I'm looking at plans on the coveredCA site, and I see both terms used. However, my understanding is that coinsurance only kicks in after the deductible has been paid anyways, so "coinsurance after deductible" seems redundant both in and of itself and with just the term "coinsurance." screencap from coveredCA


"coinsurance after deductible" seems redundant

You're right, it's redundant.

If a plan has a deductible, the deductible applies unless it is waived. A deducible is the amount of money the insured pays before the carrier will pay. The comparison you are looking at is simply reversing the waive logic. Rather than indicating where the deductible is waived, it is indicating where the deductible applies. You might notice that 3 of the 4 benefits listed are "after deductible" meaning the deductible has been waived for one of them.

"Coinsurance after deductible" is redundant because everything is after deductible unless the deductible is waived.

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    To the downvoter, when would a carrier pay coinsurance before a deductible was met? The insured meets the deductible THEN The carrier begins paying that is the definition of a deductible, except for benefits where the deductible is waived. This is redundant for clarity but it's still redundant. – quid Jul 19 '17 at 20:31
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    I'm guessing the DVers are thinking that it's possible to have coinsurance before the deductible is met. I've never heard of that but I suppose it's possible. – TTT Jul 19 '17 at 20:53
  • @TTT I've never heard of that, I've never seen. It's directly opposed to the definition of a deductible. Unless the deductible is specifically waived (like office visit co-pays or preventive care) it applies. This is a simple answer to a simple question. – quid Jul 19 '17 at 21:04
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    I just did a search for "coinsurance before deductible". There were plenty of hits, though they are mostly non reputable links. Except one and it says "0% coinsurance before deductible" which is specifically waived like you stated. Perhaps before ACA there actually were some specific types of coverage that had coinsurance before the deductible is met. I can't remember any though. Perhaps nowadays, in the US, coinsurance always implies "after deductible", which, if true, would be redundant. Good edit btw. – TTT Jul 19 '17 at 22:45
  • It's not redundant. You will sometimes see things with coinsurance but no deductible. – Loren Pechtel Jul 19 '17 at 23:59

"Coinsurance" means the amount you have to pay on any claim.

When they say "20% coinsurance after deductible", this means that you have to pay the entire amount of all bills that this clause applies to until you reach the deductible, and after that you pay 20% and the insurance company pays 80%. "100% coinsurance" means that the deductible is irrelevant, you always pay 100%.

I suppose it's redundant in the sense that if they said "100% coinsurance after deductible", that would mean you pay 100% until you reach the deductible, and after that you pay ... 100%.

  • Nice example of what would have been redundant. Hehe. – TTT Jul 19 '17 at 20:31
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    Not sure it's redundant, isn't the difference that out-of-network spending does not count towards your deductible? – Relaxed Jul 20 '17 at 5:34
  • @Relaxed That's a good point. – Jay Jul 20 '17 at 13:07

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