In an 80/20 coinsurance arrangement, after the deductible is satisfied, the insured pays 20% of covered expenses.

• A. The insurer pays 20%
• B. The insured pays 80%
• C. The insured pays 20%
• D. The insurer pays 100%

Answer: (C)

In this plan, costs are shared after you meet your deductible. An 80/20 arrangement means the insurer covers 80% of covered expenses and you cover 20% once the deductible has been satisfied. So the statement that the insured pays 20% after deductible is the correct description of how this coinsurance works.

For example, if your deductible is $500 and total eligible charges are $2,000, you first pay the $500 deductible. The remaining $1,500 is split 80/20: the insurer pays $1,200 and you pay $300. Your total out-of-pocket for that claim would be $800 ($500 deductible plus $300 coinsurance). There’s often an annual out-of-pocket maximum that, once reached, would have the insurer pay 100% of covered expenses for the rest of the year.