Please see attachment.Insert Title HCS/490 v10 Case Study Comparisons HCS/490 v10 Page 2 of 3 Case...

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Please see attachment.Insert Title HCS/490 v10 Case Study Comparisons HCS/490 v10 Page 2 of 3 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. 	Plan Type 	Characteristics of Plan 	Target Audience for Plan 	Indemnity Plan 	 	 	Preferred Provider Organization (PPO) 	 	 	Health Maintenance Organization (HMO) 	 	 	Consumer Directed Health Plan (CDHP) 	 	 	Medicaid 	 	 	Medicare 	 	 Part 2 Review the following insurance plans and then answer the questions below. 	Services 	Bronze 	Silver  	Gold 	Monthly cost 	$163 	$194 	$245 	Deductible 	$6,000 	$4,000 	$1,000 	Primary care 	$35 co-pay for three visits, then 20% of co-insurance 	$30 co-pay/provider/day 	$20 co-pay/provider/day 	Specialist visit 	$70 co-pay for three visits, then 20% of co-insurance 	$60 co-pay/provider/day 	$40 co-pay/provider/day 	Preventive care/screening/immunization 	No charge 	No charge 	No charge 	Diagnostic test (x-ray, blood work) 	$35 co-pay or 20% of co-insurance if co-pay limit is reached 	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 co-pay/30-day supply 	$15 co-pay/30-day supply 	Emergency dept. services 	20% of co-insurance 	$350 co-pay/facility/day 	$250 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 co-pay/provider/day 	$60 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 each plan for you? 2. Read and answer the questions below regarding the two consumers (A and B) and refer to the Gold, Silver, or Bronze 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. She uses her insurance plan frequently. 1) 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. 2) If Betsy was considering changing her insurance plan, which plan should she consider? Why? 3) How does the plan she should consider in this scenario compare to the plan choice from question 1? 4) Describe the impact diabetes, as a chronic disease, has 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. 1) 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.  1) Which plan should Zach consider? Why? 2) How does the plan he should consider in this scenario compare to the plan choice from question 1? Remember to consider deductibles and general costs for the services he would be using. Copyright© 2019 by University of Phoenix. All rights reserved. Copyright© 2019 by University of Phoenix. All rights reserved.

Soumi · Accepted Answer

Insert Title
HCS/490 v10
Case Study Comparisons
HCS/490 v10
Page 3 of 4
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.
	Plan Type
	Characteristics of Plan
	Target Audience for Plan
	Indemnity Plan
	· It gives significant flexibility in gaining healthcare services from any professional or hospital of the insured person’s interest. 
· It consists of deducted amount, which is given by the insured individual prior to the gain provided by the insurance company.
· It splits the expenses between the company and the individual seeking insurance.
· It limits extreme non-remunerated expenses of the individual.
· It assists the safeguarded person with highest lifetime benefits.
	It targets individuals who favor versatile insurance over extensive coverage.
	Preferred Provider Organization (PPO)
	· It does not ask the covered individuals for referrals in order to seek healthcare services.
· It accommodates the covered individual with the freedom to seek medical help from professionals outside the insurance provider’s nexus.
· It imparts treatment from healthcare personnel at a much lower expense.
· It accords the enrolled individual with extensive provider choice amongst all other insurance plans.
· PPO imparts healthcare services from the nexus of healthcare professionals or hospitals having non-proprietary relationship with the organization.
	PPO targets large groups of people and employees seeking healthcare services from a provider nexus.
	Health Maintenance Organization (HMO)
	· HMO does not assist any coverage for seeking medical help from providers or professionals from outside the network.
· Healthcare professionals listed in the network of HMO are under direct or indirect monetary risks for assisting services.
· HMO requires a referral from primary care physician in order to get healthcare services from professionals outside the network.
· HMO asks for lower premiums from the enrolled individuals.
· HMO covers delivery of healthcare services such as in-patient hospitalization and ambulance care.
	HMO targets majority of the public, especially people with families or with children who require frequent medical attention. They have low premium costs and hence, they are highly used by majority of people.
	Consumer Directed Health Plan (CDHP)
	· It exhibits high monetary risk to the employees
· CDHP is an excessively deductible health insurance.
· It increases the responsibility of covered individuals in their own healthcare expenditures.
· It saves costs of the inheritor and remunerator.
· CDHP provides tax benefits to the enrolled individual.
	CDHP targets young individuals with higher salary and excessive knowledge regarding health and healthcare plans. They tend to have better capability in associating with healthcare professionals.
	Medicaid
	· Medicaid provides coverage for disabled and aged groups.

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