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Related to out-of-pocket costs: Opportunity costs, Sunk costs


In insurance, a fee that a policyholder must pay for certain covered items for which the insurance company otherwise pays. For example, a check-up with a doctor may cost the policyholder a copayment of $25, with the insurance company paying for the remainder of the cost due. A copayment is also called a co-pay and should not be confused with a deductible. It exists to discourage policyholders from abusing the insurance policy.


If you have a managed-care health insurance plan, your copayment is the fixed amount you pay -- often $10 to $25 -- for each in-network doctor's office visit or approved medical treatment

In some plans, the copayment to see a specialist to whom you're referred is higher than the copayment to visit your primary care physician. Some plans may not require copayments for annual physicals and certain diagnostic tests.

If you see an out-of-network provider, you are likely to be responsible for a percentage of the approved charge, called coinsurance, plus any amount above the approved charge.

References in periodicals archive ?
Bronze level products have the lowest monthly premium but also have the highest member out-of-pocket costs.
Dispute was born as a result of its founder's personal experience, who watched as a family member faced more than $40,000 of out-of-pocket costs following a sudden heart attack and subsequent surgery.
Out-of-pocket costs include a health plan's annual deductible, which is the amount before insurance starts paying, as well as any copayments and cost-sharing.
of respondents expect their out-of-pocket costs (for co-pays and deductibles) to increase
It's important to factor in the out-of-pocket costs for prescription drugs when shopping for Medicare prescription drug coverage because every plan has a different drug formulary, or set of Medicare Part D approved drugs that it will pay for, and the cost-sharing for covered drugs typically varies from plan to plan.
For such beneficiaries who use a given specialty tier-eligible drug, different cost-sharing structures result in varying out-of-pocket costs only until they reach the catastrophic coverage threshold, which 31 percent of these beneficiaries did in 2007.
First, the decision to initiate therapy with these drugs is somewhat, but not highly, responsive to patient out-of-pocket costs.
Deducting the resale value of the old combine after five years and the tax savings from check-ups, repairs, overhaul, and depreciation leaves net out-of-pocket costs of $30,409.
While employers and employees typically share premium costs, employees are fully responsible for out-of-pocket costs, unless employers contribute to health savings accounts.
For the 2006 year, the company expects service revenue, excluding reimbursed out-of-pocket costs associated with client projects and programs, to be in the range of $325 to $330 million.
Dual eligibles, and those who are eligible for a Medicare Savings Program or get Supplement Security Income (SSI) benefits, automatically qualify for "extra help" to reduce their out-of-pocket costs.
Being able to recover all reasonable out-of-pocket costs and potentially lost wages should encourage taxpayers to litigate cases where the IRS appears to have no reasonable basis for the items in a deficiency notice.