Question

Say you have a health insurance policy with a $250 deductible, an 80/20 coinsurance with a $5,000 cap on co-insurance payments you have to make per year, and a $250,000 policy limit. how much will you have to pay for the $27,500 medical bill you receive?

Answer 1

Because your cap on co-insurance is too small for that medical bill, you will have to pay 27500 - 5000 = $22500

Answer 2

$5,250

Step-by-step explanation:

You must first of all pay the $250 deductible for the health insurance policy, and then you have to pay the maximum coinsurance which equals $5,000.

Your total medical bill will be = $250 + $5,000 = $5,250

Your insurance company will have to pay $22,500 (= $27,500 - $5,000)

If your insurance policy didn't have the $5,000 cap on coinsurance, then your 20% copay would have been $27,500 x 20% = $5,500 + $250 = $5,750