Reply to Health Care Insurance
Reply to a discussion about health insurance 250-275 words, APA format, scholarly sources.
Currently, I am enrolled in a preferred-provider organization (PPO) health insurance plan offered by my employer. PPO plans are a type of managed care plan. The goal of a PPO is to provide economical and effective care to patients (Masterson, 2020). My experience with this plan was interesting because this was the first time I was enrolling in my own medical insurance. Another feature that was offered by both my employer and my health insurance plan is a health benefits subsidy application to assist associates who may not have affordable access to healthcare. It offers reduced associate bi‐weekly payroll deductions for coverage & discounts on the PPO plan for eligible associates. Eligibility is determined by family size, annual income and marital status.
There are a few concerns I have with my insurance plan. The biweekly payments as well as the deductibles have increased in the short amount of time. For example, the first year I enrolled the same plan had a $500 deductible and 15% coinsurance plan and now it has a $750 deductible and 15% coinsurance plan. $250 is a large amount to some when you have monthly medications and supplies to purchase to keep yourself or a family member healthy or, in some cases, alive. Another concern is the availability of in-network specialists. It took me months to find a dermatologist in my area that was also in-network with my plan. Then, when I finally found one that was relatively close, I still had to schedule my appointment months out. Also, it is known that PPO’s typically have higher out-of-pocket expenses (Masterson, 2020).
Working in a specialist office, I am aware that these providers can book their new patient appointments out a few months. However, with my plan, my suggestion would be to add more in-network specialists in order to help solve this problem. When there are more providers to choose from in the area, the wait time for each office will be less due to the fact that patients are now split up between each office. In some cases, patients may choose to see an out-of-network provider just to be seen in a timely manner. Another concern I have with this plan is that PPO’s generally trade off the patient’s choice of access to healthcare providers for increased costs (The editors, 2007). I don’t typically believe that this is a fair trade due to the fact that when consumers are most in need for healthcare, they usually do not have an excess of income of money just laying around to pay for it.
References:
Masterson, L. (2020, February 27). HMO vs PPO vs Other Plans: What’s the Difference? Retrieved October 08, 2020, from
https://www.insurance.com/health-insurance/difference-between-ppo-hmo-hdhp-pos-epo.html
The editors of, C. R. (2007, Sep 12). Readers pick best HMOs and PPOs. Bucks County Courier Times Retrieved from
https://search-proquest-com.ezproxy.trident.edu/docview/392351345?accountid=28844
Insurance Discussion
For this discussion, research your own health insurance plan or a plan that you are familiar with. You may also choose a plan from the Federal OPM at https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/
Complete the following:
Identify the type of insurance plan (e.g. HMO, PPO, etc.)
Describe your experience with this insurance plan.
Identify 2-3 problems with the plan.
Identify 2-3 recommendations for improvements to the plan.