graphic symbolizing "Costs"

Cost 4: Co-insurance


There is one more type of cost you may have to pay.

 graphic of term: "Co-Insurance"

After you have paid your deductible for the year, you may have to pay “co-insurance” for certain health services that are NOT preventive. This charge is a part or percentage (%) of the total cost for these health services. For example, you may have to pay part of the cost of a hospital stay.

To find out if you will have to pay co-insurance, call your health plan’s member services phone number and ask. But remember: Just like there are no co-pays for preventive services, there is no co-insurance for preventive services either.

 graphic of a pie chart showing an example of how "co-insurance" works

Example: If your co-insurance is 20%, you will pay 20% of the cost of a health service and your insurance will pay 80%.



 graphic of the woman named Sonya with her 20% co-insurance example under her image

EXAMPLE:  Sonya Morales had a deductible of $1,000 for the year. After six months, Sonya had paid that full amount for her health services. From then on, the insurance paid for almost ALL of her costs. But there was a small part or percentage (%) Sonya also had to pay. 

Sonya slipped on the ice on the sidewalk and hurt her leg. Her doctor said it was probably not broken but she should get an X-ray at the hospital to be sure. A few weeks later, she got a bill from the hospital for $20. The X-ray had cost $100. Her insurance paid the hospital 80% or $80. Sonya’s co-insurance was 20%. Now Sonya had to pay the hospital $20 since 20% of $100 is $20.

 graphic showing how much Sonya pays and how much her insurance pays for her X-ray charges