PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION: 1. Please discuss t
ID: 122806 • Letter: P
Question
PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION:
1. Please discuss the impact of deductibles and co-payments on patients’ health-seeking behavior.
A deductible is a set amount that is paid up front by the patient before insurance will start covering expenses. Once the patient has incurred enough medical expenses for that year and has surpassed their deductible they can then seek medical attention and their health insurance will pay the bill. A co-payment is an expense that the patient pays out of pocket each time they see their provider, fill a prescription, or undergo other procedures. Both of these expenses are incurred by the patient and will impact how they pursue medical treatment. Higher deductible levels and co-pays often encourage patients to avoid seeking medical attention to prevent out of pocket expenses. Furthermore, co-pays often vary based on where the patient is being seen which encourages routine preventative care rather than emergent care. The ever-increasing cost of healthcare in general prohibits some patients from even being able to afford carrying health insurance because they cannot afford the monthly premiums.
2. If you were a consumer how would you decide which insurance to choose with reference to co-payments?
Is the cheapest insurance always the best? As a consumer, I wouldn’t just choose the cheapest insurance. It’s often the cheapest because it covers the least amount of procedures, has higher co-pays, or higher deductibles. Instead I would seek out insurance that would cover the widest range of procedures, allow the most flexibility with regard to choosing a hospital or provider, and balance out the cost of the monthly premiums versus the deductible level and number of co-pays.
Explanation / Answer
1.This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. Sure, some patients are holding off on elective surgeries. This might be a good thing as research has suggested that Americans get too many procedures compared to other industrialized countries. However, this could be equally as bad as there may be an equal number of people who truly need surgery to improve their quality of life and ability to walk but can’t do so because they can’t afford it. With more financial responsibility of higher deductibles and copays, patients will simply skip care, specifically, needed medical care. Co-pays can often total hundreds of dollars each month if you have several health ailments. In these cases, many patients begin to pick and choose which medications they deem necessary, making for a potentially dangerous situation. But most would say that the alternative -- no health insurance -- would be worse. Will Americans change their behaviour and become healthier? The answer is no. Americans will die sooner, have a worse quality of life, and more preventable complications as a result of consumer driven healthcare. The doctors who are best in advising patients on the right care, the primary care doctors like internists and family doctors, are leaving their practice in droves because of issues of work-life balance and decreasing reimbursement. Healthcare costs for the short-term may fall only to rise rapidly as patients are forced to be treated for conditions that could have been handled earlier more easily and for a lot less. In other words, the perfect storm of a worsening healthcare system is upon us soon.
2.Many policies also have what is known as a lifetime maximum. Once a lifetime maximum is met, the insurance company is no longer responsible for your medical expenses. If this happens, you would unfortunately have to seek coverage elsewhere, which can be very difficult with existing conditions or outstanding medical claims/bills. As with anything in health care, yearly out-of-pocket expense maximums differ greatly by plan. Let's find out exactly how.
There are many plans out there, but we'll narrow them down to two main types: fee-for-service plans and managed health care plans.
A fee-for-service plan is what most Americans think of as traditional health insurance. The deductibles and co-pays for this type of plan are generally higher than those of a managed health care provider. These fees can add up over the course of a year, but they also buy more options. Under a fee-for-service plan, you're free to choose your own doctors, usually don't need a referral to see a specialist, and can choose your hospital. Fee-for-service plans, sometimes referred to as indemnity insurance, pay a portion of a covered medical expense that you or your medical provider submits. These types of policies have deductibles and coinsurance and so usually come with an out-of-pocket expense maximum. The maximum amount for a given plan can vary by the agreement your employer makes with the insurance company.
Managed care plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point-of-service plans (POS). These types of plans may or may not include an out-of-pocket expense maximum. Normally, if you have an HMO plan, you'll have very little out-of-pocket expenses because deductibles and coinsurance are generally not part of the plan -- as long as you stay within the HMO network. So out-of-pocket expense maximums are usually not a factor in these plans. However, if you have a POS or PPO plan, you may have this type of maximum. In these plans, if you go out of network, you'll seem to fall into the rules found in a fee-for-service plan with deductibles and coinsurance costs. Because of this, many PPO and POS plans include an out-of-pocket expense maximum only when a patient goes out of the network.
Without knowing your income and monthly expenses, it’s difficult to recommend a plan outright. While you mentioned your family is relatively healthy, you are considering adding a new family member. Both of these are important considerations. The following tips should help you get a cost-effective and comprehensive plan for your family.
1. Look at your eligibility for discounts. Depending on your income, you could qualify for assistance on your monthly premiums or cost-sharing expenses. Make sure you explore these potential discounts before writing off a plan due to cost.
2. Narrow down your choices to just a few plans—perhaps one low-deductible and one high-deductible health plan.
3. Estimate your anticipated medical costs for the coming year and compare coverage: When you add up all of the anticipated expenses, including your monthly premium, one plan will likely stand out as costing you less over the course of the year. But don’t stop there.
4. Consider additional features: Deductibles are only one consideration among many when shopping for health insurance. Network size, out-of-pocket maximums, plan structure and covered expenses also are important to think about.
5. Determine your priorities: If you’re comparing a high-deductible plan with a low-deductible plan, your decision may come down to what you value more: saving cash on premiums if you’re fortunate enough to avoid medical expenses, or feeling assured that you don’t have to meet a deductible when expenses arise.
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