Major Medical Health Insurance Plans

In a 3-5 page academic paper, describe how healthcare insurance has factored or will factor into your future job search. Select a minimum of three different options for insurance and protecting you and your family from major medical expenses, while highlighting the pros and cons of each insurance offering. Include a minimum of two credible references that were used in your research. Employ the aforementioned “Guidelines for Writing Papers” instructions in the development of your work.

ANSWER

Major Medical Health Insurance Plans

Healthcare insurance is a very crucial factor in employment. Any new employee must ensure he/she gets covered as stated by the state and federal law. Consistent subscription either through personal efforts or employer guarantees the cover; the insurance only gets canceled when the employer stops to pay for the premiums or when one stops to pay for the self-sponsored subscribers. As an employee of a company that offers group coverage, one is entitled to the insurance even when he gets to another company, which supports the group coverage. The Healthcare Insurance Portability and Accountability Act (HIPAA) provides stringent rights that enable employees who transfer from one employer to another to obtain medical covers in their respective companies. The HIPAA is only applicable for those with employer health plans, those who move from one employer to the other, and finally, if the new employer offers health insurance.

The plans offered by the new employer must be able to cover all the family members who qualify as per the new plan’s requirements, the plan should also be fair thus unable to reject or charge high premiums as a result of a family member’s condition, and any family member should be able to join during the special enrolment periods without necessarily having to wait for the pre-existing conditions coverage. In occasions where one moves from a company with employer group insurance to one that does not offer the group insurance or rather to be self-employed, he/she can either continue with the group benefits that don’t go past 12 months or subscribe to an individual policy whereby one purchase a permanent policy that lasts as long as the regulations and terms of payment have adhered. One can only continue with group coverage under various laws and acts; one is through Ohio’s continuation law, which allows up to 12 months so long as the workers are above 20 in number, and Federal continuation law (COBRA), which runs between 18-36 months depending on various circumstances (Barnett & Vornovitsky 2016).

One of the options for healthcare insurance is Health Maintenance Organization (HMO); this is a type of health insurance plan whereby the coverage is limited to only doctors and healthcare providers who work for or are contracted by the HMO. The coverage usually is provided through a network of physicians; the insurance coverage can either be on monthly or yearly subscription terms. The HMO premiums are generally lower than those of traditional healthcare insurance. Some HMO coverage advantages are reduced healthcare costs, copays required for employees are generally of minimal amounts, most HMO coverage does not require a deductible, and finally, the fee charges are flat for all the subscribers. The disadvantages include restrictions for the medical providers to subscribers, high chances of copayment costs in frequent visits, and only proper coverage when the participants are referred to by the specialists as regulated.

The second insurance cover is the Point of Service (POS) insurance plan; this is a type of plan in which a participant pays less when he/she uses doctors, hospitals, and healthcare providers within the plan’s network. The insurance plans require a subscriber to obtain referrals from the primary care doctor to get medical attention. The POS plans include elements from HMO and PPO coverage plans. A primary care specialist/physician must be appointed whose key role would be making referrals to other specialists when the need arises. Advantages of POS insurance cover are easy to access healthcare services outside the network hence a plus to outpatient services; the cover allows greater geographic flexibility, thus allowing medical coverage attention anywhere. The disadvantages include high costs if the subscribers opt for out of network service provider since there are possibilities of paying high annual deductibles before service provision; the POS coverage involves lots of paperwork, especially for out-of-network care with specialist charges being paid upfront (Gale et al.,2019).

Finally, the third insurance plan is the traditional healthcare insurance, which typically works based on copays and deductibles; the subscriber enhances payment of the doctor’s bills, lab tests, and the respective prescriptions. The subscriber is wholly responsible for paying the plan’s monthly costs with copay variations depending on the provided or required service. Advantages of traditional healthcare insurance include relatively lower monthly premiums, thereby encouraging personal savings among the subscribers. The traditional healthcare insurance coverage allows tax-free spending accounts; the coverage may allow the merging with a Health Savings Account; hence the subscriber can use the savings in handling other medical expenses. The disadvantages include higher deductibles, especially when one must pay for the services using out-of-pocket funds up to the set amount before benefiting from the coverage. Lastly, the out-of-pocket medical expenses are costly for those who opt for high deductible health plans with non-preventive medical care.

References

Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015. Washington, DC: US Government Printing Office.

Gale, W. G., Gelfond, H., Krupkin, A., Mazur, M. J., & Toder, E. J. (2019). Effects of the Tax Cuts and Jobs Act: A preliminary analysis. National Tax Journal, 71(4), 589-612.