In most clinical circumstances, health care consumers in the US cannot determine their out-of-pocket expenses until after their care is delivered. Cost uncertainty and concerns about paying for care lead to many negative consequences, including forgoing high-value services and incurring medical debt.¹ Difficulty predicting and affording health care is an increasing and pervasive problem and is no longer limited to those with strained financial resources.^2,3 Most important, the clinical and economic impact of unpredictable out-of-pocket costs disproportionately affects individuals with low incomes, thereby exacerbating health inequities.⁴

While there is no 鈥渟ilver bullet鈥� for the financial toxicity problem, we propose a feasible, clinically driven, patient-centered cost-sharing model that aims to reduce cost uncertainty for patients by providing them with a guaranteed out-of-pocket cost amount for a defined clinical episode (eg, cardiac pacemaker implantation, childbirth, joint replacement) before care is delivered.