Co-pay & Coinsurance Terms

Wellmark Blue Cross and Blue Shield of Iowa are offering three new Medicare Prescription policies. Please explain what they mean by co-pay and/or coinsurance. What does 30% coinsurance mean?



Co-payment is a fixed amount paid by the member for covered services at the time they are rendered or for prescription medications. For instance, every time you have a doctor's visit, you might have a specific fee amount that you have to pay and the rest is paid by your insurance. In most cases, a co-payment is relatively small.


Coinsurance is different. In medical insurance, the insured person and the insurer sometimes share the cost of services under a policy in a specified ratio, for example 80% by the insurer and 20% by the insured. This is coinsurance. By this means, the cost of coverage to the insured is reduced. If the policy says 30% coinsurance, than I would expect that you would pay 30% of the fee for a medical procedure or visit and the insurance company would pay 70%.

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