Coinsurance Fee

A coinsurance fee represents a percentage of the cost of a covered medical expense that is paid by the enrollee and not by an insurer. For example, a 25% coinsurance fee on a $100 medical charge would obligate the enrollee to pay $25 out-of-pocket with the remainder paid by the health plan. Less commonly, coinsurance refers to the portion of medical expenses paid by the insurance company.

Coinsurance fees are a form of cost-sharing.

Coinsurance fees are capped by a health plan’s MOOP.