0 Coinsurance: What It Is & How Does It Work?

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.

Key Takeaways

• Coinsurance is a very important health insurance term and it indicates how many bills you have to bear/pay after your medical bill reaches the insurance coverage
• If you ever had health, dental, or vision insurance then you might have heard the term 0 coinsurance
• How much you have to pay as coinsurance totally depends on your health insurance policy
• Depending on your health insurance, the coinsurance could be 15%, 20%, 25%, etc.
• 0 coinsurance means when you have met your deductible, you have to pay 0% of the medical bill

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

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.

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

References:

1. https://www.healthmarkets.com/content/what-is-co-insurance
2. https://healthplancritic.com/what-does-0-coinsurance-mean/