Coinsurance Share
Calculator
Results
- Your cost share
- 2,400
- Paid by the plan
- 9,600
- Insurer share
- 80
Insurance and risk results
| Your cost share | 2,400 |
| Paid by the plan | 9,600 |
| Insurer share | 80 |
formula-map diagram
- Your cost share
- 2,400
- Paid by the plan
- 9,600
- Insurer share
- 80
Coverage and risk relationship
Formula
Member coinsurance = covered charges × coinsurance %= 2400
Note
This is generic arithmetic using the amounts, rates and factors you entered. It is not an insurance quote, a policy interpretation, or financial advice. No insurer rate, jurisdiction rule, statutory limit or policy wording is built in. Real premiums and payouts depend on underwriting, your policy's exact terms and exclusions, and applicable regulation; confirm with your insurer or a licensed professional.
More in Insurance and risk
See all →Frequently asked questions
What is coinsurance and how is it different from a copay?+
Coinsurance is a percentage of the cost you pay after meeting your deductible (e.g. 20%), while a copay is a fixed dollar amount per visit regardless of the service's total cost. Coinsurance scales with the bill; a copay does not.
How does the calculator determine my coinsurance share?+
It applies your plan's coinsurance percentage to the allowed amount of the bill remaining after the deductible has been subtracted, since coinsurance only kicks in once you've met your deductible.
Why did I pay less than the full coinsurance percentage suggests?+
You likely hit your out-of-pocket maximum partway through, after which the insurer covers 100% of the remaining allowed costs for the rest of the plan year, so your effective share drops below the stated coinsurance rate.
Does coinsurance apply to the billed amount or the negotiated rate?+
It applies to the insurer's negotiated (allowed) amount, not the provider's full billed charge. This is why an in-network coinsurance share is usually much lower than the same percentage of an out-of-network bill.
Why is my out-of-network coinsurance so much higher?+
Out-of-network coinsurance percentages are typically higher (e.g. 40-50% vs 20% in-network), and they apply to a higher allowed amount or even the full billed charge, plus providers can balance-bill you for the difference.