Which cost-sharing element represents the portion of costs that the patient pays after deductible is met?

• A. Copayment
• B. Premium
• C. Coinsurance
• D. Deductible

Answer: (C)

After meeting the deductible, the patient’s share of costs is determined by coinsurance. Coinsurance is a percentage of the allowed amount that the patient must pay for services, with the insurer paying the remaining portion. For example, if a plan has 20% coinsurance and the service costs $200 after the deductible is satisfied, the patient would pay $40 and the insurer would cover $160 (subject to any out-of-pocket maximum). This differs from a copayment, which is a fixed amount paid at the time of service, and from the deductible, which is the amount the patient must pay before insurance begins to share costs. Premium is the regular payment to maintain coverage and is not tied to a specific service.