PTCB Certified Pharmacy Technician (PTCE)Order Entry and ProcessingHard
A patient arrives at the pharmacy with a prescription for a new medication that costs $500. Their insurance plan has a $100 deductible and then covers 80% of the cost for preferred brand-name drugs. How much will the patient owe for this prescription?
- A$200.00
- B$180.00
- C$100.00
- D$400.00
Show answer & explanationAnswer & explanation
Correct answer: B. $180.00
First, the patient must meet their $100 deductible. This leaves $400 ($500 - $100) of the prescription cost. The insurance then covers 80% of the remaining cost, meaning the patient pays 20%. 20% of $400 is $80. Therefore, the patient owes the $100 deductible plus the $80 coinsurance, totaling $180.
Why the other options are wrong
- A. Incorrect. This would be 40% of the remaining cost after deductible, or 20% of the full cost.
- C. Incorrect. This only accounts for the deductible, not the remaining coinsurance.
- D. Incorrect. This would be 80% of the remaining cost, which is what the insurance pays, not the patient.
Deductible and Coinsurance Calculation
A billing calculation that applies the deductible first, then calculates the patient's coinsurance (a percentage of the remaining cost) after the deductible has been met.
- Deductible: Fixed amount patient pays before insurance coverage begins.
- Coinsurance: Percentage of cost patient pays after deductible is met.
- Insurance covers the remaining percentage.
- Order of application: Deductible first, then coinsurance on remaining balance.
Memory trick: Deduct First, then Coin-share.