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Cost sharing
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Cost sharing refers to the share of health costs that an insured individual pays out-of-pocket. Cost sharing typically includes deductibles, copays, coinsurance, and out-of-pocket maximums, and does not include any amount paid for services that are not covered.[1]
Overview
Cost sharing is an insured individual's costs for covered benefits during their policy period. It typically includes deductibles, copayments, coinsurance, and out-of-pocket maximums. As they are not part of covered benefits, it does not include premiums, any costs for services that are not covered, or balance billing. Therefore, cost sharing does not reflect the total cost to the insured for healthcare services they may use. The Affordable Care Act requires that all plans cover at least 60 percent of the costs for covered benefits, an amount referred to as the actuarial value of the plan.[2]
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