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Amount on which TRICARE figures the patient's cost-share for covered care

a) Usual and Customary (U&C) charges
b) Deductible
c) Copayment
d) Coinsurance

1 Answer

5 votes

Final answer:

TRICARE determines a patient's cost-sharing for covered care based on deductibles, copayments, or coinsurance as defined in the patient's insurance policy. Deductibles are out-of-pocket amounts to be paid before coverage, copayments are fixed fees for services, and coinsurance is a percentage of costs shared between the insurer and the policyholder.

Step-by-step explanation:

The question refers to how TRICARE determines the patient's cost-sharing for covered care. The term cost-sharing encompasses various types of payments that the insured may be responsible for, including deductibles, copayments, and coinsurance. A deductible is the out-of-pocket amount that a policyholder is responsible for before their insurance begins to cover costs. Once the deductible is met, the insurance company begins to pay for services. A copayment (or co-pay) is a fixed amount that the policyholder pays directly to healthcare providers at the time of service, such as $20 for a doctor's visit or $250 for an emergency room visit. Coinsurance is a percentage of the cost that the policyholder is responsible for after the deductible is met. For example, with a 20% coinsurance rate, the policyholder pays 20% of the costs while the insurance company covers 80%.

In the case of TRICARE, the amount on which they figure the patient's cost-share for covered care would typically be based on the deductible, copayment, or coinsurance terms specified in the patient's policy.

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