Private Health Insurance Direct Questions

What is coinsurance on a private health plan?

Coinsurance is the percentage of the cost of a covered health service you pay after you've met your deductible, and it applies until you reach the plan's out-of-pocket maximum (HealthCare.gov Glossary — Coinsurance).

Reviewed by Jason Burns, Editor & Steward · Last verified 2026-07-19

What it means

  • A common private PPO structure is 20% coinsurance in-network after deductible.
  • Higher metal tiers (Gold, Platinum) typically have lower coinsurance.

Action steps

  1. Confirm coinsurance rates for both in-network and out-of-network care.
  2. Include expected coinsurance in your annual out-of-pocket estimate.

Risks & deadlines

  • Coinsurance can be much higher out-of-network on any PPO.

Sources

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Source: full plain-language answer at Private Health Insurance Direct Answers. Licensed under Citation License 1.0 (terms).