Health Insurance Mastery Practice Exam

What cost-sharing feature requires the insured to pay a certain percentage of medical expenses after the deductible has been met?

1. Copayment

2. Deductible

3. Coinsurance

4. Out-of-pocket maximum

The correct answer is: Coinsurance

The correct answer is coinsurance. Coinsurance is a cost-sharing feature in health insurance plans where the insured pays a certain percentage of the medical expenses after they have paid the deductible. For example, if a plan has an 80/20 coinsurance, the insurer would cover 80% of the costs for eligible expenses post-deductible, and the insured would be responsible for the remaining 20%. This arrangement means that the insured shares in the cost of their healthcare services, which can help reduce overall insurance premiums but also requires the insured to budget for their medical expenses even after the deductible has been satisfied. The other options describe different aspects of health insurance. A copayment is a fixed amount paid for specific services, like doctor’s visits or prescriptions, and is usually due at the time of service. The deductible is the amount the insured must pay out-of-pocket for healthcare before their insurance begins to pay. The out-of-pocket maximum is the upper limit on the total amount an insured individual has to pay for covered services in a policy period, after which the insurance covers 100% of the costs. Understanding these distinctions is crucial for navigating health insurance effectively.