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Cost Sharing

What is Cost Sharing?

The portion of healthcare expenses that you are responsible for paying out of your own pocket, even when you have insurance coverage. Cost sharing typically encompasses various elements, including deductibles, coinsurance, and copayments. However, it does not include insurance premiums, amounts charged by non-network providers through balance billing, or the expenses associated with services not covered by your insurance plan. In Medicaid and CHIP, cost-sharing also includes premiums.

Key Points:

  • Cost sharing involves the financial responsibility that individuals have for certain healthcare expenses, beyond what their insurance covers.
  • It includes out-of-pocket costs like deductibles, coinsurance (a percentage of the bill), and copayments (fixed fees).
  • Cost sharing does not cover insurance premiums, charges from out-of-network providers not covered by insurance, or services excluded from the insurance plan.
  • In Medicaid and CHIP, cost sharing extends to premiums paid by beneficiaries.

“Glossary.” HealthCare.gov, www.healthcare.gov/glossary/.

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