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Questions and Answers
What portion of the hospital bill does L need to cover after the deductible has been paid?
What portion of the hospital bill does L need to cover after the deductible has been paid?
- 20% of the remaining bill after the deductible (correct)
- 50% of the entire bill
- 80% of the remaining bill after the deductible
- 100% of the entire bill
How is the total amount due calculated based on the coinsurance policy?
How is the total amount due calculated based on the coinsurance policy?
- Only the deductible amount since it covers all costs
- The deductible plus the coinsurance percentage of the total bill
- The total bill multiplied by the deductible amount
- The sum of the deductible and the coinsurance percentage of the remaining balance after the deductible (correct)
If L's hospital bill was $3,000, what would be L's total out-of-pocket expense?
If L's hospital bill was $3,000, what would be L's total out-of-pocket expense?
- $1,800
- $1,900
- $1,500 (correct)
- $1,200
What would happen if L had a $1,000 deductible instead of $500?
What would happen if L had a $1,000 deductible instead of $500?
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Which option correctly represents the total bill calculation based on the coverage type?
Which option correctly represents the total bill calculation based on the coverage type?
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Study Notes
Medical Insurance Terms and Calculations
- Major medical policy often includes deductibles and coinsurance terms.
- A deductible is the amount a policyholder must pay out-of-pocket before insurance coverage kicks in.
- Coinsurance is the percentage of costs that the insurance company pays after the deductible is met.
Scenario Analysis
- L's policy features a $500 deductible, meaning L is responsible for the first $500 of medical expenses.
- With an 80/20 coinsurance arrangement, the insurance covers 80% of costs after the deductible, while L pays 20%.
Total Loss and Payments
- L experiences a $2,500 loss during hospitalization.
- First, the $500 deductible is subtracted from the total loss.
- Remaining amount after deductible: $2,500 - $500 = $2,000.
- L's responsibility for coinsurance: 20% of $2,000 = $400.
Final Calculation
- Total amount L pays: $500 (deductible) + $400 (coinsurance) = $900.
Answer to Question
- The maximum amount that L will have to pay is $900, corresponding to option B.
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