Case Study Comparisons
Part 1
Complete the chart below that differentiates the following insurance types. Include 5 to 7 characteristics, as well as the target audience, for each identified plan type.
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Plan Type
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Characteristics of Plan
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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 (CDHP)
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Medicaid
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Medicare
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Part 2
Review the following insurance plans and then answer the questions below.
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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
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$194
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$245
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Deductible
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$6,000
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$4,000
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$1,000
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Primary care
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$35 co-pay for three visits, then 20% of co-insurance
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$30 co-pay/provider/day
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$20 co-pay/provider/day
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Specialist visit
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$70 co-pay for three visits, then 20% of co-insurance
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$60 co-pay/provider/day
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$40 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 co-pay or 20% of co-insurance if co-pay limit is reached
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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 co-pay/30 supply
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$15 co-pay/30 supply
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Emergency dept. services
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20% of co-insurance
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$350 co-pay/facility/day
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$250 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 co-pay/provider/day
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$60 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 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, Silver, orBronze 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; sheuses 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 several 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 department 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?
- Describe the impact diabetes as a chronic diseasehas on health care costs.
Consumer B
Zach is a healthy 30 year old who rarely goes to the doctor and does not take any medication. He has been offered the insurance plans above. He is considering the plans for use of common ailments (e.g., colds) and for preventive tests.
- Compare the plans and determine which would be the best plan for Zach.
Zach has recently been hired as a construction worker and is 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.