HA4070D – Regulatory Environment in Health Care

Discussion 06: Selecting a Plan

Base this discussion on the Problem on page 261 of your text labeled “Choosing Health Insurance”. Defend your plan selection with material from the text.

From what you have learned so far, which of the following insurance plans listed below do you personally prefer, assuming each one costs the same? Defend your choice (both your selection and rejections) with reasons drawn from these readings:

.Plan A: Covers the full range of medical care, subject to standard medical necessity or experimental exclusions, without any deductibles or copayments, but you must receive all care at an HMO clinic where doctors are paid a bonus for saving money.
.Plan B: Excludes mental health and preventative care, and the rest is subject to a $200 deductible and 20 percent copayment up to a maximum of $1,500 per year. Your choice of doctor, but all expensive treatments must be submitted for prior approval by the insurer to determine medical appropriateness.
.Plan C: Covers the full range of medical care, with no major exclusions and your choice of doctor, and no prior authorization requirement, but subject to a $3,000 deductible.
.Plan D: Coverage is defined in an approach similar to the Oregon plan, only using 5,000 specific categories of inclusion and exclusion taken from the latest practice guidelines based on medical research, as selected by a national panel of politically appointed experts. No other restrictions or financial limitations.
Base your discussion on material from the text and your own experience. Cite sources when necessary. Remember to write 150 words in complete sentences.

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