Insurance 101: Plain-English Library

Coinsurance vs. Copay: Healthcare Math Made Simple

Let's say you hurt your arm and go see the doctor. Both of these terms dictate what you owe, but they calculate it completely differently.

The Copay (The Flat Fee)

A copay is a hard, flat dollar amount. The plan says "$30 Specialist Copay". It does not matter if the doctor spends 5 minutes with you or 2 hours with you. You hand the receptionist $30, and you are done.

Coinsurance (The Percentage Split)

Coinsurance kicks in usually after you hit your deductible. It is a percentage split between you and the insurance company—usually 80/20. If your hospital bill is $1,000, the insurance pays 80% ($800) and you are billed for 20% ($200). Coinsurance is much scarier because you rarely know the total price until the bill arrives.

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