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 (the target audience is not an employer and is not "the consumer")
|
|
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 (two scenarios for each section are given - provide the right plan for each scenario)
Jenny 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 Jenny control her diabetes and blood pressure.
Jenny is considered a controlled diabetic but still uses her insurance plan frequently.
- Compare the plans provided and determine the best plan for Jenny. Remember to consider deductibles and general costs for the services she would be using.
For a couple of years, Jenny was really taking care of herself. However, after suffering a broken leg and being more inactive, Jenny has gained weight and has not been diligent about controlling her diabetes. Jenny has found that she is requiring emergency room services and urgent care more often.
- If Jenny 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 -
John 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 John in this scenario.
John 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.
- Now which plan should John 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.