Coinsurance
Clinical reviewer: Elena Gizzi, MSN, RN · Last checked September 16, 2026
What is coinsurance?
Coinsurance is the percentage of a covered service's cost you pay, such as 20%, after you've met your deductible. Unlike a copay's flat dollar amount, coinsurance rises and falls with the plan's allowed cost for the drug or service, so your share for a GLP-1 prescription depends on its price.
How much do you pay with coinsurance?
Coinsurance is a percentage, not a set fee. HealthCare.gov's example shows 20% coinsurance on a $100 allowed cost works out to a $20 payment, with the plan covering the rest [1]. Because the percentage applies to the service's actual allowed cost, your dollar share for a GLP-1 prescription changes with its price, unlike a fixed copay.
Does coinsurance count toward your out-of-pocket maximum?
Yes. Coinsurance you pay for covered, in-network care counts toward your plan's out-of-pocket maximum, along with deductibles and copayments [2]. Once you reach that maximum for the plan year, your plan pays 100% of the cost for covered benefits, including a covered GLP-1 prescription, for the rest of the year [2].
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This entry is for education and is not medical advice. Talk with a licensed clinician about your own situation before starting, stopping, or changing any treatment.
