Question
Tony is an employee of YAMA Corporation and he has single coverage under YAMA's PPO plan. YAMA also offers a HDHP with a savings account
Tony is an employee of YAMA Corporation and he has single coverage under YAMA's PPO plan. YAMA also offers a HDHP with a savings account and YAMA allows each eligible employee to enroll in either plan each calendar year during an open enrollment period. The open enrollment for the 2022 plan year is now open and Tony must choose whether to remain in the PPO plan or switch to the HDHP plan.
The plan design for the PPO plan is
- $1000 deductible
- 90% plan/10% individual individual in-network coinsurance
- 70% plan/30% individual out-of-network conisurance
- $8550 annual out-of-pocket maximum for in-network services
The plan design for the HDHP is
- $2500 deductible
- 80% plan/20% individual coinsurance
- $7000 annual out-of-pocket maximum
Tony has been told that he will need to have surgery in 2022. He has consulted with Dr. Thompson, a highly-regarded surgeon worldwide for the type of surgery Tony needs. He has told Tony that his total cost for surgery is $45,000 (including hospital costs). Dr. Thompson is not in the PPO network.
Tony's primary care physician has recommended Dr. Klay, an in-network surgeon and his total cost for the surgery is $37,000 (including hospital costs).
If Tony wants to have the surgery performed by Dr. Thompson but is also interested in minimizing his financial liability, which plan should Tony enroll in for 2022?
a. the HDHP, because the coinsurance is a lower %
b. the PPO, because the lower deductible
c. the PPO, because of the lower in-network coinsurance %
d. the HDHP, because the out-of-pocket maximum is lower
Step by Step Solution
There are 3 Steps involved in it
Step: 1
Get Instant Access to Expert-Tailored Solutions
See step-by-step solutions with expert insights and AI powered tools for academic success
Step: 2
Step: 3
Ace Your Homework with AI
Get the answers you need in no time with our AI-driven, step-by-step assistance
Get Started