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Coinsurance and Deductibles

Deductible and coinsurance—you probably know these insurance terms impact cost. But insurance terms aren’t easy to understand, and when you add them together, it gets even more complex. How do the 2 terms work together? And does coinsurance go towards deductible?

Lets start by defining the terms.

Coinsurance is a percentage you pay for the cost of a procedure or treatment. For example, if your coinsurance is 20%, then your dental plan will pay the other 80% of the cost. A $100 dental procedure would cost you $20 out-of-pocket and the dental plan would pay $80.

deductible is the total amount you must pay before an insurance provider will start paying on claims. For example, if you have a $100 deductible and you need a crown that costs $618, you will need to pay $100 before your dental plan pays its portion of the remaining $518.

So, what if your plan includes both coinsurance and a deductible? Does coinsurance go towards deductible costs? In most cases, the answer is no—coinsurance does not count toward the deductible; the deductible needs to be met (paid in full), and then your coinsurance percentage will apply to the remaining cost.

What does this mean for you?

When choosing a plan, think about how much you use your insurance and how much protection you want against unpredictable expenses. Then look at the plan’s deductible and coinsurance and find what works best for you. Here are a few things to consider.

  • A plan with a high deductible will have cheaper monthly payments. But you’ll pay more upfront when you need care. You can also look for plans that cover certain services before you pay your deductible.
  • Typically, the lower a plan’s monthly payments (premiums), the more you’ll pay in coinsurance.
  • Dental insurance is focused on prevention, so most routine services like cleanings and exams are covered entirely by the dental plan and the deductible doesn’t apply..

Still have questions? Login and check your plan benefits online, or call us toll free at 1-877-841-1478 during regular business hours. We’re happy to help you understand your benefits!