Costshares

Costshares represent a portion of the cost of a covered healthcare service that a patient is responsible for paying. This is distinct from deductibles, which must be met before most insurance benefits begin, and copayments, which are typically fixed amounts paid at the time of service. Costshares often apply after a deductible has been met and are usually expressed as a percentage of the total cost of the service. For example, an insurance plan might have an 80/20 costshare, meaning the insurer pays 80% of the covered cost and the patient pays the remaining 20%. This patient's portion is the costshare.

These costsharing arrangements are a common feature in many health insurance plans, including employer-sponsored plans, individual market plans, and government programs like Medicare. The specific costshare percentages can vary significantly between different insurance plans and often depend on factors such as the type of service (e.g., primary care visit, specialist visit, hospitalization, prescription drugs) and whether the provider is in the plan's network. Out-of-network services typically have higher costshare responsibilities for the patient. Understanding costshares is crucial for policyholders to accurately estimate their out-of-pocket expenses for healthcare services. It is advisable to review your insurance policy documents or contact your provider to determine your specific costsharing obligations.