What is the term for the percentage the patient pays for covered services after meeting the deductible?

The term for the percentage that a patient pays for covered services after meeting the deductible is known as coinsurance. This is a cost-sharing arrangement in health insurance where the insurer and the insured share the costs of healthcare services. Once the deductible, which is the initial amount a patient must pay out-of-pocket before insurance begins to cover costs, has been met, the coinsurance kicks in.

For example, if a plan has a coinsurance rate of 20%, after the deductible is satisfied, the patient is responsible for 20% of the costs of subsequent covered medical services, while the insurance company will cover the remaining 80%. This structure encourages patients to remain financially aware of the costs associated with their healthcare while ensuring that insurance providers share in the financial risk.

In contrast, copayment refers to a fixed amount the patient pays for a specific service, like a visit to the doctor, typically at the time of service. Allowed charges refer to the maximum amount a health insurance plan will pay for a covered service, and the deductible is the amount a patient must pay out-of-pocket before the insurance begins to contribute to costs. Understanding these terms is essential for navigating health insurance plans and managing healthcare expenses effectively.