88. A health insurance policy has $1,000 deductible and 80%/20% coinsurance of the next $3,000. The insured receives a medical bill of $5,000. How much would the insured be responsible to pay?
Answer: B
$1,800
To determine the amount the insured is responsible for, we first account for the $1,000 deductible, followed by the 80%/20% coinsurance on the remaining balance of the medical bill after the deductible has been paid.
A) $1,000
This option only accounts for the deductible without considering the coinsurance on the remaining balance. After the deductible is met, there are additional costs that the insured must cover, making this option incorrect.
B) $1,800
This option correctly reflects the total amount the insured will pay. First, the insured pays the $1,000 deductible. After that, the remaining bill is $4,000 ($5,000 - $1,000). The coinsurance applies to the next $3,000, where the insured pays 20%, which amounts to $600 ($3,000 x 0.20). The total payment becomes $1,000 (deductible) + $600 (coinsurance) = $1,800.
C) $3,000
This choice incorrectly suggests that the insured is responsible for $3,000 in total, which would imply that the deductible and coinsurance calculations were not properly considered. The total amount owed by the insured is less than this option.
D) $4,000
This amount inaccurately represents the insured's financial responsibility by not factoring in the deductible and the coinsurance correctly. While it may reflect part of the costs, it fails to consider the correct calculations for the deductible and the coinsurance on the remaining balance.
Conclusion
The calculation of $1,800 accurately reflects the insured's total out-of-pocket expense after applying the deductible and the appropriate coinsurance. All other options fail to properly account for the deductible and coinsurance structure, leading to inflated or incorrect amounts owed. Thus, option B is the only correct response based on the given health insurance policy.