11-5 Types of Health Insurance Plans

COMPARE: Types of Health Insurance Plans There are a LOT of options regarding health insurance, but in the end it boils down to THREE main variables: A. How is the cost of medical care being divided? - Meaning when you need medical care, what percentage are you agreeing to pay and what percentage will the insurance company pay? B. What type of plan are you purchasing? - Different plan types have different rules about which doctors you are able to see and how much it costs to see them. C. Where are you purchasing your plan from? - There are dozens of different health insurance companies competing for your business, offering a variety of plans based on the previous two criteria. (Note: This activity will focus only on variables A and B. Since purchasing a health insurance plan online often involves providing personal information, the activity does not attempt to simulate that variable.) Part I: How Is the Cost of Medical Care Being Divided? Every insurer offers a variety of plans that spread the cost of medical coverage differently between you and them. Plans in the insurance “Marketplace” are classified as Platinum, Gold, Silver, Bronze, or Catastrophic. Watch the first part of Health Insurance 101: Types of Plans through 2:05 to learn more about these categories. Then, answer the questions below. 1. In your own words, explain what actuarial value is. (1 pt.) Actuarial Value is like the average insurance cost paid by the insurer per year 2. Using the information from the video, fill out the table below for the different plan “metals”. (2 pts.) Plan Platinum Gold Silver Bronze % YOU Pay 10% 20% 30% 40% Actuarial Value 90% 80% 70% 60% 3. Finish the following sentence with the word LOWER or HIGHER. (1 pt.) a. The LOWER the actuarial value of your health insurance plan, the Higher your monthly premium. 4. Explain what a Catastrophic Plan is, who qualifies, and what it does and does not cover. (1 pt.) Below 30 years of age, Catastrophic plans, Hardship exemptions only covers a major emergency. Part II: What Type of Plan Are You Purchasing? Regardless of how costs are shared between you and the insurance company, you will be faced with choices about the type of plan you want. Depending on where you get your plan from, you may not have all these options available to you. Still, it’s valuable to know the types of options that exist. Watch the remainder of the video (starting from 2:05). Then, use the information from the video and from the article What Are the Differences Between HMO, PPO, EPO and POS Plans? to answer the question below. 6. Fill out the table below on the types of plans available to you. (2 pts.) HMO (Health Maintenance Organization) Has a number of doctors and hospitals in its “network”? Yes/No If I want to see a doctor outside of my network, I... Yes Referral from physician EPO (Exclusive Provider Network) PPO (Preferred Provider Organization) POS (Point-of-Service) Plans Yes No Yes Referral from physician No Referrals Primary Care Physician Part III: Which Plan Would You Want? We are going to focus on HMO and PPO plans and see what the government’s portal has to offer. Before you get started exploring, list four of the most important features of a health insurance plan to YOU. List them in the blue column. Next, use the link below to find three health insurance policies that you might consider. Label the yellow row with the name of the policy. Then fill in the chart below explaining how each of the three matches your criteria. (6 pts.) Decision Matrix: Health Insurance Plan Finder Policy → Features/Criteria ↓ HMO Blue cross and Shield. (Bronze) UnitedCare (Gold)UHC Gold Advantage+ Blue Precision Extra ($2 Rx + Bronze HMO℠ Dental + Vision + 3 Free 205 Primary Care & 6 Free Virtual Visits PPO Blue Cross and Shield (HMO) Blue Choice Preferred Bronze PPO℠ 601 HMO Cost $373 a month 475 a month 378 a month Deductibles 7400$ a person Max 8300 out of pocket 1000 a person Max 8000 out of pocket 7000$ Max:8700 out of pocket Extra Features None Child Dental None Copayments Emergency Room:$1000 Copayment with deductible/50% Coinsurance after deductible 10% Coinsurance after deductible Primary Doctor:$65 Emergency room care 20% Coinsurance after deductible Generic drugs $2 Primary doctor $10 Specialist doctor $50 Emergency Room:$1000 Copayment with deductible/50% Coinsurance after deductible Generic drugs $10 Primary doctor: 40% Coinsurance after Specialist:$105 deductible Specialist doctor: 50% Coinsurance after deductible 5. Make your choice of which policy is best for you, based on your decision matrix. Which are you choosing? Why? Outline the reasons for your selection, and indicate why the policy you selected is better than the other two you considered. Be specific in your answer and provide details including the terms related to insurance, when possible, to support your choice. (2 pts.) UHC Gold Advantage+ Extra ($2 Rx + Dental + Vision + 3 Free Primary Care & 6 Free Virtual Visits I am choosing this policy because its a HMO that allows me to visit the doctors within the network and my extra fees are not that high. I considered others because the others were both cheaper in price based on the monthly fee and the deductibles, but I feel like the copayments for the gold plan is so much better for anyone that gets sick a lot or needs to go in for visits because the visits for a specialist or your normal doctor is pretty cheap at 10$ and 50$ compared to the other plans. The gold plan was the only plan out of the three plans to have extra features , like it covers child dental. Those were the options I considered to determine my decision for my insurance plan.