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Understanding what you pay for your health care is an important part of understanding your coverage. Learn about coinsurance and how it works.

  Understanding Coinsurance


Understanding what you pay for your health care is an important part of understanding your coverage.

This short video explains what coinsurance is and how it works.

Let’s get started.

What is coinsurance? Coinsurance is the percentage you pay for a covered medical treatment or service after you’ve paid your deductible. The amount of your coinsurance depends on the type of medical care or service you receive and your specific plan. It is usually shown as a percentage of the overall cost of the service or treatment.

Here’s how it works.

John goes to the doctor to treat his strep throat and has a coinsurance of 20% when seeing his in-network primary care physician. John’s insurance has a $100 allowed amount for this type of in-network doctor’s office visit. Since John has a plan with a 20% coinsurance, John has to pay 20% of the $100 charge for his office visit OR $20. His insurance plan pays the rest OR $80.

Deductibles, coinsurance and copayments – understanding the differences.

Your plan can have an annual deductible, coinsurance and/or a copayment. It does not always include all three.

An annual deductible is the amount you have to pay during one benefit year before your health insurance starts paying for eligible medical treatment and services. 

Coinsurance is the percentage of the costs for covered care that you have to pay.

Your copayment is the set amount you pay each time you receive care for a covered benefit. If your plan includes a copayment for services, it will not include a coinsurance for the same service type.

What is my maximum out-of-pocket?

Your maximum out-of-pocket is the highest amount you will have to pay each year. Once you meet your maximum out-of-pocket, your insurance will pay in full for all covered services and you will no longer pay a copayment, deductible or coinsurance for the remainder of the plan year.

To learn more about your copayment, deductible and coinsurance, sign into Member Online Services at

Need more help?

If you need help finding information about your benefits, claim status and more, sign into our secure Member Online Services on to: read our FAQs, send us a question through our secure email OR ask a question through Live Chat.

Horizon Blue Cross Blue Shield of New Jersey remains committed to helping you understand your benefits.

Thank you for watching.