Cost sharing
Updated September 30, 2026
Definition
The part of the cost of covered care you pay yourself, like your deductible, copays, and coinsurance. It usually doesn't include your monthly premium.
Cost sharing is the part of the cost of covered care that you pay out of your own pocket. It usually includes your deductible, copays, and coinsurance. Your monthly premium usually doesn't count.
It also doesn't include balance bills from out-of-network providers or the cost of care your plan doesn't cover. That's why what you pay in a year can be more than your cost sharing alone.
For example, say you paid a $1,000 deductible, then $300 in coinsurance and $90 in copays. Your cost sharing for the year is $1,390. Federal surprise billing rules often limit what you pay to your in-network cost sharing. When you compare plans, look at all of these amounts, not just the premium. See choosing a plan at open enrollment.
Related terms
Guides that use this term
- GuideHow to choose a health insurance plan and avoid big billsCompare health plans by total yearly cost, not just the premium. Check networks, doctors, drugs and the SBC, with a worked example and 2027 deadlines.
- GuideDoes the No Surprises Act apply to my bill?The No Surprises Act limits many surprise out-of-network bills. See when it applies, what it doesn't cover, and what to do if you get a surprise bill.
Sources
- Cost sharing (glossary), HealthCare.gov. Accessed September 30, 2026.
- Health insurance terms you should know, Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.