Question

Scenario #2: The Rodriguez family is expecting to need a new prosthetic leg for their daughter next year. The prosthetic is considered durable medical equipment (DME) Assume the in- network charge is $7,000. (You do not need to factor in any other services (e.g. office visits), only the cost of the prosthetic device.) 1. Based solely on costs, which plan should they pick for next year (HMO or PPO)? 2. How much would the family spend on only this prosthetic device if they picked the PPO plan? 3. How much would the family spend just on only this prosthetic device if they picked the HMO plan?

Answer 1

As Per HMO and PPO insurance policy guidelines both covers the Prosthetic leg except below scenarios

• Shoe inserts
• Neoprene Knee sleeves
• Supports, ankle arch

Cost sharing method

HMO plan annual cost for prosthetic devices

$3000 per year individual member plan

$6000 per year for family plan

Note: they may need pay from patient pocket if uncovered item such experimental items and cosmetics

PPO plan also will cover prosthetic leg, the DME PPO policy price

The deductible applies to each person covered under this benefit plan. However, after deductible payments for any and all persons covered under this benefit plan of total $1500 per annual