Granny Mayberry's health insurance policy has a $500 annual aggregate deductible,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 $12,890. How much will her insurer pay for this claim?

Question

Quizplus · Accepted Answer

Granny Mayberry has a $500 annual aggregate deductible, which means she must pay the first $500 of her medical bills. After the deductible is met, her policy has an 80/20 cost sharing deductible, meaning the insurer pays 80% of covered expenses and Granny pays 20%. 
In this case, the total medical bills are $12,890, so Granny must pay the first $500, and the remaining $12,390 will be subject to the 80/20 cost sharing. 
Therefore, Granny's insurer will pay 80% of ($12,390 - $500), which is $9,912. 
So, the correct answer is C – $9,912.

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