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Dean George is the Marketing Specialist and Content Creator for Dental Insurance
Store and its social media channels. He is a regular contributor to Agent Straight Talk, the
only consumer blog explaining the ins, outs and in-betweens of dental insurance and
discount dental plans. READ MORE

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Know the Difference Between Copays and Coinsurance?

Jan 04, 2012

Insurance gobbledygook is one of the most frustrating things about insurance. (That and those pesky premiums)  Would anyone be surprised if the origin of insurance jargon was traced back to a marathon Scrabble contest? Or maybe a spilled can of alphabet soup on a Ouija board? Is it even possible to understand insurance without having a law degree and a copy of Merriam-Webster?

In a previous post we attempted to shine the light of knowledge on the tangled web of insurance terminology by explaining the difference between "copays" and "deductibles". Just as confusing as the former is the difference between "copay" and "coinsurance". Unless insurance is your occupation (unlikely) or you are oddly preoccupied with insurance terms (even more unlikely), the difference between these terms may be as indistinguishable as shades of blue to the color-blind.

Let's review for a moment: In the earlier post a copay was described as a fixed amount that you must pay for a dental procedure or visit. For example, a dental visit may require a $10 copay plus a copay for whatever procedure is provided.

Coinsurance is a percentage of a dentist's charge you may be required to pay as opposed to a fixed amount or flat-fee copay. Explained another way, coinsurance is a cost-sharing platform between you and your dental plan and the amount of coinsurance required usually varies by the type of service performed.

Let's say that you are enrolled in a PPO plan that pays 80% coinsurance on a routine exam and X-rays and you've already met your $50 annual deductible. If your dental visit cost $80, and the plan pays 80% of the $80 charge, or $64, you would pay the remaining 20%, or $16.

As a general rule, DHMO's require copays, PPO's require coinsurance, and indemnity plans may require either. Discount dental plans don't involve either copays or coinsurance, but rather negotiated discounts for dental services.

We carry all these type of plans at so we invite you to click the Get Quote button on any page of this site to view available plans in your area.

Congratulations! You now know the difference between copays and coinsurance. Please visit again soon as we continue shining the light on the nooks and crannies of insurance terms. If you have further questions about these insurance terms or others, email me at:

Find me on Twitter at Twitter@ToothTeller

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Copyright 2012, Bloom Insurance Agency, LLC ©


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