Reference no: EM133120966
Roger Strader works for a small manufacturing company and is married to Amy, who were high school sweethearts and are both currently 64 years old. He receives an annual salary of $80,000 and Amy works as an administrative assistant at a law firm and makes $30,000 annually. Amy has medical coverage through her employer and Roger's company purchased health insurance for each of their employees. The plan is a PPO with a $2,000 deductible, 80% co-insurance, $25 office copays, pharmacy benefits, and a maximum out-of-pocket limit of $7,000. It is an ACA plan and provides free preventive health services that Roger routinely utilizes.
One day as Roger was cutting a tree limb from a tree in his yard, he slipped and the chain saw fell on his leg. Roger was rushed to the local hospital where he underwent surgery and then spent 15 days in the hospital. The ride in the ambulance cost $1,000. Surgery and anesthesia were $45,000; hospital room and board cost $800 per day. Drugs and rehabilitative care came to $15,000.
How much of Roger's medical bills will be paid under his insurance policy and how much must he pay personally?
Summary
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PPO Insurance Plan Benefits
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Deductible
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$2,000
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Coinsurance
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80%
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Room & Board
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$800 per day
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Out of Pocket Max
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$7,000
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Lifetime Max
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Unlimited
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Expenses
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Ambulance
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$1,000
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S & A
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$45,000
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Room & Board
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$800 per day x 15 = $12,000
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Drugs & Rehab
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$15,000
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Total: $73,000
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If Roger's plan was an HSA with the following benefits, how much would he have to pay and what would the insurance company pay?
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HSA Insurance Plan Benefits
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Deductible
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$4,000
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Coinsurance
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100%
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Lifetime Max
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Unlimited
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