After your health insurance policy deductible, most plans have an additional cost sharing feature called co‐insurance.
Co‐insurance refers to the amount your insurer pays alongside what you pay. If, for example, your plan has a Preferred Provider Option (PPO), i.e. a Network of doctors and hospitals, the coinsurance might be 90/10 In Network and 70/30 Out of Network. That means, your insurer pays 90% of charges for In Network claims but only 70% for those Out of Network.
Here’s where it gets tricky.
Newer plan design options might require that all care must be received within an Accountable Care Organization (ACO). The Out of Network co‐insurance in that case – the amount you pay – could be 100%.
That should get your attention!