Can someone break down what coinsurance means for me like I’m a 5-year-old?
I’m 25, work in medical billing, and am still on my mom’s health insurance, so I just learned about coinsurance seven months ago. Whenever I ask my coworkers, they say, “It’s a percentage you’re responsible for based on your benefits,” but that doesn’t really help, especially when patients keep asking me about it. I usually tell them to check with their insurance companies since it can change depending on their plan. I really want to help patients understand better. How can I explain coinsurance in simple terms to someone who isn’t familiar with billing or insurance?
Sure! Explaining coinsurance can be a bit tricky, but you can think of it like sharing a pizza.
Imagine you go out to eat with your friend, and you both want to share a pizza that costs $10. If you both agree to split the cost of the pizza evenly, you each pay $5.
Now, let’s say your mom’s health insurance helps pay for some of your medical bills, just like you and your friend shared the pizza. When you go to the doctor and there’s a bill for $100, your insurance might say, “We’ll pay for 80% of that bill, and you’ll pay the other 20%.”
So, if the bill is $100, the insurance pays $80 (which is 80%) and you’re responsible for the remaining $20 (which is 20%). That $20 is what we call your coinsurance.
So, in simple terms, coinsurance means that when you go to the doctor and there’s a bill, your insurance helps cover most of it, and you just pay a smaller part. It’s like sharing the pizza, but you don’t always have to pay the same amount.