Employee Benefits
Coinsurance refers to the portion of your insurance bill that you're responsible for paying after you've met your deductible. Typically, coinsurance operates on a fixed ratio, meaning you will always be charged the same percentage of the total bill each time.
When you file a health, dental, or vision insurance claim after you’ve reached your out-of-pocket annual deductible, you are responsible for a portion of the total bill. Most often, insurance companies operate on an 80/20 coinsurance plan.
Coinsurance amounts are often represented by a ratio or percentage, outlined in your insurance policy documents. For example, in the typical ratio format of an 80/20 coinsurance plan, the first number in the ratio, 80, refers to the portion your insurance company will pay, and the second number, 20, represents the percentage of the cost you will be responsible for.
Insurance companies list percentages in coinsurance plan descriptions (e.g., 20% coinsurance, 0% coinsurance, etc.) to refer to the part of the bill that you, the insured party, will be responsible for. The most common percentages are:
Outside of your premium payments, your biggest insurance-related expenses are coinsurance, copays, and deductibles. We’ve already covered what coinsurance is, but the other two are:
Coinsurance is a cost-sharing system insurance companies use in which you are responsible for a portion of your total bill, but only after your annual deductible is met. Knowing what coinsurance is and how it works can make a huge difference in understanding how your insurance policy is used and can help you better plan for the future of your health.
This article is intended to provide general information about insurance. It does not describe any Metropolitan Life Insurance company product or feature.