What is Coinsurance?

Health insurance 101 terms to know

Coinsurance is the cost for care that Blue Cross of Idaho splits with you. Coinsurance kicks in after you have already met your deductible and is usually represented as a percentage.

Coinsurance example

If you have already met your deductible, then you would only pay a portion of the cost for your care after that. For example, if you need to get a treatment or surgery that costs $4,000, you would only pay 30% of the $4,000, bringing your out-of-pocket costs to $1,200. Your plan would pay the remaining 70%, or $2,800.

Example coinsurance scenario

Total cost for surgery	$4,000
Your plan pays 70% coinsurance	-$2,800
You pay 30% coinsurance	$1,200

What is the difference between a copay and coinsurance?

Coinsurance is different than a copay because a copay is a fixed-dollar amount that you pay for specific covered services. For example, your plan may have a $30 copay for a doctor office visit. Both copays and coinsurance count towards your out-of-pocket maximum.

Have questions about other terms?

Health insurance can be confusing, but we have resources to help you find the information you need to understand your plan. Watch the Blue Bulletin blog for information on things like health insurance terms and other information on understanding your benefits.

Download the member app

You can also find health insurance term definitions and resources on the Blue Cross of Idaho member app. Go to your profile and then select Resources at the bottom of the screen to find FAQs and other helpful information. Don't have the app? Download it in the App Store or Google Play Store today!

Posted: December 1, 2021