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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.
Farlex Financial Dictionary. © 2012 Farlex, Inc. All Rights Reserved


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.

Dictionary of Financial Terms. Copyright © 2008 Lightbulb Press, Inc. All Rights Reserved.
References in periodicals archive ?
As shown in Table 5, out-of-pocket costs would range from $334 for a pneumonia episode to $15,241 for stroke.
Caption: The goal is to help keep out-of-pocket costs low for seniors.
"Capping out-of-pocket costs -- and ultimately passing a final bill with caps as low as possible -- would make drugs more affordable for elderly patients and improve their ability to pay for drugs, sustain their prescribed regimen, and improve their overall health," stated Alan G.
Researchers found that of 106 patients who started tyrosine kinase inhibitors (TKIs) for advanced lung cancer, one-quarter with the highest out-of-pocket costs died sooner: They were more than twice as likely to have died three months after beginning treatment, than patients with the lowest personal costs.
Prices and out-of-pocket costs are lower, and will go lower still, because of the work we did to execute on President Trump's American Patients First blueprint.
Insurance companies used to apply the value of these copay cards to a person's out-of-pocket costs, but now these discount cards come with a steep price tag.
The bill would limit drug copays for people with the Medicare Part D prescription plan by capping their out-of-pocket costs at $3,100 per year starting in 2022, the Associated Press reported.
Over that time period, both total and out-of-pocket costs were considerably and consistently higher for those aged 65 years and older than for those under 65.
-- Cigna and Express Scripts recently announced a program aimed at capping eligible consumers' out-of-pocket costs for insulin at $25 a month.
The Patient Assurance Program will be available to members in participating non-government funded pharmacy plans managed by Express Scripts, including Cigna and many other health plans, with out-of-pocket costs for insulin greater than $25.
Maine and Vermont have limits on the annual out-of-pocket costs to consumers, and Virginia and five other states require insurance companies to provide notice to consumers of cost-sharing tiers and all changes to the plans.