Which term refers to the actual cost incurred by a patient after the insurance has paid?

The term that refers to the actual cost incurred by a patient after insurance has paid is known as the out-of-pocket maximum. This amount represents the total limit on what a patient would pay for covered healthcare services in a given policy period. Once this limit is reached, the insurance will cover 100% of the costs for covered services for the remainder of the period.

This concept is crucial because it helps patients understand their financial responsibilities when navigating healthcare. It is designed to protect individuals from excessive out-of-pocket expenses, enabling them to plan for health-related expenses without facing financial ruin.

In contrast, a premium is the monthly fee required to maintain an insurance policy, a co-pay is a fixed amount that a patient pays for specific services at the time of care, and a deductible is the amount a patient must pay out of pocket before their insurance begins to cover costs. Each of these costs plays a role in the overall healthcare expense structure but does not specifically refer to the patient's cost after insurance has provided its benefits as the out-of-pocket maximum does.