Certified Medical Assistant Practice Exam

When an insurance policy pays a percentage of the balance after application of the deductible, it is referred to as

1. Co-payment

2. Coinsurance

3. Deductible

4. Premium

The correct answer is: Coinsurance

The correct term for when an insurance policy pays a percentage of the balance after the deductible has been applied is coinsurance. Coinsurance is the arrangement wherein, after the deductible amount is met, both the insurance company and the insured share the costs of covered services. For example, if a policy has an 80/20 coinsurance, the insurance pays 80% of the costs while the insured pays the remaining 20%. Co-payment refers to a fixed amount that a patient pays for a specific service at the time of care, such as a set fee for a doctor’s office visit. A deductible is the amount that the insured must pay out-of-pocket before the insurance company begins to cover expenses. The premium is the amount paid periodically to the insurance company for coverage, and it is distinct from the costs associated with utilizing the insurance benefits.