What is a coinsurance cap?

A coinsurance cap is a type of limit on the amount of coinsurance that a person has to pay in relation to their health insurance plan. Coinsurance is the percentage of a medical cost that a person must pay out of pocket after the deductible is paid. Coinsurance caps limit the amount of coinsurance a person has to pay on any given medical procedure, even if it surpasses the normal amount of coinsurance for the plan. For example, if a health insurance plan has a coinsurance rate of 20%, and a coinsurance cap of $2,000, a person on that plan may only be responsible for paying a maximum of $2,000 for any medical procedure, even if the total cost of the procedure is much higher. The remaining amount would be covered by the insurance company. In Texas, coinsurance caps are governed by the Texas Health Care Rights and Responsibilities Act (THCRRA). According to this law, insurers are limited to charging no more than $1,000 per person per year in coinsurance. This cap applies to all health insurance policies purchased in Texas, and it cannot be exceeded, regardless of the policy’s coinsurance rate. By having coinsurance caps, Texas residents can ensure that they will not be held financially responsible for excessive medical bills. It also helps ensure that people have access to the medical care they need rather than being unable to afford the coinsurance rate associated with more advanced treatments.

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What is a coinsurance cap?

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