Discussion: Patients will often look to healthcare providers for information healthcare plans, coverage, and options.
Discussion Patients will often look to healthcare providers for information healthcare plans, coverage, and options.
There are three patients : Joe, Scott, and Steve. Joe is 42, relatively healthy, and was a member of the Army for 20 years. Scott is 67 and suffers from chronic bronchitis. Steve is 25 and is battling stage 2 cancer.
These three patients can choose from one of the following plans (either from Group A or Group B):
Group A Plans: Medicare, TRICARE
Group B Plans: HMO, PPO, and POS
Joe, Scott, and Steve would like recommendations on the best plan options.
Select one patient (Joe, Scott, or Steve) and provide a Group A Plan and a Group B Plan that would be the best options for the provided parameters. Include the following:
A comparison of the two plans
Rationale for selection of the plans
A selection (between the two plans) of what the patient should ultimately choose and why.
Refer to the background material in this unit for assistance and complete outside research as appropriate. Be sure to cite your resources.
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You have choices when you shop for health insurance. If you’re buying from your state’s Marketplace or from an insurance broker, you’ll choose from health plans organized by the level of benefits they offer: bronze, silver, gold, and platinum. Bronze plans have the least coverage, and platinum plans have the most. If you are under 30, you may also be able to buy a high-deductible, catastrophic plan.
How are the plans different? Each one pays a set share of costs for the average enrolled person. The details can vary across plans. In addition, deductibles — the amount you pay before your plan picks up 100% of your health care costs — vary according to plan, generally with the least expensive carrying the highest deductible.
Platinum: covers 90% on average of your medical costs; you pay 10%
Gold: covers 80% on average of your medical costs; you pay 20%
Silver: covers 70% on average of your medical costs; you pay 30%
Bronze: covers 60% on average of your medical costs; you pay 40%
Catastrophic: Catastrophic policies pay after you have reached a very high deductible ($8,150 in 2020). Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.
You will also see insurance brands associated with the care levels. Some large national brands include Aetna, Blue Cross Blue Shield, Cigna, Humana, Kaiser, and United.