Case Study Comparisons
Complete the chart below that differentiates the following insurance types. Include 5 to 7 characteristics as well as the target audience for each identified plan type.
|Plan Type||Characteristics of Plan||Target Audience for Plan|
|Preferred Provider Organization (PPO)|
|Health Maintenance Organization (HMO)|
|Consumer Directed Health Plan (CDHP)|
Review the following insurance plans and then answer the questions below.
|Primary care||$35 co-pay for three visits, then 20% of co-insurance||$30 co-pay/provider/day||$20 co-pay/provider/day|
|Specialist visit||$70 co-pay for three visits, then 20% of co-insurance||$60 co-pay/provider/day||$40 co-pay/provider/day|
|Preventive care/screening/immunization||No charge||No charge||No charge|
|Diagnostic test (x-ray, blood work)||$35 co-pay or 20% of co-insurance if co-pay limit is reached||Office visit co-pay or 20% of co-insurance||Office visit co-pay or 20% of co-insurance|
|Level 1 prescription drugs||$25 co-pay/30-day supply||$15 co-pay/30-day supply||$15 co-pay/30-day supply|
|Emergency dept. services||20% of co-insurance||$350 co-pay/facility/day||$250 co-pay/facility/day|
|Emergency medical transportation||20% of co-insurance||20% of co-insurance||20% of co-insurance|
|Urgent care||$75 co-pay||$60 co-pay/provider/day||$60 co-pay/provider/day|
|Hospital stay (facility fee, physician/surgeon fee)||20% of co-insurance||20% of co-insurance||20% of co-insurance|
1. Compare the plans above.
2. Read and answer the questions below regarding the two consumers (A and B) and refer to the Gold, Silver, or Bronze plans listed above.
Betsy has Type 2 diabetes and high blood pressure. She visits the doctor often to keep her diabetes and blood pressure controlled. The doctor regularly checks her blood levels and prescribes level 1 prescriptions to help Betsy control her diabetes and blood pressure.Betsy is considered a controlled diabetic. She uses her insurance plan frequently.
For several years, Betsy was really taking care of herself. However, after suffering a broken leg and being more inactive, Betsy has gained weight and has not been diligent about controlling her diabetes. Betsy has found that she is requiring emergency department services and urgent care more often.
Zach is a healthy 30-year-old who rarely goes to the doctor and does not take any medication. He has been offered the insurance plans above. He is considering the plans for use of common ailments (e.g., colds) and for preventive tests.
Zach has recently been hired as a construction worker and is considering changing his health plan. He realizes that this new job may have more hazards than his last job.
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