OU T-O F-P O C E T H E ALTH CARE IN SURAN CE CO STS. Brian Nam 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 Brian 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 Brian’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 Brian? What other factors should be considered when deciding between the two plans? L01