Health Insurance Answers

Sammy is a full-time students who does not work. He is too old to stay on his parents health insurance and is looking for his own health care program. The two options he is considering are outlined in the tables below. OPTION 1: Fee-for-service OPTION 2: HMO $225 monthly premium $630 monthly premium$7,500 deductible No annual deductible Co-pays: Co-pays:Name-brand Drugs: $30 Name-brand Drugs:$25 Generic Drugs:$12 Generic Drugs$10 Visits: Visits: Primary Care Physician$30 Primary Care Physician$20 Specialist: $75 Specialist: $62 Urgent Care:$100 Urgent Care:$50 Emergency Room:$250 Emergency Room:$175 The first option is a fee-for-service plan with a $7,500 deductible. Sammy must pay the deductible amount in health-related costs (not including co-pays) before the insurance company will contribute. This plan costs $225.00 per month and requires co-pays for most standard healthcare costs.The second option is an HMO. It is significantly more expensive at $630 per month, but has no annual deductible. The standard co-pays are also less than those in the other option.Sammy is a young man in very good condition. He visits his primary care physician every other month to get physicals for school sports. He fills a prescription for his name-brand asthma inhaler every month. Sammy is an avid sportsman who loves skiing and snowboarding, two potentially dangerous activities.Considering the real possibility of a serious skiing or snowboarding accident that could put Sammy in the hospital for an extended period of time, which of the following statements is true for his situation? (Assume an extended hospital stay costs at least $12,000.)

What is the difference between a co-payment and co-insurance?

Leroux Health Insurance is considering changing the options in one of their health care plans (Plan A) based on customer feedback that prescriptions and regular visits to the doctor are too expensive for the insured individual. How can Leroux reduce the costs of regular health care without driving up the price of their health care plan?Leroux Health InsurancePlan A Cost: Monthly Premium: $248.00 Annual Deductible: $5,500.00 Co-pays: Brand-name Prescriptions $35.00 Generic Prescriptions $15.00 Visits: Primary Care Physician: $40.00 Specialist: $60.00 Urgent Care: $125.00 Emergency Room: $325.00

Which of the following acronyms does not represent a managed care plan?

Jim and Stephanie just got married and are thinking about changing their health care insurance plans to be more affordable. Currently, both Jim and Stephanie are insured through their own employers. Jim’s employer pays 42% of his $378 monthly premium. His insurance plan will also pay for 23% of the $345 premium for additional beneficiaries. Stephanie’s employer pays 35% of her $298 monthly premium but offers to pay an extra 10% of her premium for each beneficiary Stephanie adds to her plan. Her employer would then pay 30% of the $349 premium for each additional beneficiary.Insurance Jim's Employer BeneficiaryMonthly PremiumEmployer ContributionJim$378 42%Additional (each)$345 23% Stephanie's EmployerBeneficiaryMonthly PremiumEmployer ContributionStephanie$298 35% (+10% for each additional beneficiary)Additional (each)$349 30%Which would be the most economical way for the couple to purchase health insurance?

Gerald would like to add a dental and vision option to the health insurance plan he purchased through his employer. In addition to the 65% of Gerald’s $345 monthly health insurance premium, his employer has offered to pay 50% of a $38 monthly dental premium and 75% of a $23 monthly vision premium. If Gerald adds both the dental and vision options to his insurance plan, how much will he pay each month towards health insurance?Soopergood InsuranceOptionMonthly PremiumEmployer ContributionHealth Insurance$345 65%Dental$38 50%Vision$23 75%

Bob’s employer covers 23% of his family’s annual health insurance premium. The balance of the premium is deducted in equal amounts from Bob’s paycheck 26 times over the calendar year. If $185.30 is withheld from each of Bob’s paychecks, what is his family’s annual health insurance premium?

Which of the following statements best describes the difference between a health maintenance organization (HMO) and a preferred provider organization (PPO)?

The health benefits Tom receives from his employer cover 43% of the total monthly premium of $345.00. How much does Tom have to pay each month?

Sally’s employer pays for 38% of her annual health insurance premium of $4,350.00. Sally pays the remaining balance by having it deducted in equal amounts from her 26 paychecks throughout the calendar year. How much will Sally have deducted from each paycheck?

Liam has purchased a fee-for-service health insurance plan from Leroux Health Insurance. Plan A includes a $248.00 monthly premium and an annual deductible of $5,500.00 (not including co-pays). Liam is a fairly healthy young man. He visits his primary care physician three times a year on scheduled visits. He sees a chiropractic specialist every week to help with lower back pain. He has no current prescriptions that need refilling regularly.Assuming Liam maintains his regular visits with his primary care physician and his chiropractor, and avoids any trips to the emergency room or urgent care, how much will Liam pay in health care related fees this year?Leroux Health InsurancePlan A Cost: Monthly Premium: $248.00 Annual Deductible: $5,500.00 Co-pays: Brand-name Prescriptions $35.00 Generic Prescriptions $15.00 Visits: Primary Care Physician: $40.00 Specialist: $60.00 Urgent Care: $125.00 Emergency Room: $325.00

Which of the following is not a way health insurance helps to save you money?

In a fee-for-service health insurance plan with a $6,500 annual deductible, _____.