Question

Jon Snow was recently stabbed with resulting

medical bills of $4,000. His health insurance

includes the following:



$1,000 calendar-year deductible



80/20 coinsurance clause



$5,000 out-of-pocket max

1.

After insurance is applied, how much will Jon

owe for the medical bill?

2.

Jon needs surgery during the same calendar

year that costs $30,000. After insurance is

applied, how much will Jon owe for the surge

Answer 1

Question 1.

medical bills = $4,000

Deductible amount = $1,000

Deductible amount is paid by Jon and 20% of the remaining amount is paid by Jon as per the coinsurance

Coinsurance dollar amount paid by Jon = 20% of $3,000 = $600

Jon Snow owes for the medical bill = $1,000 + $600 = $1,600

Question 2.

Cost for surgery = $30,000

Jon first pays $1,000 deductible

out of the remaining amount $29,000; 20% is supposed to be paid by Jon = 20% of $29000 = $5,800

total amount to be paid by Jon sums upto $6,800 ($1,000+$5,800) but the out of pocket max = $5,000

so Jon pays a total of $5,000 and the insurer pays remaining $25,000 ($30,000 - $5,000).