PFIN 5th Edition by Randall Billingsley,Lawrence Gitman,Michael Joehnk

Exercise 2

Out-of-pocket health care insurance costs. Alan Oh was seriously injured in a skiing accident that broke both his legs and an arm. His medical expenses included five days of hospitalization at $900 a day, $6,200 in surgical fees, $4,300 in physician's fees (including time in the hospital and eight follow-up office visits), $520 in prescription medications, and $2,100 for physical therapy treatments. All of these charges fall within customary and reasonable payment amounts.
a. If Alan had a health insurance plan that pays 80 percent of his charges with a $500 deductible and a $5,000 stop-loss provision, how much would he have to pay out of pocket?
b. What would Alan's out-of-pocket expenses be if he belonged to an HMO with a $20 co-pay for office visits?
c. Monthly premiums are $155 for the standard plan and $250 for the HMO. If he had no other medical expenses this year, which plan would have provided more cost-effective coverage for Alan? What other factors should be considered when deciding between the two plans?