Glossary · Costs
What is coinsurance?
Coinsurance is the percentage of a covered service's cost you pay after you have paid your deductible, such as 20%. Your plan pays the rest of the allowed amount.
Definition and figures from HealthCare.gov glossary, Medicare.gov, checked October 23, 2026. This page explains the term; it does not recommend a plan.
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Coinsurance: the facts
| Item | Fact | Source |
|---|---|---|
| Example from HealthCare.gov | $100 allowed amount, 20% coinsurance, deductible already met: you pay $20 | HealthCare.gov glossary: Coinsurance |
| Before the deductible is met | You pay the full allowed amount ($100 in the same example) | HealthCare.gov glossary: Coinsurance |
| Original Medicare Part B (2026) | Usually 20% of the Medicare-approved amount after the $283 yearly deductible | Medicare.gov: Medicare costs (2026) |
| Typical in-network vs out-of-network | HealthCare.gov examples: 20% in network, 40% out of network | HealthCare.gov glossary: Out-of-network coinsurance |
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Related terms
Questions
What does coinsurance mean in health insurance?
Coinsurance is the percentage of a covered service's cost you pay after you have paid your deductible, such as 20%. Your plan pays the rest of the allowed amount.
Is coinsurance the same as a copay?
No. A copay is a fixed dollar amount, like $20. Coinsurance is a percentage of the allowed amount, like 20%.
Does coinsurance count toward the out-of-pocket maximum?
Yes. HealthCare.gov counts deductibles, copayments, and coinsurance for in-network covered care toward the out-of-pocket maximum. Premiums do not count.