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Understanding Cost Sharing: Deductibles, Copayments & Coinsurance

​All health insurance requires consumers to pay some of the cost of covered health care services. This is called "cost sharing" or "out-of-pocket" costs. Cost sharing varies with different types of health plans, but most will have a copayment, coinsurance or deductible amount. 

Cost Sharing Requirements

  • Your plan may require you to pay before the plan begins to pay. This is called a deductible (e.g. if your deductible is $500 per year you would pay the first $500 of incurred medical expenses). Plans also may charge a deductible for certain services (e.g., you pay $100 for a hospital stay).
  • You also may need to pay a portion of each visit called a copayment (e.g., you pay $10 for each prescription medication). You may have a copayment for emergency room services. Also check your plan for details emergency services for non-emergency problems.
  • Some plans require you to pay part of each service as a coinsurance (e.g., 20% of the cost of a service).

Children's Preventive Services

Children's preventive services, such as well-child checkups and immunizations, may or may not be covered without cost sharing. You should carefully review your plan's benefit description for details. The best time to review a plan is before you sign up with it.

Methods of Payment

Before visiting your child's doctor, check the accepted methods of payment for your out-of-pocket expenses. Options for payment may include cash, check, or credit card. Remember to bring your insurance card with you to each visit.

Last Updated
American Academy of Pediatrics (Copyright © 2013)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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