Question
Review health insurance plans below and answer the question in the blank provided. Show your work on a separate piece of paper. Plan Two: Deductible & 500 Co-insurance & 90 / 10 Out-of-Pocket Limit & 5,000 If a medical expense is 55,000 , how much does the policyholder need to pay? Answer:
Answer
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Wynona
Professional · Tutor for 6 years
Answer
#Explanation#In this question, we are asked to calculate the total amount the policyholder has to pay given a medical expense of
500, a co-insurance of 90/10, and an out-of-pocket limit of
500 deductible.After the deductible is met, the co-insurance kicks in. The co-insurance is a percentage that the policyholder and the insurance company share. In this case, it's 90/10, meaning the insurance company pays 90% of the remaining medical expenses and the policyholder pays 10%.However, there is also an out-of-pocket limit. This is the maximum amount the policyholder will have to pay for covered services in a policy period (usually a year). Once the out-of-pocket limit is reached, the insurance company pays 100% of the covered benefits for the rest of the policy period.Let's calculate the amount the policyholder needs to pay.#Answer#First, the policyholder pays the
55,000 -
54,500.Next, the policyholder pays 10% of the remaining medical expense, which is
5,450. However, this amount exceeds the out-of-pocket limit of
500 +
5,500.