Consumer directed health plan cdhp target audience

Case Study Comparisons

Part 1

Complete the chart below that differentiates the following insurance types.

Plan Type

Characteristics of Plan (5 to 7 characteristics)

Target Audience for Plan

Indemnity Plan

Preferred Provider Organization (PPO)

Health Maintenance Organization (HMO)

Consumer Directed Health Plan (CDHPs)

Medicaid

Medicare

Part 2

Review the insurance plans and answer the following questions.

Services

Bronze

Silver

Gold

Monthly Cost

$163.00

$194.00

$245.00

Deductible

$6,000.00

$4,000.00

$1000.00

Primary Care

$35.00 co-pay for three visits, then 20% of co-insurance

$30.00 co-pay/provider/day

$20.00 co-pay/provider/day

Specialist Visit

$70.00 co-pay for three visits, then 20% of co-insurance

$60.00 co-pay/provider/day

$40.00 co-pay/provider/day

Preventive Care/Screening/Immunization

No charge

No charge

No charge

Diagnostic Test (x-ray, blood work)

$35.00 co-pay or 20% of co-insurance if co-pay limit is researched

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

$15.00 co-pay/30 supply

$15.00 co-pay/30 supply

Emergency Room Services

20% of co-insurance

$350.00 co-pay/facility/day

$250.00 co-pay/facility/day

Emergency Medical Transportation

20% of co-insurance

20% of co-insurance

20% of co-insurance

Urgent Care

$75 co-pay

$60.00 co-pay/provider/day

$60.00 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.

· What are the major differences between the plans?

· What are the major similarities between the plans?

· If you were presented with these plans, what would be the major selling points and pitfalls of the plans for you?

2. Read and answer the questions below regarding the two consumers and refer to the Gold, Bronze, or Silver plans listed above.

Consumer A

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 but still uses her insurance plan frequently.

· Compare the plans provided and determine the best plan for Betsy. Remember to consider deductibles and general costs for the services she would be using.

· For a couple of 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 room services and urgent care more often.

· If Betsy was considering changing her insurance plan, which plan should she consider? Why?

· How does the plan she should consider in this scenario compare to the plan choice from the first question?

Consumer B

Zach is a healthy 30 year old who rarely goes to the doctor and is not on any medication. He has been offered the following insurance plans and he is considering the plans for use of common alignments (i.e., colds) and for preventive tests.

· Compare the plans and determine what would be the best plan for Zach.

Zach has recently been hired as a construction worker and was considering changing his health plan. He realizes that this new job may have more hazards than his last job.

· Which plan should Zach consider? Why?

· How does the plan he should consider in this scenario compare to the plan choice from the first question? Remember to consider deductibles and general costs for the services he would be using.