How Deductibles & Coinsurance Work

Understanding deductibles and coinsurance can help you better estimate your healthcare costs and avoid unexpected medical bills.

💡 What Is a Deductible?

A deductible is the amount you must pay for covered healthcare services before your insurance company begins sharing the cost of your care.

Example

If your deductible is $2,000, you are responsible for paying the first $2,000 of eligible medical expenses before your insurance starts contributing.

Deductible = $2,000

Medical Bills = $2,000

You Pay = $2,000
Insurance Pays = $0

Once your deductible has been met, your insurance plan typically begins paying a portion of covered services.

📊 What Is Coinsurance?

Coinsurance is your share of the cost of covered healthcare services after your deductible has been met.

Instead of paying the full cost, you and your insurance company split the expense based on your plan's benefits.

Example

If your plan includes 20% coinsurance:

• Insurance pays 80%
• You pay 20%

For a $1,000 covered service:

Service Cost = $1,000

Insurance Pays = $800
You Pay = $200

🔄 How Deductibles and Coinsurance Work Together

Many patients are surprised to learn that meeting their deductible does not always mean insurance pays 100% of future expenses.

In most plans:

Step 1: Meet Your Deductible

You pay the full cost of covered services until your deductible is met.

Step 2: Coinsurance Begins

After meeting your deductible, you and your insurance company share costs.

Step 3: Reach Your Out-of-Pocket Maximum

Once you reach your plan's out-of-pocket maximum, insurance typically pays 100% of covered services for the remainder of the plan year.

📈 Example: Deductible + Coinsurance

Let's say your health plan includes:

• Deductible: $2,000
• Coinsurance: 20%
• Out-of-Pocket Maximum: $5,000

Hospital Visit Cost: $5,000

Step 1: Deductible

You pay the first $2,000.

Remaining balance:

$5,000 - $2,000 = $3,000

Step 2: Coinsurance

The remaining $3,000 is split:

Insurance Pays 80% = $2,400
You Pay 20% = $600

Total Patient Responsibility

Deductible = $2,000
Coinsurance = $600

Total You Pay = $2,600

📊 Understanding the Process

Healthcare Service
        ↓
Pay Deductible
        ↓
Coinsurance Begins
        ↓
You & Insurance Share Costs
        ↓
Reach Out-of-Pocket Maximum
        ↓
Insurance Pays 100%

🏥 Common Healthcare Costs That May Apply to Your Deductible

Depending on your plan, deductible and coinsurance requirements may apply to:

• Emergency Room visits
• Hospital stays
• Surgical procedures
• Imaging services
• Laboratory testing
• Specialist visits
• Observation services

Coverage varies by insurance plan.

❓ Frequently Asked Questions

Is a deductible the same as a copay?

No.

Do I have to meet my deductible every year?

Most insurance plans reset deductibles annually, usually at the beginning of the plan year.

Check with your insurance company for specific details.

Why do I still owe money after meeting my deductible?

After meeting your deductible, coinsurance may still apply until you reach your out-of-pocket maximum.

What is an out-of-pocket maximum?

The out-of-pocket maximum is the most you will pay for covered healthcare services during a plan year.

Once reached, insurance typically pays 100% of covered services for the remainder of the year.

How can I find my deductible and coinsurance amounts?

You can find this information on:

• Your insurance card
• Your insurance company's member portal
• Your Explanation of Benefits (EOB)
• Your insurance plan documents

💡 Helpful Tips

Before receiving non-emergency care:

✅ Verify your deductible amount

✅ Understand your coinsurance percentage

✅ Check if prior authorization is required

✅ Confirm Family Hospital Systems is in-network

✅ Review your Explanation of Benefits (EOB)

Understanding your benefits can help reduce unexpected healthcare costs.

📞 Need Help?

💳 Billing Department

📞 (737) 241-9033

✉️ billing@familyhospitalsystems.com

🎫 Submit a Billing Support Ticket

🤝 Customer Support & Care Coordination

📞 (737) 238-0936

✉️ Support@familyhospitalsystems.com

🎫 Submit a Support Ticket