Out-of-pocket cost

Out-of-pocket cost refers to the direct outlay of cash that may or may not be later reimbursed from a third-party source. It is a term used in healthcare to refer to the portion of the payment for medical services and treatment that the patient pays out of their own pocket (directly) because it is not covered by health insurance.

Definition

The term "out-of-pocket cost" refers to the expenses that an individual pays out of pocket for healthcare services. These costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

Types of Out-of-Pocket Costs

Deductibles

A deductible is the amount you pay for healthcare services before your health insurance begins to pay.

Coinsurance

Coinsurance is your share of the costs of a healthcare service. It's usually figured as a percentage of the amount we allow to be charged for services.

Copayments

A copayment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service.

Impact on Healthcare

Out-of-pocket costs have a significant impact on healthcare. They can affect the affordability of healthcare and can also influence the decision to seek medical care.

See Also

• Healthcare costs
• Health insurance
• Deductible
• Coinsurance
• Copayment

Out-of-pocket cost Resources
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