Coinsurance is a very important health insurance term because coinsurance tells you the percentage of your medical costs that you would have to pay once your insurance coverage reaches maximum deductible. If you ever had health, dental, or vision insurance then you might have heard the term coinsurance and 0 coinsurance. However, many people don’t know exactly what it means to have 0 coinsurance.
0 coinsurance means if you have health insurance coverage then the insurance company will pay all the cost of medical care and you don’t have to spend money from your pocket. For example, if your health insurance plan has a 20%coinsurance requirement then you have to pay at least 20% of the medical cost. So, if your medical bill is $100 then you have to pay $20 and the rest will be paid by the insurance company. But if your plan has 0 coinsurance then the insurance company will pay the total $100 bill.
Jump To A Section
- 1 What Is Coinsurance?
- 2 What Is 0 Coinsurance?
- 3 Coinsurance VS. Copay: What’s The Difference?
- 4 Comparison Of Coinsurance And Copay
- 5 Coinsurance And The Metal Tiers
- 6 How To Lower Coinsurance Rates
- 7 FAQs About 0 Coinsurance
- 7.1 Is 0% Coinsurance Good Or Bad?
- 7.2 Is It Better To Have A Copay Or Coinsurance?
- 7.3 What Does It Mean If My Copay Is $0?
- 7.4 What Is A Good Coinsurance Percentage?
- 7.5 Is It Better To Have A Higher Or Lower Deductible?
- 7.6 What Does 80/20 Coinsurance Mean?
- 7.7 Does Coinsurance Go Towards The Out-Of-Pocket Maximum?
- 7.8 Is A Zero-Deductible Good?
- 7.9 What Happens If You Don’t Meet Your Deductible?
- 7.10 Is It Better To Have A $500 Deductible Or $1000?
What Is Coinsurance?
Coinsurance is the percentage of your medical bill that you have to bear/pay after your medical bill reaches the deductible amount that your health insurance will cover. So, once you reach the deductible, the insurance company will split the medical bill based on a set percentage of the costs. So, the percentage or amount of money you pay is your coinsurance. How much you have to pay as coinsurance totally depends on your health insurance policy. Usually, coinsurance is represented as a number, like 15%, 20%, 25%, etc. So, if you have 15% coinsurance then you have to pay 15% of the cost of medical care, and your insurance will cover the rest 85%. The higher your coinsurance, the more amount of money you have to pay for the medical bill. Therefore, when buying health insurance, you must try to minimize the coinsurance percentage. But lower coinsurance means you have to pay a higher monthly premium.
What Is 0 Coinsurance?
Many health insurance plans are available with 0 coinsurance. So, what does 0 coinsurance means? 0 coinsurance means when you have met your deductible, you will be responsible for 0% of the balance. 0 coinsurance is very rare but a good feature of a health plan. However, one disadvantage of 0 coinsurance is that your monthly premium may be higher than the conventional health insurance premium. The good thing about 0 coinsurance is, you don’t have to worry about high medical bills or medical expenses. It means you won’t be responsible for a percentage portion of the medical bill.
Coinsurance VS. Copay: What’s The Difference?
Both coinsurance and copay are very common health insurance terms and they are very similar except for one key difference. A coinsurance is a percentage of the total cost while a copay is a flat fee. Your health insurance might have coinsurance or copay. Let’s see an example. If your medical cost is $200 and your insurance includes a copay of $20 then you only have to pay $20. The rest $180 will be paid by the insurance company. On the other hand, if your insurance includes 20% coinsurance then you have to pay $40 of $200 bill. The advantage of a copay is, it allows for greater predictability for the consumer and it is affordable. With copay, you know that you have to pay a set amount regardless of the total bill amount. However, for coinsurance, you have to pay a percentage of the bill so the higher the bill the more you have to pay from your pocket. So, while you are buying health insurance make sure you check the difference between copay and coinsurance and pick one that best suits you.
Comparison Of Coinsurance And Copay
|How it’s charged||Percentage of costs||Flat fee per service|
|Does it vary based on what service you get?||No, the percentage is always the same||Yes|
|Do you pay it before or after reaching your deductible?||Only after||Before and after|
|Does it count toward your out-of-pocket maximum?||Yes||Yes, in most plans|
Coinsurance And The Metal Tiers
Usually, the coinsurance percentage depends on the details of the individual insurance policy. There are four types of tiers available. They are Bronze, Silver, Gold, Platinum. These are also known as metal tiers. What tire your insurance will fall depends on how the insurer will split all costs with you and it’s totally different from the coinsurance split. For example, if your insurance plan falls into the Bronze plan then the insurance company will cover an average of 60% of your medical costs, and the rest 40% have to be paid by you. So, the average cost-sharing value for the tier of your insurance plan would not be the same as your coinsurance percentage. Therefore, you might have a plan with 0% coinsurance meaning you have to pay 0% of health care costs.
|Metal Tier||Consumer Pays||Insurer Pays|
How To Lower Coinsurance Rates
If you think your health insurance has a high coinsurance rate then you can lower the coinsurance rate. Cost Sharing Reduction (CSR) subsidies are available to health insurance customers with a silver-level plan. With these CSR subsidies, you will be able to reduce coinsurance, copayments, deductibles, and out-of-pocket maximums. You have to increase the actual value of the insurance plan. Moreover, few plans are available that offer “100% after deductible,” which is similar to 0% coinsurance. It means, if you reach your insurance deductible then the provider will pay for 100% of your medical costs and you won’t need any coinsurance payment.
FAQs About 0 Coinsurance
Is 0% Coinsurance Good Or Bad?
0% coinsurance has both advantages and disadvantages. If you have 0% coinsurance then you don’t have to pay any out-of-pocket costs once you reach the deductible. But health insurance with 0% coinsurance usually has a higher monthly premium. Moreover, it also includes deductible or copays to make up for not paying any coinsurance.
Is It Better To Have A Copay Or Coinsurance?
Copay means, you have to pay a fixed amount and it will remain fixed regardless of your medical bills. On the other hand, coinsurance means you have to pay a fixed percentage of the total medical bill. So, the amount is not fixed. You might have to pay lots of money if you receive a high medical bill. Therefore, the copay is better than coinsurance.
What Does It Mean If My Copay Is $0?
Once you reach the deductible of your health insurance, you have to pay the copay amount for medical expenses and your health plan pays the rest. If your copay says $0 then it means you don’t have to pay any money after reaching the deductiblI.
What Is A Good Coinsurance Percentage?
There is no exact answer to this question but according to many personal finance experts, a coinsurance of 80/20 or 70/30 is considered a good percentage.
Is It Better To Have A Higher Or Lower Deductible?
Both higher and lower deductible has advantages and disadvantages. For example, if you require frequent extensive medical care then a low deductible is best. On the other hand, if you need more manageable premiums and access to HSAs then a higher deductible is a good option.
What Does 80/20 Coinsurance Mean?
The 80/20 coinsurance means if you reach the deductible then the insurance company will cover 80% of your medical care bill and you have to bear the rest 20%. So, if you have a medical care bill of $1000 then the insurance company will pay $800 and you have to pay $200.
Does Coinsurance Go Towards The Out-Of-Pocket Maximum?
Yes, coinsurance goes towards the out-of-pocket maximum. Usually, the deductible is a part of the out-of-pocket costs and it will add to your yearly limit. On the other hand, the out-of-pocket limit is the maximum amount that you have to pay for medical care, deductible cost, copayments, and coinsurance.
Is A Zero-Deductible Good?
Yes, a zero-deductible is good because health insurance without a deductible provides good coverage. Moreover, a zero-deductible will be a good option for you if you need expensive medical care or already receiving expensive medical treatment. However, the only disadvantage of zero-deductible is you have to pay higher monthly premiums.
What Happens If You Don’t Meet Your Deductible?
If you don’t meet the minimum deductible then your insurance won’t pay the expenses that are subject to the deductible. Apart from that, you will receive other benefits from the insurance even when you don’t meet the minimum deductible requirement.
Is It Better To Have A $500 Deductible Or $1000?
A deductible difference of $500 will play a significant role in your monthly premiums. If you have a $1000 deductible then the insurance company will pay for anything that is over $1000. So, the lower the deductible you want the higher your premium could go. So, it’s totally up to you whether you want a higher deductible and lower monthly premium or a lower deductible and higher monthly premium.
Magalie D. is a Diploma holder in Public Administration & Management from McGill University of Canada. She shares management tips here in MGTBlog when she has nothing to do and gets some free time after working in a multinational company at Toronto.