In order to make premiums more affordable for their customers, Leroux Health Insurance is considering some changes to one of the plans they offer. Both the current options and proposed changes are outlined in the charts below.

Question

Leroux Health Insurance
Plan A
Proposed Changes
Cost:

Monthly Premium:
$248.00
$203.00
Annual Deductible:
$ 5,500.00
$8,500.00

Co-pays:

Brand-name Prescriptions
$35.00
$30.00
Generic Prescriptions
$15.00
$10.00

Visits:

Primary Care Physician:
$40.00
$30.00
Specialist:
$60.00
$45.00
Urgent Care:
$125.00
$90.00
Emergency Room:
$325.00
$250.00

If Kevin is currently insured under Leroux for his medical insurance under Plan A, how will the proposed changes affect his health care costs?
a.
Costs for regularly scheduled health care will go down, but Kevin may end up paying more if he finds himself seriously ill or injured.
b.
Costs for regularly scheduled health care will go up, but Kevin will probably pay less than he would have if he finds himself seriously ill or injured.
c.
Both the cost for regularly scheduled health care and the cost for emergency health care will go down, making the changes very good for Kevin.
d.
Both the cost for regularly scheduled health care and the cost for emergency health care would go up, contradicting the intentions of Leroux Insurance.

Answer 1

To analyze how the proposed changes to Leroux Health Insurance's Plan A affect Kevin's health care costs, we can break down the components presented in the charts.

1. Monthly Premium:

   • Current: $248.00
   • Proposed: $203.00
   • Change: Decrease of $45.00 per month (which is an annual savings of $540.00).

2. Annual Deductible:

   • Current: $5,500.00
   • Proposed: $8,500.00
   • Change: Increase of $3,000.00.

3. Co-pays (for regularly scheduled health care):

   • Brand-name Prescriptions:
     • Current: $35.00
     • Proposed: $30.00 (decrease of $5.00).
   • Generic Prescriptions:
     • Current: $15.00
     • Proposed: $10.00 (decrease of $5.00).
   • Primary Care Physician:
     • Current: $40.00
     • Proposed: $30.00 (decrease of $10.00).
   • Specialist:
     • Current: $60.00
     • Proposed: $45.00 (decrease of $15.00).
   • Urgent Care:
     • Current: $125.00
     • Proposed: $90.00 (decrease of $35.00).
   • Emergency Room:
     • Current: $325.00
     • Proposed: $250.00 (decrease of $75.00).

In summary, the proposed changes decrease co-pay amounts for regularly scheduled health care, which means Kevin would save on routine visits and prescriptions. However, the annual deductible has increased significantly, which means if Kevin faces serious health issues or an injury and needs to utilize his insurance to its higher limit, he would end up paying significantly more out-of-pocket before receiving any insurance coverage.

Given this breakdown, the most accurate conclusion regarding how the proposed changes will affect Kevin's health care costs is:

a. Costs for regularly scheduled health care will go down, but Kevin may end up paying more if he finds himself seriously ill or injured.