Texas All Lines Adjuster Practice Test

In the context of health insurance, what does coinsurance refer to?

1. The total amount covered by the insurance

2. The deductible amount that must be paid

3. The portion of a covered claim the insured pays after the deductible

4. The percentage that the insurer pays for the claim

The correct answer is: The portion of a covered claim the insured pays after the deductible

Coinsurance in the context of health insurance refers specifically to the portion of a covered claim that the insured is responsible for paying after the deductible has been met. This means that once the insured has paid their deductible, they share in the costs of their healthcare services with their insurance company according to a predetermined percentage. For instance, if a health plan has a coinsurance rate of 20%, the insurer will cover 80% of the claim, while the insured is responsible for the remaining 20%. This arrangement helps balance the sharing of healthcare costs between the insurer and the insured, incentivizing responsible usage of health services. Understanding coinsurance is essential for policyholders, as it directly impacts their out-of-pocket costs for medical services after they satisfy any deductible requirements.