What is meant by cost sharing in health insurance?

Prepare for the Certified Billing and Coding Specialist Exam. Improve your skills with multiple choice questions; each question comes with hints and explanations. Get confident for your exam!

Cost sharing in health insurance refers to the expenses that the insured individual must pay out of their own pocket in addition to what the insurance covers. This typically includes deductibles, copayments, and coinsurance. When a person gets healthcare services, even with insurance, they still have a financial responsibility. The balance the policyholder must pay to the provider after their insurance has made its payment is considered cost sharing. This directly reflects the concept that even when insurance is involved, the cost of healthcare is not borne solely by the insurer, but shared with the policyholder.

The other options provided do not accurately reflect the definition of cost sharing. The total amount billed by the provider represents the full price before any insurance adjustments or payments are made. The portion of costs covered by insurance refers to how much of the medical expenses the insurer will pay, which does not account for what the insured person must contribute. Lastly, the insurance premium is the regular fee paid for the policy and does not involve the cost-sharing mechanisms that occur during service utilization.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy