200.00, while the insurance company is responsible for the remaining 80% or $800.00.