Your client has a major medical policy with an unlimited benefit. The policy also features $2,000/year deductive after which benefits are paid 80%. Due to an injury, he has surgery costs $10,000. How much will your client have to pay?

Your client has a major medical policy with an unlimited benefit. The policy also features $2,000/year deductive after which benefits are paid 80%. Due to an injury, he has surgery costs $10,000. How much will your client have to pay?

• A. 2,000
• B. 3,600
• C. 4,000
• D. 8,000

Answer: (B)

The key idea is how deductible and coinsurance work together. You must pay the deductible first, then the insurer covers a percentage of the remaining charges, with you sharing the rest as coinsurance. Here, the deductible is 2,000 per year, and after you meet it, benefits are 80% of the remaining costs. So for a 10,000 surgery: - Pay the deductible: 2,000 - Remaining eligible costs: 10,000 − 2,000 = 8,000 - Insurer pays 80% of 8,000: 6,400 - Your coinsurance (20%) of 8,000: 1,600 Total you pay: 2,000 + 1,600 = 3,600.

The key idea is how deductible and coinsurance work together. You must pay the deductible first, then the insurer covers a percentage of the remaining charges, with you sharing the rest as coinsurance. Here, the deductible is 2,000 per year, and after you meet it, benefits are 80% of the remaining costs.

So for a 10,000 surgery:

• Pay the deductible: 2,000

• Remaining eligible costs: 10,000 − 2,000 = 8,000

• Insurer pays 80% of 8,000: 6,400

• Your coinsurance (20%) of 8,000: 1,600

Total you pay: 2,000 + 1,600 = 3,600.