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What is Co-Insurance?

by | Dec 18, 2024

Understanding Co-Insurance With a Health Plan

Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.

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What Is Co-Insurance?

A “deductible” is an amount you pay before the insurance company starts paying. Insurance plans will have different “deductibles” $250, $500, $2,000 etc., so read your plan. Think of it like 1st base in a game of baseball. Once you’ve paid all your deductible, you are standing on 1st base. Now you’ll begin to move towards 2nd base – “Co-insurance”. During this time, co-insurance is where you and the insurance company split the medical bills, for example 70/30 or 80/20. Usually, the insurance company will pay the larger amount and you pay the lesser amount.​

Your next step is 3rd base or your “Out of Pocket Maximum”. This is the maximum YOU will pay in a year, not the insurance company. Once you’ve met your “out of pocket maximum”, you will no longer have to pay for any future medical services. This also includes the cost of prescription drugs. The insurance company will then pick you up on 3rd base, and carry you to home plate, meaning, the insurance company covers the rest of the bill, no matter how high it is.

Note: This is an annual accrual, meaning it starts over every January 1st and ends December 31st each year.

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Getting Help From Nevada Insurance Enrollment

Navigating through the many options of insurance can be confusing and costly. However, speaking with a locally licensed insurance agent will help you to obtain the right coverage you need at a price you should be able to afford. You’ll have peace of mind knowing that you are properly insured when life complications arise. We work hard to find the most competitive quotes for your needs. Contact us today to begin the process of finding the best insurance plan for your family.

Health Insurance Open Enrollment

Health Insurance Open Enrollment

Health Insurance Open Enrollment is Here! Open Enrollment for Obamacare health insurance coverage is from November 1st, through January 15th. If you call after January 15th, you will have missed the time frame to receive a Health Insurance Subsidy and a Qualified Health Insurance Plan.

Health Insurance Notices from Employers

Health Insurance Notices from Employers

Employer health insurance notices explain how Nevada employees can explore Marketplace options. Learn how to use these notices to compare costs, check subsidy eligibility, and make informed decisions.

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Health Insurance Open Enrollment

Health Insurance Open Enrollment is Here! Open Enrollment for Obamacare health insurance coverage is from November 1st, through January 15th. If you call after January 15th, you will have missed the time frame to receive a Health Insurance Subsidy and a Qualified Health Insurance Plan.

Health Insurance Notices from Employers

Employer health insurance notices explain how Nevada employees can explore Marketplace options. Learn how to use these notices to compare costs, check subsidy eligibility, and make informed decisions.

Does My Age and Gender Affect My Auto Insurance Premium?

Curious how your premium affected by age and gender impacts auto insurance in Nevada? Learn why age, gender, and other factors like driving record and vehicle type influence rates. Understand Nevada’s minimum liability coverage and discover cost-saving tips to manage your premium. Nevada Insurance Enrollment helps you find a policy that fits your needs.

Why Have PPO Plans Vanished from Nevada’s Individual Market?

The PPO plan decline reflects a Nevada health plan shift, with Nevada Health Link offering HMO/EPO plans due to ACA rules and record 2025 enrollment. These plans limit provider choices but ensure affordable coverage. Learn why PPO plan reduction occurred and how to choose coverage.

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