Andrew is insured by Leroux Health Insurance under Plan A. The plan includes a $248.00 monthly premium with a $5,500.00 annual deductible (not including co-pays).

Question

Andrew is severely asthmatic. He visits his primary care physician twice a month and his asthma specialist once a month. He has two separate generic inhalers that need to be refilled on a weekly basis. To make matters worse, Andrew has recently been diagnosed with appendicitis and is scheduled to have his appendix removed in the morning. The procedure will cost about $1,500.

Considering his frequent doctor visits, many prescription refills, and his appendix removal in addition to his monthly premium, how much will Andrew 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.
$2,976.00
b.
$5,500.00
c.
$6,216.00
d.
$7,716.00

Answer 1

To calculate Andrew's total health care-related fees for the year, we will account for the following:

1. Monthly Premium:
   \(\text{Monthly Premium} = $248.00\)
   \(\text{Annual Premium} = 12 \times $248.00 = $2,976.00\)

2. Doctor Visits:

   • Visits to his primary care physician (2 visits/month):
     \(2 \text{ visits/month} \times 12 \text{ months} = 24 \text{ visits/year}\)
     \(\text{Total cost for primary care visits} = 24 \text{ visits} \times $40.00 = $960.00\)

   • Visits to his asthma specialist (1 visit/month):
     \(1 \text{ visit/month} \times 12 \text{ months} = 12 \text{ visits/year}\)
     \(\text{Total cost for specialist visits} = 12 \text{ visits} \times $60.00 = $720.00\)

   • Total cost for doctor visits:
     \($960.00 + $720.00 = $1,680.00\)

3. Prescription Refills:

   • He has 2 inhalers that need to be refilled weekly:
     \(2 \text{ inhalers} \times 52 \text{ weeks} = 104 \text{ refills/year}\)
     \(\text{Total cost for inhalers} = 104 \text{ refills} \times $15.00 = $1,560.00\)

4. Appendix Removal:
   The cost of the procedure is $1,500. Since it exceeds the annual deductible, this cost counts towards Andrew's total expenses.

5. Calculating Total Annual Costs:

   • Total Premium: $2,976.00
   • Total Doctor Visits: $1,680.00
   • Total Prescription Costs: $1,560.00
   • Appendix Removal: $1,500.00

Annual Total Cost =
\($2,976.00 + $1,680.00 + $1,560.00 + $1,500.00 = $7,716.00\)

Thus, considering all the healthcare-related costs, Andrew will pay a total of $7,716.00 in health care-related fees this year. The correct answer is (d) $7,716.00.