In a policy with 80/20 coinsurance after the deductible, the insured pays:

In a policy with 80/20 coinsurance after the deductible, the insured pays:

• A. 100% until deductible is met
• B. 20% of total charges after deductible
• C. 20% of remaining charges after deductible
• D. Zero after deductible

Answer: (C)

The main idea is that after you’ve met your deductible, you share the costs of covered services with the insurer in an 80/20 split. That means the insurance pays 80% of the remaining eligible charges, and you pay 20% of those remaining charges. The deductible is paid first, so the coinsurance doesn’t apply to the amount that goes toward meeting the deductible. For example, if your deductible is $500 and the bill is $2,000, you pay the first $500 to satisfy the deductible. The remaining $1,500 is then split: you would pay 20% of $1,500 ($300), and the insurer would pay 80% of $1,500 ($1,200). Your total out-of-pocket in this scenario would be $800, with the insurer covering $1,200. Some plans also have an out-of-pocket maximum that limits your total payments. The other ways this could be phrased would not reflect how coinsurance works. Before the deductible is met, you typically pay 100% of charges until the deductible is satisfied. Saying you pay 20% of total charges after deductible would ignore the portion paid to meet the deductible. Saying you pay zero after deductible would ignore the shared-cost nature of coinsurance.

The main idea is that after you’ve met your deductible, you share the costs of covered services with the insurer in an 80/20 split. That means the insurance pays 80% of the remaining eligible charges, and you pay 20% of those remaining charges. The deductible is paid first, so the coinsurance doesn’t apply to the amount that goes toward meeting the deductible.

For example, if your deductible is $500 and the bill is $2,000, you pay the first $500 to satisfy the deductible. The remaining $1,500 is then split: you would pay 20% of $1,500 ($300), and the insurer would pay 80% of $1,500 ($1,200). Your total out-of-pocket in this scenario would be $800, with the insurer covering $1,200. Some plans also have an out-of-pocket maximum that limits your total payments.

The other ways this could be phrased would not reflect how coinsurance works. Before the deductible is met, you typically pay 100% of charges until the deductible is satisfied. Saying you pay 20% of total charges after deductible would ignore the portion paid to meet the deductible. Saying you pay zero after deductible would ignore the shared-cost nature of coinsurance.