Georgia Navigator Practice Exam

What does coinsurance entail?

1. Paying the full amount for a claim

2. A share of expenses after the deductible is met

3. Payment made entirely by the insurance company

4. Cost associated with preventive care services

The correct answer is: A share of expenses after the deductible is met

Coinsurance is a cost-sharing agreement in a health insurance policy, where after the insured has met their deductible, both the insured and the insurance company share the expenses for covered health services. This typically means that the insured is responsible for a specified percentage of the costs, while the insurance company pays the remainder. For example, if a health plan has a coinsurance rate of 20%, the insured would pay 20% of the medical costs after the deductible is met, and the insurance company would cover the remaining 80%. Understanding this concept is crucial for managing healthcare expenses effectively and knowing how much out-of-pocket cost can be expected after a deductible has been reached. The other options do not accurately describe coinsurance. Paying the full amount for a claim refers to situations where the insured has not yet met their deductible or is in a policy that does not offer coinsurance at all. Likewise, total payment by the insurance company would indicate no cost-sharing, which contradicts the fundamental idea of coinsurance. Finally, preventive care services often have different cost-sharing rules, including potential no-copay features, which do not align with the concept of coinsurance.