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
The insured would be responsible to pay $1,800.
To determine the amount the insured is responsible for, we first apply the $1,000 deductible, leaving $4,000 from the medical bill. For the next $3,000, the insured pays 20% coinsurance, which totals $600. Adding the deductible and the coinsurance results in $1,800.
A) $1,000
This option only accounts for the deductible amount and does not include any coinsurance calculations. After paying the deductible, the insured has additional costs due to the coinsurance on the remaining medical bill, making this option incorrect.
B) $1,800
This option correctly reflects the total amount the insured must pay after applying the deductible and the coinsurance. The insured first pays the $1,000 deductible, and then for the remaining $4,000, they are responsible for 20% of the first $3,000, which is $600. Therefore, the total out-of-pocket cost is $1,800.
C) $3,000
This amount incorrectly assumes that the insured would pay the entire remaining balance after the deductible without considering the coinsurance. Since only part of the remaining balance incurs coinsurance, this option does not accurately reflect the cost.
D) $4,000
This option suggests that the insured would pay the entire remaining medical bill after the deductible, which is incorrect. After the deductible, only a portion of the medical bill is subject to coinsurance, making this option invalid.
Conclusion
The correct answer is $1,800, as it accurately combines the deductible and the 20% coinsurance on the applicable medical expenses. All other options fail to account for either the deductible or the proper application of coinsurance, leading to an incorrect total for the insured's responsibility.