Question

Liam has purchased a fee-for-service health insurance plan from Leroux Health Insurance. Plan A includes a $248.00 monthly premium and an annual deductible of $5,500.00 (not including co-pays).

Liam is a fairly healthy young man. He visits his primary care physician three times a year on scheduled visits. He sees a chiropractic specialist every week to help with lower back pain. He has no current prescriptions that need refilling regularly.

Assuming Liam maintains his regular visits with his primary care physician and his chiropractor, and avoids any trips to the emergency room or urgent care, how much will Liam pay in health care related fees this year?


Leroux Health Insurance
Plan A
Cost:

Monthly Premium:
$248.00
Annual Deductible:
$5,500.00

Co-pays:

Brand-name Prescriptions
$35.00
Generic Prescriptions
$15.00

Visits:

Primary Care Physician:
$40.00
Specialist:
$60.00
Urgent Care:
$125.00
Emergency Room:
$325.00
a.
$716.00
b.
$3,816.00
c.
$5,500.00
d.
$6,216.00

Answer 1

Calculate each component:

- Annual premium: $248 × 12 = $2,976
- Primary care copays: 3 × $40 = $120
- Specialist (chiropractor) copays: 52 × $60 = $3,120

The deductible ($5,500) does not apply to copays, and Liam has no other services, so it isn't incurred.

Total = $2,976 + $120 + $3,120 = $6,216

Answer: d. $6,216