Health Plans - Example 3 When looking over different health care problems, there were a few things I had to consider. I know I do not visit the hospital or doctor more than twice or three times a year (each), and I do not make enough money working part time to pay high deductibles or high monthly fees. I need a plan that only includes myself, and I need coverage for my prescription. If possible, I would like to keep my current doctor, however I’m confident that in the bay area there is a large choice of doctors from which I would be able to easily find a doctor I like. The three healthcare plans I researched are: Anthem Blue Cross, Kaiser Permanente Copay 50, and Blue Shield Vital Shield 2900.

Anthem Blue Cross (Individual) has no deductible, a very low monthly cost (about through my job), and fairly broad coverage. The office visit copay is very affordable for my budget (), and my prescription is covered for for the generic and for the brand name. I prefer the brand name personally due to side effects with the generics, but it will not hurt my wallet to get the brand name instead. The inpatient/outpatient costs are done by 20% of the bill, which I’m not too worried about, seeing as how I am in good health and expect no need for any hospital visits. Kaiser Permanente: Copay 50 has no annual deductible, and preventive care – such as annual physicals, immunizations, and mammogram screenings – are free.

A visit to a primary care physician or specialist is . X-rays and lab test are a procedure. Outpatient surgery is 0 a procedure; I’m also not worried about needing any surgeries, my current health coverage covers outpatient, non-cosmetic surgeries completely. Kaiser Permanente’s plan also costs 0 a day for inpatient hospital care, and emergency room visits are 0. I could not find a monthly cost for this plan, however.

Blue Shield: Vital Shield 2900 costs a month. There is a ,000 deductible. The copay max is ,900. However, they only offer coverage for generic prescriptions, which would be slightly cheaper for me, but I would rather pay an extra to get the quality without the side effects. Office visits are for the first visit of the year, then

Health Plans Example 3when Looking Over Different Health Care Proble

Health Plans - Example 3 When looking over different health care problems, there were a few things I had to consider. I know I do not visit the hospital or doctor more than twice or three times a year (each), and I do not make enough money working part time to pay high deductibles or high monthly fees. I need a plan that only includes myself, and I need coverage for my prescription. If possible, I would like to keep my current doctor, however I’m confident that in the bay area there is a large choice of doctors from which I would be able to easily find a doctor I like. The three healthcare plans I researched are: Anthem Blue Cross, Kaiser Permanente Copay 50, and Blue Shield Vital Shield 2900.

Anthem Blue Cross (Individual) has no deductible, a very low monthly cost (about $50 through my job), and fairly broad coverage. The office visit copay is very affordable for my budget ($20), and my prescription is covered for $10 for the generic and $30 for the brand name. I prefer the brand name personally due to side effects with the generics, but it will not hurt my wallet to get the brand name instead. The inpatient/outpatient costs are done by 20% of the bill, which I’m not too worried about, seeing as how I am in good health and expect no need for any hospital visits. Kaiser Permanente: Copay 50 has no annual deductible, and preventive care – such as annual physicals, immunizations, and mammogram screenings – are free.

A visit to a primary care physician or specialist is $50. X-rays and lab test are $10 a procedure. Outpatient surgery is $250 a procedure; I’m also not worried about needing any surgeries, my current health coverage covers outpatient, non-cosmetic surgeries completely. Kaiser Permanente’s plan also costs $500 a day for inpatient hospital care, and emergency room visits are $150. I could not find a monthly cost for this plan, however.

Blue Shield: Vital Shield 2900 costs $80 a month. There is a $29,000 deductible. The copay max is $5,900. However, they only offer coverage for generic prescriptions, which would be slightly cheaper for me, but I would rather pay an extra $20 to get the quality without the side effects. Office visits are $40 for the first visit of the year, then $0 after the out-of-pocket maximum has been reached.

Lab tests and x-rays are only covered after the out-of-pocket maximum has been reached as well. Emergency room visits are $100 plus 40% after deductible. As stated before, I am in fairly good health and do not expect to be hospitalized or sent to an emergency room, however if something unexpected were to occur and I would need to go to the emergency room, I might not have $100 + 40% to cover the costs. Under this healthcare plan, one accident might cause serious financial problems. In conclusion, after reviewing the different types of plans, I have decided that the best plan for me is the Anthem Blue Cross (Individual), which happens to be the plan I have been with for the past several years.

I am comfortable with my plan, my doctor, my coverage, and I am able to pay for the costs as needed. The other plans I reviewed have either high deductibles or high monthly costs which I would not be able to pay on a regular basis. I rely on the low-cost of Anthem Blue Cross to get the amount of medical attention needed for my lifestyle. Health Insurance Plan Research Assignment For this assignment I researched individual health insurance options. I looked at three insurance plan types, HMO, PPO, and PPO with a health savings account.

I received quotes from three different carriers: Kaiser Permanente, Anthem Blue Cross, and Aetna. I considered potential healthcare plans that would cover myself as an individual. I have read in the news that individual insurance can be difficult to obtain, primarily because the recent healthcare reform legislation that would lift the insurance carriers ability to exclude individuals with pre-existing conditions, does not come into play until 2014. Given my age of 28, active lifestyle, I am fortunate to not have pre-existing conditions, and am confident that I can and will be accepted for a plan at a relatively low cost. I considered five factors when evaluating different insurance options; monthly premium cost, deductible amount, out of pocket cost, Rx coverage, and provider network.

The first option I considered was an HMO plan with Kaiser Permanente. This plan was called the Kaiser HMO $25 co-pay plan. This plan was attractive because it had a $0 deductible, $25 office visit co-pays, low out of pocket costs ($2,500), and good Rx coverage. The negative aspect of this plan was that as an HMO, I would be limited to using only Kaiser facilities and seeing only Kaiser doctors. Additionally, the monthly premium cost of $356 was too expensive relative to other options I researched.

All things considered, although there are a lot of new Kaiser facilities in Oakland and San Francisco, I don’t use my medical plan enough to need that expensive of a plan. I felt that a PPO plan was a better option for me because it would allow me more flexibility as far as providers to choose from. Even if my doctor or specialist I wanted to see was not “in-network†I would be able to see them and still receive some level of coinsurance coverage. I researched my primary care doctor, and found that he was included in both the Aetna and Anthem Blue Cross PPO provider networks. Had I selected the Kaiser HMO plan option I would not have been able to see my normal primary care physician as an “in-network†benefit.

I looked at two PPO plans, the first was the Anthem Blue Cross Core Guard PPO. This plan was attractive because it had a low deductible amount, $750, and 50% co-insurance after the deductible was reached. The out of pocket costs were $4250, but this plan had really bad Rx Coverage. There was a really high Brand Rx deductible, and at $169 per month, I didn’t think the benefit levels were good enough with this option. The final plan I looked at ended up being the most compelling option.

This plan was a health savings account compatible design with Aetna, called the Aetna H.S.A. Preventative and Hospital $3000 plan. This plan had a significantly lower premium than the other options, at $101 per month. Because of the high deductible amount of $3,000 this plan is considered an H.S.A. compatible plan. With an H.S.A. compatible plan I am able to open a health savings account at my bank and contribute money into my account tax-free.

The money in the account is then used to cover my medical expenses, helping me reach the deductible amount. I can contribute up to $3,100 annually into my H.S.A. plan and take it as a write off on my federal income taxes, plus I the money I contribute rolls over year to year. This money will collect interest and allow me to save for future medical expenses. Additionally I can use the H.S.A. money to cover other qualified medical expenses like dental and vision care, or Rx costs. This plan design also features preventative coverage at 100%.

In the end, the fact that I don’t frequently use my medical insurance plan, I wanted an option that had the lowest possible monthly premiums, not necessarily the best benefit levels. I liked the PPO model better than the HMO because it gave me more flexibility in doctor selection, but would still cover me in the event of unforeseen emergency situation. With the Aetna H.S.A. plan, I liked the fact that with the significantly lower monthly premium cost, I could use the money I was saving each month to fund into my H.S.A. account. Over the course of the year, that account will build up and allow me to have a savings for any future medical expenses. Picking a Health Plan - Example 1 For my ideal health plan, I would like coverage for my spouse and myself.

Overall, we are generally healthy people. We try to exercise on a regular basis and we eat diet that is heavily focused on whole grains, fruits and vegetables. Our individual healthcare needs differ in the fact that I require long term preventative and maintenance treatment. In 2009 I was diagnosed with a brain tumor. I underwent a craniotomy had it removed and am currently going in for routine check ups and maintenance.

Also My husband has a condition called Gastroesphageal reflux disease aka G.E.R.D. I would like a plan that will not leave us paying a huge amount of money in case, I need to undergo another craniotomy or GammaKnife radiation treatment or in case my husband needs to have surgery for my his GERD. In essence, I would like a plan that covers the major events. Monthly premiums should be in the range of $150 to $250. Because I would like the freedom to choose my physicians out of the network, a PPO plan that does not have a large deductible, requires that I pay minimal or no co-insurance, covers hospital stays (inpatient or outpatient) and has no caps on lifetime maximums would be ideal.

Based on the aforementioned criteria, I have found three PPO health plans that I can compare with. The first plan is through Anthem Blue Cross Clear Protection Plus 5000. The monthly premium is $124. The office visit for primary doctor for the first two office visits, I’d have to pay $40 co-pay, where the deductible (in and out of the network is $10,000 annually), is waived. Then additional office visits, I would have to pay 100% of negotiated fee and then there is a 0% co-insurance after my out-of-pocket maximum is reached.

Co-insurance in network is 40% after deductible. Out of network my co-insurance is 40% for inpatient and 0% for outpatient both after the deductible is met. My annual out of pocket limit for family is $17,000 dollars in and out of network (includes deductible). Outpatient surgery and hospitalization is 40% coinsurance after the deductible is reached. This seems a little too much money to pay out of pocket.

This plan also allows for out of network coverage, however, if I am out of the country, only emergency care is covered. The second provider is Blue Shield of California Shield Savings Plan 3500. This plan is also a PPO, but the monthly premium is $172. Although this plan is a little more expensive than the first, it provides better coverage and is still in my budget. The coverage for this plan is the following: no charge for office visit for primary doctor and office visit for specialist (after the deductible for the latter), 0% for co-insurance after the deductible, which is $7,000 annually for families.

The annual out of pocket is $10,000 (includes deductible), unlimited lifetime maximum, and there is out of network coverage. When I am out of the country, I am fully covered. Periodic health exam has no charge and my deductible is waived. Emergency room visit is $100 per visit, but waived if admitted. For the first plan, the cost is 40% coinsurance after the deductible plus $100 emergency room co-pay (co-pay waived if admitted).

Outpatient lab/x-ray is no charge, while the first plan is 40% coinsurance after deductible. A big plus with this plan is that outpatient surgery and hospitalization is no charge after deductible. However, a disadvantage to this plan is that out of network co-insurance is 50% after deductible and out of network out of pocket limit is $30,000 including deductible for family. The last plan is also a PPO through Health Net Optimum Advantage HAS NG $4,500 deductible. Monthly cost is $130.

This plan is very similar to the second plan in that there is no charge after deductible for office visit for primary doctor/specialist and co-insurance is the same at 0% after deductible. However the annual deductible is $2,000 higher than the second ($9,000). Annual out of pocket limit for family is $9,000 as well. There is no cap on lifetime maximum and as in the first plan with Anthem Blue Cross, out of the country coverage is only for emergency care. Advantages to this plan are that the periodic health exam is covered in full with the deductible waived.

For emergency room and outpatient lab/x-ray there is no charge after deductible. This was true the plan with Blue Shield, while Blue Cross required I pay. Other pluses about this plan are that outpatient surgery and hospitalization are of no charge after deductible. Disadvantages for this plan include the out of network coverage. The deductible for out of network is the same as in network, however, the out of network co-insurance is a high 50% and out of network out of pocket maximum is $29,000 for family (includes deductible).

Comparing all three of these plans, the trend is that the lower the monthly premiums, the more the consumer pays during major medical events, such as surgeries and hospitalization. This seemed to be the case with Blue Cross. I am mainly concerned with large medical bills, so this plan will not work for me. I could easily see myself being stuck with medical debts on this plan. With Blue Shield of California and Health Net, it seems more promising.

The coverage for big ticket items, such as outpatient surgery and hospitalization seem more reasonable. I would be rest assured that if I had to undergo another craniotomy or if my husband needed surgery for his GERD, we’d be paying no more than $7,000/$9,000, respectively. In the end, I would choose Blue Shield of California as a healthcare provider. I like that the annual deductible is not as high, the emergency room is $100 a visit, but would be waived if I was admitted, compared to HealthNet, which was no charge only after the deductible. Essentially, with Blue Shield of California, I’d be covered wherever my husband and I go, and that’s a huge piece of mind that’s worth paying for.

Works Cited "State-specific Health Insurance Resources." Affordable Health Insurance - Individual Family and Self-employed . Web. 17 Apr. 2011. <