Health Insurance

PART A “Health Insurance” Please respond to the following:

Determine two to three (2-3) benefits of having health insurance for a family. Specify two (2) avenues through which families may obtain health insurance.
Compare and contrast two (2) differences between health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Classify the plan that you believe would be most beneficial for the majority of insured patients. Provide support for your rationale.

PLEASE RESPOND TO CLASSMATE DISCUSSION WHETHER YOU AGREE OR NOT & A DETAILED WHY: In my opinion having health insurance for a family are more than a benefit, is necessary. Especially when you have kids, they get sick so often, doctor’s offices visits are costly, medications and if need to go to emergency department is even more expensive. Avenues through which families can get health insurance are through their jobs, private companies and government.

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The differences between HMO and PPO, is that HMO’s premiums and deductibles are usually lower than PPO, with HMO patient will have to select a primary physician and will need a referral to see a specialist. HMO’s outside network are limited to emergencies only. PPO plans usually have some coverage outside network although is not as generous as if is in-network. Generally speaking, HMO and PPO differences are plan cost, ability to see specialist and coverage outside network. In my opinion the best plan for an individual will really depends on the individual health needs.

Part B – “Health Economics” Please respond to the follwoing:

As a Human Resources manager for a mid-sized company in your area, you have been tasked with purchasing the best group health insurance for your organization. Analyze at least two (2) lifestyle choices relative to the effect(s) that these choices could have on the organization’s premiums. Support your rationale with two (2) health economic examples.
Debate It: Take a position that the full implementation of the Affordable Care Act in 2014 will or will not create a market failure for insurance companies. Provide evidence to support your position.

PLEASE RESPOND TO CLASSMATE DISCUSSION WHETHER YOU AGREE OR NOT & A DETAILED WHY: Smoking still is an issue when it comes to medical insurance. That would be the first lifestyle choice that I would analyze because that would effect the premiums offered. Smokers have been proven to have higher smoking related health issues than non-smokers resulting in higher medical costs.Smoking-related illness in the United States costs more than $300 billion each year, including:^11,12

*Nearly $170 billion for direct medical care for adults

*More than $156 billion in lost productivity, including $5.6 billion in lost productivity due to secondhand smoke exposure

I would offer a a discounted premium for non-smokers and a cessation class for the smokers and upon completion and successful quitting will be able to benefit from the discount as well. Another life-style choice to analyze would be maternity and pediatric benefits. In family plans it is safe to assume that those two benefits would be necessaryto be included in the premium. When people are looking for employment they look at which company will offer family medical benefits so they can provide insurancefor their families. Employees that have coverage for their families tend to stay longer.

I think the full implementation of the Affordable Care Act in 2014 will create a market failure for insurance companies because there was one example of when United Healthcare withdrew from most of the ACA’s exchange markets because of the massive losses they experienced. Premiums increased more then expected as a result and many new insurers that focused on the individual market have failed and are in financial distress.