Coinsurance: Understanding How It Affects Your ACA Health Plan

What is Coinsurance?

Coinsurance is a type of cost-sharing arrangement in an ACA health insurance plan where you pay a percentage of covered medical expenses after meeting your deductible. The percentage you pay is known as your coinsurance rate, which can vary depending on your plan.

How Coinsurance Works

Before your coinsurance kicks in, you must first meet your annual deductible. Once the deductible is met, you will start paying your coinsurance rate for covered services. For example, if your plan has a 50% coinsurance rate and your deductible is $2,000, you will pay $1 for every $2 of covered medical expenses until you reach your out-of-pocket maximum.

Out-of-Pocket Maximum

Your out-of-pocket maximum is the total amount you pay for covered services during a year. This includes your deductible, coinsurance payments, and copayments. Once you reach your out-of-pocket maximum, the insurance company will cover 100% of covered medical expenses for the rest of the year.

Contrast with Copay

Another cost-sharing arrangement in ACA plans is a copay. A copay is a fixed amount you pay for specific medical services, such as a doctor’s visit or prescription drug. Copays are usually lower than coinsurance payments.

How to Choose a Coinsurance Rate

When selecting an ACA health plan, consider your expected medical expenses and financial situation. A plan with a higher deductible and lower coinsurance rate may be more cost-effective if you expect significant medical expenses. Conversely, a plan with a lower deductible and higher coinsurance rate may be better if you anticipate lower medical expenses.


Coinsurance is one of several ways you may share the costs of your healthcare under an ACA health insurance plan. Understanding how coinsurance works can help you make informed decisions about your coverage and budget for your medical expenses. If you need assistance in understanding your plan or need help selecting the right insurance for your needs, consult with a licensed agent or broker.

Question? or Need a Free Quote?
Contact Us

Reach out to us for free expert insurance advice and solutions. We will help you solve ACA (Obamacare) related questions and problems. Will contact you within 24 hours of receiving your message.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *