Question

Patients will often look to healthcare providers for information healthcare plans, coverage, and options. Understanding and being able to communicate this information to patients is an important part of working in the healthcare field. Practice making recommendations in this discussion. There are three patients: Joe, Scott, and Steve. Joe is 42, relatively healthy, and was a member of the Army for 20 years. Scott is 67 and suffers from chronic bronchitis. Steve is 25 and is battling stage 2 cancer. These three patients can choose from one of the following plans (either from Group A or Group B): Group A Plans: Medicare, TRICARE Group B Plans: HMO, PPO, and POS Joe, Scott, and Steve would like recommendations on the best plan options. Instructions: Select one patient (Joe, Scott, or Steve) and provide a Group A Plan and a Group B Plan that would be the best options for the provided parameters. Include the following: A comparison of the two plans Rationale for selection of the plans A selection (between the two plans) of what the patient should ultimately choose and why. Refer to the background material in this unit for assistance and complete outside research as appropriate.

Answer 1

Steve 20 years with stage 2 cancer

Group A plan

Under age 65 with certain disabilities or end stage diseases. (If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment [if you qualify]. If you do, your Prime enrollment fees are waived. You can also get a refund for any Prime enrollment fees that you paid. Check with your regional contractor for details.)

But Group B plan

the difference between HMO, PPO, and POS

It’s open enrollment season at your job and your employer offers you a choice between the biggest plan types: HMO, PPO and PSO.It really depends on your financial and medical situation – and preferences.

For instance, would you rather the flexibility of not having to go to a smaller group of providers in an HMO and don’t mind paying more upfront for your care via premiums? Then, a PPO might be right for you.

Do you not care about having a large network of providers, but paying as little as possible for health care is more important to you? Then, an HMO could be perfect.

Choosing the right health insurance plan is a personal decision and depends on your situation and preferences. Whether you ultimately choose a PPO, HMO,or POS , take costs, flexibility, coverage and convenience into account when making that decision