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).

Question

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

To calculate how much Liam will pay in health care-related fees in one year, we need to take into account his monthly premium, his annual deductible, and his copays for the physician visits.

1. Monthly Premium Calculation:

   • Monthly Premium: $248.00
   • Annual Premium = $248.00 * 12 = $2,976.00

2. Annual Deductible:

   • Liam's annual deductible is $5,500.00. He must pay this amount out-of-pocket before the insurance starts to cover costs.

3. Visits to Primary Care Physician:

   • He visits his primary care physician 3 times per year.
   • Each visit costs $40.00.
   • Total cost for primary care visits = 3 * $40.00 = $120.00

4. Visits to Chiropractor:

   • He sees a chiropractic specialist every week, which is 52 times a year.
   • Each visit costs $60.00.
   • Total cost for chiropractic visits = 52 * $60.00 = $3,120.00

5. Total Costs Before Insurance Payment:

   • Primary Care Physician: $120.00
   • Chiropractic: $3,120.00
   • Total Medical Fees = $120.00 + $3,120.00 = $3,240.00

However, since he only pays until he reaches his deductible, we need to factor that together:

6. Total Fees Including Premiums:
   • Total healthcare costs (medical fees + premium) = $3,240.00 + $2,976.00 = $6,216.00

Since Liam has to meet his deductible of $5,500, we'll consider that amount independently as he won't be covered until reaching this limit.

However, In this comic situation, he essentially pays ALL his medical fees up until his deductible, which covers most of these expenses.

Thus:

• Annual Deductible is NOT surpassed until the total is counted with the cost of his healthcare fees minus the premium plan.

In case that number is exceeded, he will pay:

Total cost: $6,216.00

So, the correct answer is (d) $6,216.00.