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cost sharing

What is cost sharing?

Cost-sharing refers to the fact that you – as a health insurance policy holder – and your health insurance company share in the cost of your covered healthcare services. (“Covered” doesn’t mean the health plan pays for all of it.)

Your portion of the cost-sharing is determined by the deductible, copays, and/or coinsurance, depending on how your plan is designed. Not all plans include all of those cost-sharing features, but all plans include at least one or two of them.

Once your portion of the cost-sharing (for in-network services) reaches the amount that the plan has set as the out-of-pocket maximum, you won’t have to pay any additional cost-sharing for the rest of the year – as long as you use in-network providers and follow any prior authorization rules set by your plan.

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