Medical Insurance Coverage Percentages: What You'll Pay Out-of-Pocket
Insurance coverage varies by plan type, network status, and service category.
Typical Coverage Ranges
| Plan Type | In-Network Coverage | Patient Share | Notes |
|---|---|---|---|
| PPO | 70–80% | 20–30% (coinsurance) + deductible | Out-of-network: lower %, higher OOP max |
| EPO | 70–80% | 20–30% | No out-of-network coverage (except emergency) |
| HMO | 90–100% | $0–$50 copay | PCP referral required; strict network |
| Medicare (Part B) | 80% | 20% coinsurance (no cap) | Medigap/Advantage plans alter this |
| Medicaid | Varies by state | Often $0–$5 copay | Comprehensive for eligible populations |