Medical Assistant Certification (MAC) AMCA Practice Exam

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How is co-insurance calculated?

Flat fee per service
Percentage of total cost
% of charge
Fixed annual deductible

The correct answer is: % of charge

Co-insurance refers to the percentage of the total cost of a covered healthcare service that a patient is responsible for after meeting their deductible. It is typically calculated as a percentage of the allowable charges for the service received. For instance, if a health plan specifies an 80/20 co-insurance, the insurer pays 80% of the allowed amount, and the patient would be responsible for the remaining 20%. This method allows for shared financial responsibility between the payer (insurance company) and the patient, which can help manage healthcare costs and prevent overutilization of services. This is why calculating co-insurance is based on a percentage of the total cost rather than a flat fee, a percentage of charges, or a fixed annual deductible. Each of those alternatives represents different methods of cost-sharing or payment structures that don't align with how co-insurance specifically functions.