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 annual healthcare costs under his insurance plan, we need to consider the following components: monthly premiums, annual deductible, co-pays for doctor's visits, co-pays for prescriptions, and the cost of the appendicitis surgery.

Step 1: Calculate the total premium cost for the year

• Monthly premium: $248.00
• Annual premium cost: \( 248 \times 12 = 2,976.00 \)

Step 2: Calculate the annual deductible

Andrew has an annual deductible of $5,500.

Step 3: Calculate the co-pays for doctor visits

• Primary care visits: 2 per month × 12 months = 24 visits

  • Co-pay: $40.00
  • Total for primary care: \( 24 \times 40 = 960.00 \)

• Specialist visits: 1 per month × 12 months = 12 visits

  • Co-pay: $60.00
  • Total for specialist: \( 12 \times 60 = 720.00 \)

Step 4: Calculate the co-pays for prescription refills

• Andrew needs two generic inhalers that need to be refilled weekly:
  • Total refills in a year: \( 2 \text{ inhalers} \times 52 \text{ weeks} = 104 \text{ refills} \)
  • Co-pay per refill for generic: $15.00
  • Total for inhalers: \( 104 \times 15 = 1,560.00 \)

Step 5: Calculate the cost of the appendicitis surgery

• Cost of the appendicitis surgery: $1,500.00

Step 6: Calculate total costs before applying the deductible

Now, we add all these costs together (before the deductible):

• Premiums: $2,976.00
• Co-pays for primary care: $960.00
• Co-pays for specialist: $720.00
• Co-pays for prescriptions: $1,560.00
• Appendix surgery: $1,500.00

Total costs before applying the deductible: \[ 2,976 + 960 + 720 + 1,560 + 1,500 = 7,716.00 \]

Step 7: Verify with the deductible

Now, since the total costs amount to $7,716.00 and Andrew must meet a deductible of $5,500.00, this means he pays the deductible first. Any costs beyond the deductible are covered by his insurance.

However, in this case, all of the costs (including the annual costs) exceed the deductible amount. Thus, Andrew will need to pay:

• Total costs: $7,716.00 (which includes the deductible)

Final Answer:

Andrew's total annual healthcare costs will be $7,716.00, hence the correct option is: d. $7,716.00