What Is Coinsurance?

Coinsurance is the percentage of medical costs a patient must pay after meeting their deductible. For example, if your coinsurance is 20%, you pay 20% of covered medical expenses while your insurance covers the remaining 80%. Unlike copays, which are fixed amounts, coinsurance is a percentage-based cost that can vary depending on the total bill.

How is coinsurance different from a copay?

• Coinsurance: A percentage of costs you pay after meeting your deductible (e.g., 20% of a hospital bill).
• Copay: A fixed dollar amount you pay per service (e.g., $30 for a doctor’s visit).
• Impact on costs: Coinsurance charges can be unpredictable since they depend on the total cost of care, whereas copays are set amounts known in advance.

How does coinsurance work with Medicare?

• Medicare Part A: Covers hospital stays, but patients may owe coinsurance for extended inpatient care.
• Medicare Part B: Typically has a 20% coinsurance rate for covered outpatient services after the deductible is met.
• Medigap plans: These supplemental plans can help cover coinsurance costs that Medicare does not pay.

How Solace Can Help

Coinsurance costs can add up quickly, especially for ongoing treatments or hospital stays. A Solace advocate can help you estimate out-of-pocket expenses, find cost-saving programs, and ensure you're enrolled in the right Medicare or supplemental plan to reduce your financial burden.

What to Do Next

Concerned about high coinsurance costs? A Solace advocate can help you explore coverage options and financial assistance. Find an advocate today.