Coinsurance After Deductible: The 20% That Feels Like 200%

Last updated: January 2025

"Great news! You've met your $10,000 deductible. Now you only pay 20%!"

Only. Only 20%. Like 20% of catastrophic medical bills is pocket change.

My spine surgery was $87,000. My 20% "only" cost me $17,400. On top of the $10,000 deductible I'd already paid.

That's $27,400 for one surgery. But hey, at least I "only" paid 20% after the deductible!

The Coinsurance Con Game

Here's what they don't explain clearly when you sign up:

Phase 1: You pay 100% until you hit $10,000 (deductible) Phase 2: You pay 20% of everything after that Phase 3: You pay until you hit out-of-pocket max ($15,000 typical) Phase 4: Insurance finally covers 100%

Notice how you're still paying thousands in Phase 2? That's the coinsurance scam.

Real Bills That Show the 20% Horror

The Cancer Treatment Nightmare

My neighbor's breast cancer treatment:

Deductible: $10,000 (paid) Surgery: $45,000 x 20% = $9,000 Chemotherapy: $150,000 x 20% = $30,000 Radiation: $65,000 x 20% = $13,000 Scans/Tests: $25,000 x 20% = $5,000

Wait, that's $57,000 in coinsurance!

Out-of-pocket maximum "saves" her: Capped at $15,000

Total paid: $10,000 (deductible) + $5,000 (coinsurance to max) = $15,000

"Only" $15,000 for cancer. What a deal!

My Spine Surgery Breakdown

Pre-deductible costs: $10,000 (various appointments, MRIs, etc.) Surgery cost: $87,000 My 20% coinsurance: $17,400 But wait... Out-of-pocket max: $15,000 So I "only" paid: $5,000 more

Total for the year: $15,000 Insurance "saved" me: $12,400 in coinsurance I still paid: A car's worth of money

The Services Where 20% Destroys You

Specialty Drugs

Dialysis

NICU Stay

Air Ambulance

The Math That Makes You Scream

Let's say you need a procedure that costs $50,000:

Without insurance: $50,000 (but negotiable, often reduced to $20,000 cash)

With insurance (haven't met deductible): $50,000 (you pay all)

With insurance (met deductible): $10,000 (your 20%)

With insurance (met out-of-pocket max): $0

But to get to that $0, you've already paid $15,000 that year. So it's not really $0, is it?

The January vs December Coinsurance Trap

January Surgery:

• Pay $10,000 deductible
• Pay 20% coinsurance until hitting $15,000 max
• Rest of year: Everything covered!
• Actually beneficial (if you can afford it)

December Surgery:

• Already met deductible (maybe)
• Pay 20% coinsurance
• January 1st: RESET
• Same surgery follow-up now costs full price again

The same 20% coinsurance has completely different financial impacts based on the calendar.

When 20% Equals Bankruptcy

Real examples where 20% destroyed families:

Tom's Heart Transplant:

• Procedure: $1,400,000
• His 20%: $280,000
• Out-of-pocket max "saved" him
• Still paid: $15,000
• Plus: Anti-rejection drugs forever at 20%

Lisa's Premature Twins:

• NICU bill: $2,100,000
• Her 20%: $420,000
• Out-of-pocket max: $15,000
• Paid $15,000 while on unpaid maternity leave

David's Car Accident:

• Multiple surgeries: $380,000
• His 20%: $76,000
• Out-of-pocket max: $15,000
• Lost job during recovery, couldn't pay

The Out-of-Network Coinsurance Disaster

Here's what they really don't tell you:

In-network: 20% coinsurance counts toward out-of-pocket max

Out-of-network: Could be 40% coinsurance with NO maximum

Emergency surgery, anesthesiologist is out-of-network:

• Their bill: $15,000
• Your 40%: $6,000
• Doesn't count toward out-of-pocket max
• You pay forever

The Alternative to Coinsurance Chaos

This is where services like MyPhysicianPlan make sense for routine care.

With MyPhysicianPlan:

• No coinsurance calculations
• No percentage math
• One flat rate
• You know exactly what you'll pay

For major medical events, you still need traditional insurance. But for the 90% of healthcare that's routine, MyPhysicianPlan removes the coinsurance confusion.

The Psychology of "Only" 20%

Insurance companies are masters of framing:

"You only pay 20%" sounds so much better than:

• "You pay $17,400 of your $87,000 surgery"
• "You pay $30,000 of your cancer treatment"
• "You pay until we decide you've paid enough"

That word "only" does heavy psychological lifting.

Countries That Don't Do This

Germany: Maximum 2% of annual income for all healthcare Japan: 30% coinsurance but monthly cap of ~$1,000 UK: 0% coinsurance. It's free. France: 20% coinsurance but most have secondary insurance that covers it USA: 20% until you're bankrupt or hit an arbitrary maximum

The Coinsurance Shopping Impossibility

Try asking for prices to calculate your 20%:

"How much will my surgery cost?" "We won't know until after."

"Can I get an estimate?" "It depends on many factors."

"How can I budget for 20% if I don't know the total?" "🤷‍♀️"

You're expected to agree to pay 20% of a number nobody will tell you.

Real People's Coinsurance Horror Stories

Mary, Teacher: "20% of my MS medications is $1,100/month. That's my mortgage."

James, Contractor: "Kidney stones required lithotripsy. My 20% was $3,400. For a 30-minute procedure."

Sandra, Freelancer: "Needed foot surgery. My 20% was $8,000. I'm still paying it off 3 years later."

The Coinsurance Fine Print

What counts toward coinsurance:

• "Allowed amounts" (not actual bills)
• In-network providers only
• Approved procedures only
• Correctly coded services only

What doesn't count:

• Balance billing
• Out-of-network anything
• Non-covered services
• Billing errors (until fixed)

Good luck figuring out which is which!

The Bottom Line

20% coinsurance after meeting a $10,000 deductible isn't insurance - it's a discount program with a $10,000 entry fee.

You pay thousands to earn the right to pay 20% of bills that can reach hundreds of thousands.

The insurance company acts like they're doing you a favor by "only" making you pay 20% of astronomical bills.

In any other industry, paying full price for something, then paying 20% of future purchases, wouldn't be called insurance. It would be called a scam.

But in healthcare, we're supposed to be grateful for the privilege of "only" paying 20% into bankruptcy.

That's not insurance. That's institutionalized theft with a percentage calculator.

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Note: Based on actual coinsurance bills and out-of-pocket experiences. Your 20% may vary based on how creatively your provider bills.