How does coinsurance operate after the deductible is met?

• A. The insurer pays 100% of all covered expenses.
• B. The insured pays a fixed amount for each service.
• C. The insured pays a specified percentage of covered expenses and the insurer pays the remainder.
• D. Coinsurance applies only after the out-of-pocket maximum is reached.

Answer: (C)

After you’ve met the deductible, you share the cost of covered expenses with the insurer through coinsurance. This means you pay a specified percentage of each covered bill, and the insurer pays the remaining percentage. For example, if the deductible is met and your coinsurance is 20%, a $3,000 bill would leave you responsible for $600 while the insurer covers $2,400. This sharing continues until you reach your out-of-pocket maximum, at which point the insurer generally pays 100% of covered expenses for the rest of the policy period.

This isn’t a fixed amount per service (that would be a copayment), nor does it imply full payment by the insurer after the deductible in all cases. Coinsurance is the shared-cost mechanism that kicks in after the deductible and ends once the out-of-pocket maximum is reached.