How to Calculate Co-Insurance

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Calculating co-insurance is something that you do between you and your insurance company. Calculate co-insurance with help from an experienced insurance professional in this free video clip.

Part of the Video Series: Insurance Questions
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Video Transcript

Hi, my name is Susan Combs, and today were gonna talk about how to calculate co-insurance. So co-insurance can be kind of a confusing thing. A lot of times people just don't understand it be quite honest. So what co-insurance is by definition is the split between you and the insurance company. So when you think about it typically this comes into play when it's health insurance also with other insurance type of plans. So how it typically works is you have a deductible and after a deductible, so a deductible is the money you have to pay out first before any percentage is covered and then it goes to co-insurance. So say you have a 2000 dollar deductible and then you have 80 percent co-insurance. So you would pay out the first 2000 dollars and then after you pay 2000 dollars then the rest of the bills will be covered at 80 percent and you'd be responsible for paying 20 percent of the bills until you'd reach usually a maximum out of pocket. So and if this is done with insurance if it's done in network then it's true numbers because it's negotiated rates with the doctors and the hospitals. So you know that the, the percentages are a 100 percent accurate. If this, we're talking about this in terms of out-of-network coverage so out-of-network meaning on the health insurance side that you're going to doctors and hospitals that do not take insurance. All the services go through a deductible and the co-insurance but keep in mind that the co-insurance only covers a percentage of the allowable charges. So if you go to a doctor that charges you over those allowable charges then you're still only going to get that smaller benefit. So for example if you go to a doctor and he charges you 200 dollars and the allowable charge is a 100 dollars with 80 percent co-insurance that insurance carrier is only going to reimburse you 80 dollars. So that's something to keep in mind and to really understand because a lot of times people think oh I hit my threshold I'm good a 100 percent. If we're talking about out-of-network it's a 100 percent of the allowable charges so there's still a chance you can be balance billed. So the best thing to do is to talk to the insurance carrier, talk to your insurance broker and really understand what they're reimbursing and what the allowable charges are so you don't have any surprises.


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