Under the carryover provision, with a deductible of $200 and an 80/20 coinsurance, total expenses of $100 in November and $400 in January amount to what the insurer will pay?

• A. 240
• B. 300
• C. 200
• D. 0

Answer: (A)

The carryover provision lets any unmet deductible from earlier months be applied to the deductible for the next year. Here the deductible is 200 and the coinsurance is 80/20.

In November you have 100 of expenses, which goes toward the next year’s deductible. That leaves 100 of deductible still to meet in January.

In January you have 400 in expenses. The first 100 of those 400 go to finish meeting the deductible (so the deductible is fully satisfied). Now 300 remains subject to coinsurance. With 80/20 coinsurance, the insurer pays 80% of 300, which is 240.

So, under the carryover provision, the insurer will pay 240.