This is your share of the cost of services when you seek treatment at a doctor, specialist, urgent care, emergency room, or hospital. Your share of the costs may include co-payments (or copayments), deductible(s), and coinsurance amounts.
Family cost sharing refers to the share of the costs for deductibles and out-of-pocket costs for you, your spouse, and children that you must pay out of pocket.
Other costs, such as your insurance premiums, balance billing amounts for use of non-network health care providers, or the costs of care not covered by your plan are not considered in determining your cost sharing.
All health plans have an out-of-pocket maximum for covered services. After you reach your policy’s maximum, your insurer will pay 100% for future in-network services.
If you get your health insurance through HealthCare.gov or a state exchange, you could be eligible for a Cost Sharing Reduction (CSR). That allows you to receive discounts that reduce your out-of-pocket costs on deductibles, copays, and coinsurance if you are a lower-income individual buying a Silver-tier Affordable Care Act plan. Ask your ACA enroller or health insurance agent or broker for more information.