What Is Medicare Coinsurance?
Short answer
Coinsurance is your share of the cost of a covered service after Medicare or a plan applies its payment rules. It is often a percentage, but some Medicare benefits use daily coinsurance amounts.
Coverage
Part B commonly uses percentage coinsurance based on the Medicare-approved amount. Part A hospital and skilled-nursing benefits can use daily coinsurance during later portions of a covered stay.
Not Automatic
Do not assume a single coinsurance percentage applies to all Medicare services. Benefit, setting and plan determine the rule.
Costs And Ma
Annual Part A and Part B dollar amounts can change. Medicare Advantage plans may use copayments or coinsurance defined in the current Evidence of Coverage.
Practical Example
A Part B physician service may use percentage coinsurance, while an extended Part A inpatient stay can use a daily coinsurance amount instead.
Questions to verify
- Which Medicare part or plan benefit applies?
- Is this percentage coinsurance or a daily amount?
- Am I looking at current-year values?