If a plan has a $2,000 deductible and 30% coinsurance, and a covered bill of $5,000, what is the insured's payment after meeting the deductible?

If a plan has a $2,000 deductible and 30% coinsurance, and a covered bill of $5,000, what is the insured's payment after meeting the deductible?

• A. $600
• B. $0
• C. $900
• D. $1,400

Answer: (C)

When a plan has both a deductible and coinsurance, you first satisfy the deductible, then the coinsurance applies to the remaining allowed charges. Here, the bill is 5,000 and the deductible is 2,000, so 3,000 of charges remain after meeting the deductible. With a coinsurance of 30%, the insured pays 30% of that remaining amount, which is 0.30 × 3,000 = 900. So the insured’s payment after the deductible is 900. The insurer would cover the other 2,100, and the total out-of-pocket (including the deductible) would be 2,900.

When a plan has both a deductible and coinsurance, you first satisfy the deductible, then the coinsurance applies to the remaining allowed charges. Here, the bill is 5,000 and the deductible is 2,000, so 3,000 of charges remain after meeting the deductible. With a coinsurance of 30%, the insured pays 30% of that remaining amount, which is 0.30 × 3,000 = 900. So the insured’s payment after the deductible is 900. The insurer would cover the other 2,100, and the total out-of-pocket (including the deductible) would be 2,900.