First, what is the official definition of co-insurance?
Coinsurance
Once you have met your deductible, you pay coinsurance for additional medical care. It is a percentage of the billed charge. For example, your insurance company might pay 80%, and then you would pay 20%. It is similar to a co-pay, but is a percentage instead of a dollar amount.
Now, let’s dig a little deeper. With California health insurance, it is common to speak of their plan as an 80/20 plan or a 70/30 plan. They are essentially referring to the co-insurance part of it. With the 80/20 example, the health carrier is picking up 80% of the charges and you are picking up the remaining 20%. If there is any kind of deductible, you must pay that first at 100% until met.
Let’s take an example and see how California health insurance plans essentially break down into three main stages.
Stage 1 – The deductible YOU PAY 100%
Let’s say you have a $500 deductible. Except for services that are separate from the deductible (usually office visits and prescriptions…see COPAYS), you will pay the discounted charges at 100% until you meet your deductible....
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