What is a coinsurance cap?

A coinsurance cap is an element of a health insurance policy in Washington State. It refers to the maximum amount of coinsurance (a form of cost sharing between an insurance company and a policy holder) that an insured person must pay out of pocket for care before the insurer pays 100 percent of the balance. Coinsurance is typically a percentage of the total cost of care; for example, if the coinsurance is 20 percent, the insurer pays 80 percent and the policy holder pays 20 percent. A coinsurance cap limits the amount the person must pay for their share of the costs. For example, if the coinsurance cap is $2500, an insured person must pay no more than $2500 for covered services and care before the insurance company covers the rest of the cost for the policy holder.

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What is a coinsurance cap?

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