To determine how much you will pay out of pocket for each doctor visit, we need to consider your deductible, co-pay, and co-insurance.
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Deductible: You have a deductible of $250. You must pay this amount out of pocket before your insurance starts to cover costs.
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Cost per visit: Each doctor's visit costs $160.
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Co-pay: After meeting the deductible, you will pay a co-pay of $70 per visit for the following visits.
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Co-insurance: After the deductible is met, co-insurance will apply, which is 15% of the remaining balance after the co-pay has been paid.
Step 1: Calculate your total out-of-pocket expenses for the first visit.
For your first visit:
- You will pay the full visit cost since you have not met the deductible yet: \[ \text{Out of pocket for 1st visit} = $160 \]
Step 2: Calculate expenses for subsequent visits after the deductible is met.
After the first visit, you have paid $160 towards your deductible, leaving you with: \[ $250 - $160 = $90 \text{ remaining in your deductible.} \] You need to pay another $90 before the deductible is fully met, which means that for your second visit, you will also pay an additional $90. So, the total out-of-pocket for the first two visits will be: \[ \text{Total for visits 1 and 2} = $160 + $90 = $250 \] Now, you have met your deductible.
Step 3: Calculate the cost for subsequent visits (3rd through 8th).
From the third visit onwards, the cost structure changes:
- You will first pay the $70 co-pay.
- Then, you will pay 15% co-insurance on the remaining amount after the co-pay. The remaining amount after the co-pay for each $160 visit is: \[ $160 - $70 = $90 \] 15% of this remaining amount is: \[ 0.15 \times 90 = $13.50 \]
Therefore, for the 3rd, 4th, 5th, 6th, 7th, and 8th visits, your out of pocket will be: \[ \text{Total for each visit after deductible} = \text{Co-pay} + \text{Co-insurance} = $70 + $13.50 = $83.50 \]
Step 4: Total costs for all visits.
- First visit: $160
- Second visit: $90
- 3rd to 8th visits (6 visits): \[ 6 \times 83.50 = 501 \]
Total Out-of-Pocket:
Adding these amounts gives: \[ \text{Total Out of Pocket} = 160 + 90 + 501 = 751 \]
Summary of Out-of-Pocket by Visit:
- 1st visit: $160
- 2nd visit: $90
- 3rd to 8th visits: $83.50 each.
So, you pay:
- Total for visits 1 and 2: $250
- Total for visits 3-8: $501
Your total out-of-pocket expense for all 8 visits is $751. For each of the 3rd to the 8th visits, you will specifically pay $83.50.