Case Study Comparisons
HCS/490
February 9, 2015

Case Study Comparisons

There is a lot to consider when it comes to choosing a healthcare plan for you and your family. We are going to talk about the different options you have, such as whether you want a HMO, PPO, or a CDHP. There are many things you need to consider when looking at health plans. Some of these include your age, health, and whether you are single or have a family. We will discuss each of the options and which one may work the best for this situation.
HMO
Health maintenance organization or HMO, is a standard health care plan available through most health insurance companies. An individual with an HMO maintains their health by visiting their primary care physician on a regular basis for routine check-ups. Typically with an HMO, the individual will select their primary care physician within the preferred network. The individual will see their primary care physician for routine check-ups and preventive care. If the individual has a particular issue, they must go to their primary care physician first. If the primary care physician is unable to treat the patient, the patient will be referred to a specialist by their primary care physician. If the individual chooses to see a doctor outside their preferred network, the individual will be subjected to pay 100% of costs.
Health maintenance organizations tend to be more cost effect for the insurance provider and less expensive for the patient. When choosing the preferred HMO, the patient must keep in mind several factors. The factors include how often the patient goes to the doctor, if they have a chronic illness, their age, and prescription drug coverage (WebMD, 2015, p.3). The individual must also determine which HMO is best by deciding how much they want to pay in premiums, co-payments, deductibles, and coinsurance (WebMD, 2015, p.3).
The best HMO for case study E must be determined by the information given. The individuals are young and healthy. They are getting married in a few months and want to start a family, but the individual’s soon-to-be spouse visits the doctor often, but does not have a chronic condition. There are five categories of health care plans: bronze, silver, gold, platinum, and catastrophic (HealthCare.gov, 2015, p.1). Below is an overview of rate comparisons for each of the five HMO categories from Blue Cross Blue Shield.
Bronze
With the bronze plan, the individuals will have a low monthly premium but will have a higher deductible. The bronze plan is suitable for individuals who do not go to the doctor frequently.
Silver
"The silver plans offer the best balance between cost and coverage. With this plan, you choose a primary care doctor who refers you to other physicians in our wide HMO network” (Blue Cross Blue Shield, 2015). The silver plan is best for individuals who are willing to pay more for premiums each month, but co-pays and deductibles are a little less than the bronze plans.
Gold
Gold plans offer fixed monthly payments that are higher, but the deductibles and out-of-pocket max are lower than the bronze and silver plans.
Platinum
The platinum plan offered by Blue Cross Blue Shield is a PPO. The premiums are the highest, but the deductibles are the lowest.

Catastrophic Individuals, who are under that age of 30 and are in good health, should look into a catastrophic plan. Catastrophic health plans usually have low premiums, but higher deductibles.
PPO
Preferred provider organization (PPO) is a managed care organization. Under PPO, payments are usually made by the employer on behalf of an employee and his/her family after receiving any form of health care service, PPO does not make any payments in advance. Patients with a PPO plan pay less for services if they use the plan's network. And under PPO the patients have the choice and flexibility to use doctors and hospitals outside the plan's network with extra cost. PPO plan does not require the insurer to have a primary care physician and under the plan the insurer have the freedom to see any specialist without a referral (Smith, 1998).
Preferred provider organization offer both large and small provider networks. Plans with a larger network might have higher monthly premiums than plans with a smaller network (smaller provider networks have less doctors and hospitals). If one prefer to keep cost down by lower deductible and co-pays it would be wise to choose a smaller provider network and stay in network when receiving care.
Individuals with higher deductible plan with no other secondary coverage might be eligible to open a health savings account (HSA). Individuals can make pre-tax contributions to HSA and the person can withdraw the money any time tax free for qualified medical expenses. The main advantage of HSA is its portability (from one job to another or from one plan to another) and the ability of year-to-year rollover (Eastman, 2004).
For a person who is a hypochondriac it is better to do some research on plan's provider list and select smaller network if possible to reduce the cost of deductible and co-pays. But if he prefers to stay with plan's larger network, it is advisable to check HSA eligibility and a start an account to set aside money for unexpected and future medical expenses. As the character in the study receive health care more often, it is better to stick to the providers and specialist in-network to save money. And only use emergency department for serious and life threatening illness.
CDHP
Hypochondriacs are people that suffer from fear of contracting a serious illness. The condition is known as hypochondria or hypochondriasis. A hypochondriac continues to believe that he/she is seriously ill despite medical evaluations and reassurances from the provider that they are healthy (Medical News Today, 2009). To a hypochondriac normal body functions such as a heartbeat can be perceived as part of a serious illness. Hypochondriacs normally suffer from depression or an obsessive-compulsive disorder. Normally what starts a hypochondriasis reaction is hearing or viewing information about a certain disease that one fears they may contract and obsessing over symptoms that for the disease that the individual believes they have in common with the disease. One of the individuals in a marriage having this condition will most likely have more medical expenses than the one that does not have this condition.
For a young married couple if they are starting off and both work it is probably best to get separate insurance through their employer. Since one is a hypochondriac it may be good to start out with employer health insurance, but it would probably be best, especially if it is the female with the hypochondriasis condition to consider pairing it with a CDHP insurance plan. A CDHP is a consumer-directed health plan (Pacificsource, 2015). CDHP’s give an individual or a couple more control over managing their health expenses. They are like a savings account that helps one put money away for health care costs or a serious illness. The insurance plan can be combined with a health savings account (HAS), a flexible spending account (FSA), or a health reimbursement arrangement account (HRA) to help manage health care expenses. With this sort of plan one obtains cost and quality information about health care that helps make the decisions, along with guidance form your doctor, as far as what medications to use, buy, and what type of treatment you can afford.
The hypochondriac may require some extra medical expenses such as mental health treatment that is not normally covered, but with this type of plan it will probably cost less once the deductible is reached. Using a federally-qualified, high-deductible health plan with a high savings account, routine preventative care is usually covered at no cost. Most of the hypochondriac situations may be controlled because there is an out of pocket expense, and the costs that aren’t covered by the health plan, if they qualify, can be covered by the health care account until the deductible is reached, at which time the insurance will cover the rest of the health care for that year. It is possible to save the deductible in a tax-free health savings account that rolls over from year to year (Lander, 2014). While they are both young and relatively healthy they normally won’t need much care, but since one is a hypochondriac it will be best if the deductible is reached to try and get as much care as possible during that year it is reached.

As you can see, each health care plan covers different things for different situations. What may work for one person may not work for another. There is a lot to consider when making a decision. For our couple, who is getting married, the best plan would be an HMO with a CDHP as an extra cushion since the soon to be spouse is a hypochondriac. The CDHP will give them the extra money for any medical expenses that may arise. With an HMO, such as Blue Cross and Blue Shield, you can pick the level of coverage is right for you and your family.

References
Blue Cross Blue Shield. (2015). Individual and Family. Retrieved from http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html
Eastman, A. D. (2004). Health Saving Accounts: Beneficial reform or Tax Break for the Wealthy? Journal of Insurance Regulation, 23(2), 67-90. Retrieved from http://search.proquest.com
HealthCare.gov. (2015). Comparing Health Plans. Retrieved from https://www.healthcare.gov/choose-a-plan/
Lander, S. (2014). The Best Health Insurance for a Young Married Couple. Retrieved from http://budgeting.thenest.com/health-insurance-young-married-couple-32415.html
Medical News Today. (2009). What is Hypochondria? Retrieved from http://www.medicalnewstoday.com/articles/9983.php
Pacificsource. (2015). Pacificsource Health Plans. Retrieved from https://www.pacificsource.com/consumer-directed-health-plans-101/page-1.aspx
Smith, D. G. (1998). The Effects of Preferred Provider Organizations on Health Care Use and Costs. Inquiry - Blue Cross and Blue Shield Association, 34(4), 278-287. Retrieved from http://search.proquest.com
WebMD. (2015). Health Care Reform: Health Insurance & Affordable Care Act. Retrieved from http://www.webmd.com/health-insurance/wi/wisconsin-health-insurance-marketplace?page=3&state=WI