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What is Cost Sharing?

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Summary

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Cost sharing is when more than one party pays for a total cost. In health care, cost sharing means patients pay part of the costs that insurance doesn’t cover. This includes deductibles, coinsurance, and copayments.

Frequently Asked Question

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What is cost sharing in healthcare?

Cost sharing is when patients pay a portion of healthcare costs that their insurance doesn’t cover, such as deductibles, copayments, and coinsurance.

How does cost sharing work?

Cost sharing requires patients to pay a percentage of the costs for covered healthcare services, while insurance covers the rest.

What are examples of cost sharing?

Examples of cost sharing include copayments for doctor visits, deductibles for hospital stays, and coinsurance for prescriptions.

Why is cost sharing important?

Cost sharing helps manage healthcare expenses by making patients responsible for a portion of the costs, encouraging them to make cost-effective healthcare decisions.

Scientific Definition

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Cost sharing refers to the portion of healthcare expenses that patients are required to pay out of pocket after their insurance has paid its share. This typically includes deductibles, coinsurance, and copayments, but not premiums or costs for non-covered services.

Helpful Resources

A Real Life Example of Cost Sharing

Let’s look at how cost sharing affects a child named Ben, who has ADHD and needs regular therapy.

  • Therapy sessions: Ben’s insurance covers 80% of the therapy cost, and his parents pay the remaining 20%.
  • Medication: Ben’s medication costs $100, and his insurance covers $80. His parents pay $20.
  • Doctor visits: Each visit has a $30 copayment, which his parents pay each time.

By understanding cost sharing, Ben’s parents can better plan for his healthcare expenses.

How Does Cost Sharing Work?

Cost sharing works by splitting healthcare costs between the insurance company and the patient. Here are some examples:

  • Deductibles: The amount paid before insurance starts covering costs.
  • Coinsurance: The percentage of costs the patient pays after the deductible is met.
  • Copayments: A fixed amount paid for each healthcare service.
Type of Cost Sharing Example
Deductible $500 per year
Coinsurance 20% of service cost
Copayment $30 per visit

Understanding these terms helps parents manage healthcare costs effectively.