Read the article https://www.forbes.com/sites/johnnosta/2014/04/09/be-healthy-an
ID: 364233 • Letter: R
Question
Read the article https://www.forbes.com/sites/johnnosta/2014/04/09/be-healthy-and-get-rewarded-incentives-driving-engagement-in-health-and-wellness/#24ec727373ce
Taking into consideration some of the significant changes to health insurance policies, please review the article and address the following two questions. Explain your answers in at least 200 words.
As described in the article, what options do patients with preexisting health conditions have in regards to wellness initiative compliance?
Are the new health plans truly helping consumers to live a better and healthier lifestyle or are they actually hindering consumers ability to freely pursue getting proper treatment, if needed, due to the fear of high deductible costs?
Explanation / Answer
1) People with prior health conditions can take the help of Preexisting Condition Insurance Plan (PCIP). This insurance plan temporarily insures persons with previous health conditions between 2010 and 2014 and also protects those with such conditions after 2014, from being refused insurance coverage.
People with pre-existing health conditions are usually having higher risks of health and need more frequent checkups of their health conditions. If such people are given rewards or incentives, then they will be more diligent in going for frequent checkups. Also, they are more likely to give up smoking or drinking excess alcohol and others. Further, they will become more disciplined in their daily exercise routines, nutrition control, and others.
2) New health plans are helping people to lead a better lifestyle as they are getting better benefits and opportunities. Examples are Patient Protection and Affordable Care Act (PPACA), Health Insurance Portability and Accountability Act (HIPAA) and others. HIPAA gives extra opportunities to persons to sign up for a group health plan if they happen to be dropped from other coverage or undergo some life events like divorces and others.
The 5 Different types of health plans are Health Maintenance Organization – HMO Plans, Preferred Provider Organization (PPO) plans, Exclusive Provider Organization (EPO) plans, Point of Service (POS) plans, and High Deductible Health Plan (HDHP) plans.
Health Maintenance Organization (HMO) plans: HMOs are one of the most popular types of health insurance you can purchase. With this plan, an entire network of health care providers agrees to offer patient its services. Patient has to select a primary care provider (PCP) who coordinates all of the health services and care. HMOs usually offer coverage for most types of preventive care, including specialist visits, but specialist visits are only covered when your PCP makes a referral. Additionally, you will pay copayment fees for every non-preventive medical visit, and you may have an annual deductible. HMOs are usually best suited for individuals and families that plan to see their primary care doctor on a regular basis for check-ups and other health concerns. Since 2014, the popularity of HMO plans has increased significantly.
Preferred Provider Organization (PPO) plans: Under a PPO plan, both you and your family can see any health care provider in the insurance company’s network, including specialists, without a referral. In most cases, you are not required to choose a primary care physician or to get referrals to see specialists. You will typically have copayments for any non-preventive medical care you receive, and you may have an annual deductible. Individuals who visit a specialist regularly generally prefer this type of health insurance. Since 2014, the popularity of PPO plans has declined.
Exclusive Provider Organization (EPO) plans: With an EPO plan, you have access to all of the health care providers within the EPO network, including specialists. Whereas PPO plans may offer you some coverage outside of your network, EPO plans typically will not (except for emergencies). EPO plans can be suited well to individuals who don’t mind limiting themselves to providers within a network and who don’t want to coordinate their care through a primary care doctor. Since 2014, the popularity of EPO plans has increased.
Point of Service (POS) plans: POS plans are a hybrid of HMOs and PPOs. With a POS plan, you will typically have to designate a primary care physician for regular check-ups and referrals. But you can also use out-of-network providers if you’re willing to pay more out of pocket; you’ll usually have a copayment and deductible as well. This type of plan is versatile and can be right for people who are willing to pay a bit more for extra flexibility.
High Deductible Health Plan (HDHP) plans: High-deductible plans cross categories. Some are PPO plans while others may be EPO or HMO plans. This type of health insurance has a high deductible that you have to meet before your health insurance coverage takes effect. These plans can be right for people who want to save money with low monthly premiums and don’t plan to use their medical coverage extensively. HDHPs are often coupled with a Health Savings Account (HSA). If you already contribute money to an HSA, you can buy an HSA-compatible health plan. Money contributed to an HSA can be saved on a pre-tax or tax-deductible basis to pay for qualifying medical expenses, including annual deductibles.
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