Which of the following terms defines the portion of costs the insured must cover?

• A. Cost sharing
• B. Capitation
• C. Enrollment
• D. Coverage

Answer: (A)

Cost sharing is the portion of medical costs the insured pays out of pocket. It includes deductibles, copayments, and coinsurance, and it continues until the insured reaches the plan’s out-of-pocket maximum. This concept describes how, even with insurance, the patient must share in the cost of care to some extent. Capitation refers to a fixed payment to a provider per patient, enrollment is the process of joining a plan, and coverage is the protection the plan offers. So, the term that defines the insured’s share of costs is cost sharing.