Question

In your student workbook, review the Alternate Real-World Case (also attached here) and decide whether Alexander should change his insurance or not. For your two follow up posts, what factors might impact the decision?

Alternate Real-World Case:

Alexander is a 55-years-old man. He has a healthcare insurance identification card identical to the card in figure 3.3 (except his name is substituted for Iam A. Worker).

This year, Alexander saw his in-network primary care provider (a family practice physician). His primary care provider ordered a colonoscopy. Alexander had the colonoscopy at an in-network ambulatory surgery center. No abnormalities were found. Alexander has a chronic skin condition. Each year, he sees his dermatologist in order to have his prescription renewed. The prescription for his daily medication is a common antibiotic for which his physician orders the generic equivalent. He is a former high-school and college quarterback. He currently exercises 60 to 90 minutes per day, alternating daily between cardiovascular and free-weight routines. Last year, his hip started to “catch” sporadically. He saw a physical therapist twice. The physical therapist gave him two sets of exercises to strengthen the muscles supporting the hip joint.

       Information about Alexander’s individual coverage that you will need, but that is not available on the card includes the following:

-Premium: $21.72 per month (employer pays $197.45 per month)

-Benefit year deductible: $700 for in-network; $1,400 for out-of-network

-Cost of visit to primary care physician: $79

-Colonoscopy facility costs to Alexander after insurance payment: $664 (total was $2,346)

-Colonoscopy physician costs to Alexander after insurance payment: $400 (total was $667)

-Colonoscopy anesthesiologist costs: $100 (total was $250)

-Cost of visit to dermatologist: $85

-Cost of visit to physical therapist: $52

-Alexander lives in your state (MA) and zip code(02134)

-Alexander would like to pay about $1,000 for his deductible

Should Alexander change his health insurance from the one on the healthcare insurance identification card to a high-deductible plan with a health savings account? Why or why not?

Answer 1

Alexander initial health insurance identification card covers the following cost:

Colonoscopy Facility Cost after insurance payment = $1682 [$2346-$664]

Colonoscopy Physician Cost after insurance payment =$267 [$667-$400]

Colonoscopy Anesthesiologist Cost= $150 [$250-$100]

Total Coverage under health insurance identification card =$2099

Alexander's individual Coverage not included in card covers the following cost:

Colonoscopy Facility Cost after insurance payment = $664

Colonoscopy Physician Cost after insurance payment =$400

Colonoscopy Anesthesiologist Cost =$100

Cost of Visit to Primary Care Physician =$79

Cost of Visit to Dermatologist =$85

Cost of Visit to Physical Therapist =$52

Amount to be paid on deductibles =$1000

Benefit year Deductible: In Network =$700

: Out Network =$1400

Premium to be paid( $21.72*12) =$260.64

Total Gross Cost to be covered under high deductible plan= $4740.64

Less: Premium paid by Employer($197.45*12) =$2369.40

Net benefit Covered in high deductible plan =$2371.24

Conclusion: Although benefit Covered in high deductible plan is more than health Insurance identification card but it all depends on individual requirement and suitability.

Alexander should change his health insurance from Health Insurance identification card to a high deductible plan with a health saving account as it gives him more coverage and as his age increases its always better to get an overall coverage rather than adopting 2-3 plans at a time. His future condition(indicated by "his hip started to catch sporadically"and visiting therapist twice last year ) indicates opting overall coverage health saving plan suits its requirements.