Which cost-sharing arrangement requires the insured to pay a percentage of covered expenses after the deductible is met?

Which cost-sharing arrangement requires the insured to pay a percentage of covered expenses after the deductible is met?

• A. Coinsurance
• B. Copay
• C. Premium
• D. Deductible

Answer: (A)

After you meet the deductible, the amount you pay is determined by coinsurance, which is a share of the covered costs expressed as a percentage. This means you and the insurer split the cost of services—you pay a set percentage, the insurer pays the rest—until you reach the plan’s out-of-pocket limit. For example, if the deductible is met and coinsurance is 20%, a $2,000 podiatry bill would leave you responsible for $200 of the remaining amount after the deductible has been paid (you’ve already paid the $1,000 deductible), while the insurer covers $800. Copays are fixed dollar amounts per visit, not a percentage of the bill, and premiums are monthly payments to maintain coverage, not tied to a specific claim. So the scenario described is governed by coinsurance.

After you meet the deductible, the amount you pay is determined by coinsurance, which is a share of the covered costs expressed as a percentage. This means you and the insurer split the cost of services—you pay a set percentage, the insurer pays the rest—until you reach the plan’s out-of-pocket limit. For example, if the deductible is met and coinsurance is 20%, a $2,000 podiatry bill would leave you responsible for $200 of the remaining amount after the deductible has been paid (you’ve already paid the $1,000 deductible), while the insurer covers $800. Copays are fixed dollar amounts per visit, not a percentage of the bill, and premiums are monthly payments to maintain coverage, not tied to a specific claim. So the scenario described is governed by coinsurance.