Granny Clampett's health insurance policy has a $500 annual aggregate deductible, and 80/20 cost sharing deductible, and a $5,000 maximum annual out-of-pocket cap of $5,000. She wrecks her Harley and breaks her hip, and her total medical bills for the injury are $122,721. How much will her insurer pay for this claim?

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The insurer will pay $97,777 for this claim. The annual aggregate deductible is $500, so Granny Clampett must pay the first $500 of her medical bills. The 80/20 cost sharing means that the insurer will pay 80% of the remaining medical bills, and Granny Clampett will pay 20%. The remaining medical bills after the deductible are $122,721 - $500 = $122,221. The insurer will pay 80% of this amount, which is $122,221 x 0.80 = $97,777.

Granny Clampett's Health Insurance Policy Has a $500 Annual Aggregate