What is an enrollee cost sharing?

Enrollee cost-sharing is a type of payment arrangement in health insurance law for California residents. It requires that the enrollee, or the person with health insurance coverage, pays a portion of their health care costs out of pocket. This type of cost-sharing can include things like deductibles, coinsurance, and copayments. A deductible is a fixed dollar amount that the enrollee must pay each year before their health insurance will start to pay any of their medical costs. For example, if an enrollee has a deductible of $2,000, they must pay the first $2,000 of their health care costs each year out of pocket before the insurance starts to cover any of their medical expenses. Coinsurance is a percentage of covered health care costs that enrollees must pay out of pocket after they meet their deductible. For example, if coinsurance is set at 20%, then the enrollee must pay 20% of the costs of health care after they have already met their annual deductible. Lastly, a copayment is a fixed fee the enrollee must pay for each health care visit. For example, if an enrollee has a $20 copayment, their insurance will only cover the costs of each health care visit after the enrollee has paid $20 out of pocket. Enrollee cost-sharing is an important part of health insurance law in California. By requiring enrollees to pay a portion of their health care costs out of pocket, this type of cost-sharing can help to reduce the amount of money that insurance companies have to pay for health care services.

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