answersLogoWhite

0

== == Coinsurance An arrangement under which the insured person pays a fixed percentage of the cost of medical care after the deductible has been paid. For example, a health plan might pay 80% of the allowable charge, with the enrollee responsible for the remaining 20%; the 20% amount is then referred to as the coinsurance amount. Coinsurance maximum This is the maximum dollar amount of Covered Expenses for which the Member is responsible in a Calendar Year. After that maximum is reached, this plan will pay 100% of Covered Expenses incurred during the remainder of that Calendar Year.

User Avatar

Wiki User

16y ago

Still curious? Ask our experts.

Chat with our AI personalities

DevinDevin
I've poured enough drinks to know that people don't always want advice—they just want to talk.
Chat with Devin
SteveSteve
Knowledge is a journey, you know? We'll get there.
Chat with Steve
RafaRafa
There's no fun in playing it safe. Why not try something a little unhinged?
Chat with Rafa
More answers

Co-insurance is the amount that can be billed to a member or another insurance the member might hold. With medicare, it's the amount that your secondary will get billed and whatever they don't pay you are responsible for. If medicare is your only insurance, that is the amount that you are responsible for.

User Avatar

Wiki User

17y ago
User Avatar

Coinsurance refers to a type of insurance whereby the insured pays a share of the payment made against a claim.

User Avatar

Wiki User

11y ago
User Avatar

An insurance plan in which your insurance does not pay the full cost of care but will cover a percentage 80/20

User Avatar

Amber Suders

Lvl 4
3y ago
User Avatar

Add your answer:

Earn +20 pts
Q: What is coinsurance?
Write your answer...
Submit
Still have questions?
magnify glass
imp
Continue Learning about Math & Arithmetic

What does eighty twenty coinsurance mean?

Eighty twenty coinsurance is usually expressed 80/20 by insurance companies. The first number (80) represents the percentage of payment an insurance company will pay for a service and the second number (20) is the percentage the person receiving the service is required to pay. Other popular coinsurance amounts are 70/30, 60/40, 50/50. It is important to note a couple of factors in determining when an insurance company will pay coinsurance. First, an insurance company will only pay 80% on what the insurance considers the "allowed" amount of a fee. Generally insurance companies have fee schedules which designate the maximum amount they will pay on any particular service. This allowed amount could be more or less than the fee that is charged for the service (usually the allowed amount is lower than the fee). Second, an insurance company will only pay 80% for services rendered after the insured has satisified their deductible. Therefore, if your insurance policy has a deductible of $500, the insured must pay out $500 towards their claims then insurance companies will consider paying 80% coinsurance on the remaining balance of unpaid services. Coinsurance does not apply to deductible amounts. Third, the service that is rendered must be a covered service under the insurance policy. If the service is not a covered service most insurance policies will not pay for the service, and usually it does not apply towards the deductible either. Lastly, if the provider of the service does not have a contract with your insurance company, the insured will most likely owe the difference between the allowed amount of the insurance company and the billed amount from the provider. Coinsurance does not apply to the portion of the fee that exceeds the insurance companies allowed amount. Billing the insured for this difference is referred to as balance billing.