Coinsurance
Also known as: Cost-Sharing, 20% Cost-Sharing
The percentage of a Medicare-approved cost that the beneficiary pays after the deductible — typically 20% under Part B.
Coinsurance is the portion of Medicare-approved costs that the beneficiary is responsible for after the annual deductible is met. Under Medicare Part B, the standard coinsurance is 20% of the Medicare-approved amount for most covered services, including DME.
For diabetic supply costs: if Medicare approves $100/month for test strips, Medicare pays $80 and the beneficiary owes $20 in coinsurance. Without a Medigap plan, this 20% accumulates across all Part B services and has no cap in Original Medicare.
Medigap plans (Plans C, D, F, G, M, N) cover all or part of the 20% coinsurance. Medicare Advantage plans typically substitute copays (fixed dollar amounts) for the percentage-based coinsurance structure. For beneficiaries with significant DME needs — CGM, insulin pump, therapeutic shoes — the Medigap coinsurance coverage can represent hundreds to thousands of dollars per year in savings.
Frequently asked
What is Coinsurance?
The percentage of a Medicare-approved cost that the beneficiary pays after the deductible — typically 20% under Part B. Coinsurance is the portion of Medicare-approved costs that the beneficiary is responsible for after the annual deductible is met. Under Medicare Part B, the standard coinsurance is 20% of the Medicare-approved amount for most covered services, including DME.
How does Coinsurance relate to Medicare coverage?
Medicare Part B covers most durable medical equipment related to Coinsurance. Contact us to verify your specific coverage for related diabetic supplies.
Where can I get diabetic supplies related to Coinsurance in Phoenix?
We deliver Medicare-covered diabetic supplies throughout the Phoenix metro area. Call us or complete the form above to verify your coverage.