Case Study Comparisons

Part 1

Complete the chart below that differentiates the following insurance types.

Plan Type/Characteristics of Plan (5 to 7 characteristics)/ Target Audience for Plan

Indemnity Plan

Preferred Provider Organization (PPO)

Health Maintenance Organization (HMO)

Consumer Directed Health Plan (CDHPs)

Medicaid

Medicare

Part 2

Review the insurance plans and answer the following questions.

Services          Bronze                                  Silver                                     Gold

Monthly Cost $163                                      $194                                $245

Deductible $6,000                                     $4,000                              $1000

Primary Care -$35 co-pay for three visits, then 20% of co-insurance(bronze)    /$30 co-pay/provider/day (silver)      /$20 co-pay/provider/day(gold)

Specialist Visit- $70 co-pay for three visits, then 20% of co-insurance  (bronze)  $60 co-pay/provider/day (silver)     $40 co-pay/provider/day(gold)

Preventive Care/Screening/Immunization No charge No charge No charge (ALL THREE PLANS)

Diagnostic Test (x-ray, blood work) $35 co-pay or 20% of co-insurance if co-pay limit is researched Office visit co-pay or(bronze)   20% of co-insurance Office visit co-pay(silver) or 20% of co-insurance Office visit co pay(gold)

Level 1 Prescription Drugs $25 co-pay/30 day supply(bronze)/ $15 co-pay/30 supply(silver)/ $15 co-pay/30 supply(gold)

Emergency Room Services 20% of co-insurance (bronze)/ $350 co-pay/facility/day(silver) $250 co-pay/facility/day(gold)

Emergency Medical Transportation 20% of co-insurance 20% of co-insurance 20% of co-insurance (ALL THREE PLANS)

Urgent Care $75 co-pay  (bronze) $60 co-pay/provider/day (silver) $60 co-pay/provider/day(gold)

Hospital Stay (facility fee, physician/surgeon fee) 20% of co-insurance 20% of co-insurance 20% of co-insurance (ALL THREE PLANS)

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 the plans for you?

2. Read and answer the questions below regarding the two consumers and refer to the Gold, Bronze, or Silver 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 diabetic but still uses her insurance plan frequently.  

o Compare the plans provided and determine the best plan for Betsy. 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 room services and urgent care more often.  

o If Betsy was considering changing her insurance plan, which plan should she consider? Why?

o How does the plan compare with the plan?

Consumer B

Zach is a healthy 30 year old who rarely goes to the doctor and is not on any medication. I have been offered the following insurance plans and are considering the plans for use of common alignments (eg, colds) and for preventive tests.  

o Compare the plans and determine what would be the best plan for Zach. 

Zach has recently been hired as a construction worker and was considering changing his health plan. I have realized that this job may have more hazards than his last job.

Which plan should Zach consider? Why?

o How does the plan compare with the plan? Remember to consider deductibles and general costs for the services I would use.

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