Case Study Comparisons
Part 1
Complete the chart below that differentiates the following insurance types.
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Plan Type
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Characteristics of Plan (5 to 7 characteristics)
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Target Audience for Plan
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Indemnity Plan
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Preferred Provider Organization (PPO)
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Health Maintenance Organization (HMO)
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Consumer Directed Health Plan (CDHPs)
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Medicaid
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Medicare
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Part 2
Review the insurance plans below and answer the questions that follow the chart.
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Services
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Bronze
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Silver
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Gold
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Monthly Cost
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$163.00
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$194.00
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$245.00
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Deductible
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$6,000.00
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$4,000.00
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$1000.00
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Primary Care
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$35.00 co-pay for 3 visits, then 20% of co-insurance
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$30.00 co-pay/provider/day
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$20.00 co-pay/provider/day
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Specialist Visit
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$70.00 co-pay for 3 visits, then 20% of co-insurance
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$60.00 co-pay/provider/day
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$40.00 co-pay/provider/day
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Preventive Care/Screening/Immunization
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No charge
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No charge
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No charge
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Diagnostic Test (x-ray, blood work)
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$35.00 co-pay or 20% of co-insurance if co-pay limit is researched
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Office visit co-pay or 20% of co-insurance
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Office visit co-pay or 20% of co-insurance
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Level 1 Prescription Drugs
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$25 co-pay/30 day supply
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$15.00 co-pay/30 supply
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$15.00 co-pay/30 supply
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Emergency Room Services
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20% of co-insurance
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$350.00 co-pay/facility/day
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$250.00 co-pay/facility/day
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Emergency Medical Transportation
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20% of co-insurance
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20% of co-insurance
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20% of co-insurance
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Urgent Care
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$75 co-pay
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$60.00 co-pay/provider/day
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$60.00 co-pay/provider/day
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Hospital Stay (Facility fee, physician/surgeon fee)
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20% of co-insurance
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20% of co-insurance
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20% of co-insurance
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1. Compare the plans in the chart in the space provided below-- feel free to expand the space if you need to.
- What are the major differences of the three plans?
- What are the major similarities of the three plans?
- If you needed to choose, what would be the major advantages and disadvantagesof eachplan, in relation to your needs?
2. Answer thequestions below regarding the two consumers and refer to the Gold, Bronze, or Silver plans listed above.
Consumer A - Betsy
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 glucose (sugar) levels and prescribes level 1 drugs (see chart) to help Betsy control her diabetes and blood pressure.
Compare the plans in the chart and determine the best plan for Betsy. Remember to consider deductibles and general costs for the services she would be using.Use the space provided-- feel free to expand it if necessary.
Betsyis able to control her diabetes, but still uses her insurance plan frequently. For several years, she was careful to follow the proper diet and exercise plans. However, after suffering a broken leg and being inactive, she gained weight and has not been diligent about controlling her diabetes. She has found that she needs emergency room services and urgent care more often than she did previously.
Please answer the questionsthat follow, in the spaces provided--- feel free to expand them if necessary.
1. If Betsy was considering changing her insurance plan, which plan should she consider? Why?
2. How does the plan she should consider in this scenario compare to the plan choice from the first question?
Consumer B - Zach
Zach is a healthy 30 year old who rarely goes to the doctor and is not on any medication. He is evaluating the three insurance plans in the chart. He is considering selecting one of the plans for common ailments (i.e., colds) and for preventive tests.
Compare the plans and determine the best plan for Zach. Use the space provided-- feel free to expand it if necessary.
Zach recently started a new job as a construction worker. He is considering a change in his health insurance plan. He is aware that this new job may have more hazards than the previous job.
Please answer the following questions in the spaces provided--- feel free to expand them if necessary.
1. Which plan should Zach consider? Why?
2. 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.