Assume that you have a health insurance plan with the following provisions:

  • Office visits require a co-payment of $35
  • Emergency room visits have a $400 deductible (you pay the first $400)
  • Surgical operations have a $2000 deductible (you pay the first $2000)
  • You pay a monthly premium of $450

During a one-year period your family has the following expenses:

 

Expenses

  • Feb 18 Emergency room
  • Mar 13 Office visit
  • Apr 14 Surgery
  • May 12 Office visit
  • Nov 23 Emergency room
  • Total cost (before insurance)

  • $740
  • $100
  • $8200
  • $120
  • $1120
  • Determine your health care expenses for the year with and without the insurance policy

     

    A) with policy $8270 without policy $10280

    B)with policy $3320 without policy $10280

    C)with policy $12810 without policy $10820

    D) with policy $7860 without policy $10730

    Assuming a healthcare plan with those provisions:

    1. Co-pay has to be paid for every visit.
    2. Deductible means for every visit, the deductible has to be paid and the rest is paid by the policy.
    3. Insurance premium will also be paid in case one desires a policy.
    4. Expense (w/o policy) = $10,280 and with policy = $8,270.
    5. Option (a) is correct.

    Expert Answers

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    This question deals with a typical scenario involving medical expenses and whether medical insurance is worth it.

    The deductibles for the various services are as follows:

    Emergency room visit: $400 deductible (the patient pays the first $400)

    surgery: $2000 deductible (the patient pays the first $2000)

    Office visits have a...

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    This question deals with a typical scenario involving medical expenses and whether medical insurance is worth it.

    The deductibles for the various services are as follows:

    Emergency room visit: $400 deductible (the patient pays the first $400)

    surgery: $2000 deductible (the patient pays the first $2000)

    Office visits have a co-payment of $35.

    Healthcare expenses (before insurance) = $740 (emergency room) + $100 (office visit) + $8200 (surgery) + $120 (Office visit) + $1120 (Emergency room) = $10,280

    Thus, the expenses without the insurance policy are $10,280.

    This means that you can reject the solution choices c and d straightaway since they mention a different value of expense without the policy.

    Let's see what happens when the patient has the stated insurance.

    For each of the office visits, the patient will pay $35 each, for a total of $70 (2 x $35/visit).

    For the surgery, the patient will only pay $2000, instead of the full amount.

    For the emergency visit, the patient will pay first $400 for each visit. Since there are two emergy visits, the total cost to the patient is $800 (2 x $400).

    In addition, the patient must pay the health insurance premium of $450 per month for a total of $5400 (12 x $450) per year.

    Thus, the total expenses with the medical insurance policy are:

    $70 + $2000 + $800 + $5400 = $8,270.

    Thus, option (a) is correct.

    Hope it helps.

    Approved by eNotes Editorial Team