Health Insurance Exchange

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Chapter9.docx

Instructions For this assignment, you will research and analyze four insurance plans offered by a federally facilitated health insurance exchange (marketplace). Download the Excel “Health Insurance Exchange Assignment Template” which includes a completed submission example on one sheet and a blank template for you to complete.

Part One: Pick a zip code Pick a non-Florida zip code for a state with a federally-facilitated exchange. The list of states below has federally-facilitated exchanges. AL, AK, AZ,, GA, IN, KS, LA, ME, MS, MO, MT, NE, NJ, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WY

Part Two: Pick Your Four Plans Use the website: https://www.healthcare.gov/see-plans/#/ to find all available insurance product offerings for your selected zip code. To find products, input your zip code. Then hit "skip" until you see "Go to Full-Price Plans." (Close the pop-up that says, "Help Comparing Plans.") Next, pick at least four insurance product offerings, including one from each metal level (bronze, silver, gold, and platinum). If a platinum plan is not available for your zip code, you may substitute another metal. Some states do not have platinum plans.

Part Three: Complete the Template After you select four insurance products from any insurance company, fill out the Excel template titled “Health Insurance Exchange Assignment Template.” When inputting information in the template, make sure you specify the zip code you used (at the top) and the metal type for each plan.

Part Four: Identify Plan Recommendations Analyze each of the products and determine which product you will recommend to a low-income family to purchase. The family is seeking a fairly comprehensive insurance product at a good price and they are eligible for cost-sharing subsidies (reductions) (as described in this chapter’s lecture). Provide your rationale for your recommendation in your assignment submission.

Please add all the replies in a paragraph format

Using the information from your completed template, please type your answer to the questions below.

A. What zip code did you use?  

B. Did the state have platinum plans? (Yes or No) 

Using the information from your completed template, please type your answer to the questions below.

A. What was the name of the  BRONZE plan you selected?

B. What was its monthly premium?

C. What was its deductible?

D. What was the out-of-pocket maximum?

Using the information from your completed template for the  BRONZE plan, please type your answers to the questions below.

A. What is the copayment or coinsurance requirement for  emergency room (ER)  visits?

B. What is the copayment or coinsurance requirement for  generic  drugs?

C. What is the copayment or coinsurance requirement for  primary care  visits?

D. What is the copayment or coinsurance requirement for  specialist  visits?

E. What is the copayment or coinsurance requirement for  specialty  drugs?

F. What is the copayment or coinsurance requirement for  outpatient mental/behavioral health?

Using the information from your completed template, please type your answer to the questions below.

A. What was the name of the  SILVER plan you selected?

B. What was its monthly premium?

C. What was its deductible?

D. What was the out-of-pocket maximum?

Using the information from your completed template for the  SILVER plan, please type your answers to the questions below.

What is the copayment or coinsurance requirement for  emergency room (ER)  visits?

A. What is the copayment or coinsurance requirement for  generic  drugs?

B. What is the copayment or coinsurance requirement for  primary care  visits?

C. What is the copayment or coinsurance requirement for  specialist  visits?

D. What is the copayment or coinsurance requirement for  specialty  drugs?

E. What is the copayment or coinsurance requirement for  outpatient mental/behavioral health?

Using the information from your completed template, please type your answer to the questions below.

A. What was the name of the  GOLD plan you selected?

B. What was its monthly premium?

C. What was its deductible?

D. What was the out-of-pocket maximum?

Using the information from your completed template for the  GOLD plan, please type your answers to the questions below.

A. What is the copayment or coinsurance requirement for  emergency room (ER)  visits?

B. What is the copayment or coinsurance requirement for  generic  drugs?

C. What is the copayment or coinsurance requirement for  primary care  visits?

D. What is the copayment or coinsurance requirement for  specialist  visits?

E. What is the copayment or coinsurance requirement for  specialty  drugs?

F. What is the copayment or coinsurance requirement for  outpatient mental/behavioral health?

Using the information from your completed template, please type your answer to the questions below.

A. What was the name of the  PLATINUM (or substitute metal) plan you selected?

B. What was its monthly premium?

C. What was its deductible?

D. What was the out-of-pocket maximum?

Using the information from your completed template for the  PLATINUM (or substitute metal) plan, please type your answers to the questions below.

A. What is the copayment or coinsurance requirement for  emergency room (ER)  visits?

B. What is the copayment or coinsurance requirement for  generic  drugs?

C. What is the copayment or coinsurance requirement for  primary care  visits?

D. What is the copayment or coinsurance requirement for  specialist  visits?

E. What is the copayment or coinsurance requirement for  specialty  drugs?

F. What is the copayment or coinsurance requirement for  outpatient mental/behavioral health?

Which of the following metal types do you recommend for the scenario family?

Silver

Bronze

Gold

Platinum

In  one sentence or phrase , answer the question: why did you recommend the plan above for the scenario family?

ch09_Assignment_Template-HealthInsuranceExchange-1.xlsx

Blank Template

Zip Code Used: 78701 Texas
Name of Insurance Product and Metal Type Estimated Monthly Premium Deductible Out-of-Pocket Maximum Copayments or Coinsurance Amounts Comments/Observations
ER Generic Drugs Primary Care Specialist Specialty Drugs Mental/ Behavioral Health Outpatient
Moda Select Texas Standard Bronze (Bronze) $ 344.00 $7,500 $9,400 50% coinsurance after deductible $25 $50 per visit from day 1 $100 per visit fom day 1 $500 copay after deductible $50 per visit fom day 1 General and mental health consultation copayments are low, which may attract people seeking consistent healthcare.
UHC Gold Standard (Gold) $ 467.76 $1,500 $8,700 25% coinsurance after deductible $15 $30 per visit from day 1 $60 per visit from day 1 $250 $30 per visit from day 1 Specialist consultation copayments are high, which may affect patients who need regular specialised care.
Sendero Health Capital Silver/$40 PCP/$80Specialist/$20 Gen RX (Silver) $ 513.73 $5,900 $9,100 40% coinsurance after deductible $20 $40 per visit from day 1 $80 per visit from day 1 $350 copay after deductible $40 per visit from day 1 Modest deductible and out-of-pocket limit, making it a good alternative for healthcare users.
Silver Elite Saver Plus $ 628.20 $200 $9,100 50% $3 $60 per visit from day 1 $100 per visit from day 1 50% coinsurance after deductible $30 per visit from day 1 low deductible for quick healthcare, but the high out-of-pocket maximum may make protracted treatment difficult. .
Plan You Recommend (Indicate metal type): Sendero Health Capital Silver (Silver)
Rationale for Recommending (Remember that the scenario family is price conscientious and eligible for a cost-sharing subsidy.) I recommend the Sendero Health Capital Silver plan for its affordability, $5,900 deductible, and reasonable primary care and mental health copayments. Cost-sharing subsidies help low-income families afford vital healthcare and protect their finances.

Example Completed Template

Zip Code Used:
Name of Insurance Product Estimated Monthly Premium Deductible Out-of-Pocket Maximum Copayments or Coinsurance Amounts Comments/Observations
ER Generic Drugs Primary Care Specialist Specialty Drugs Mental/Behavioral Health Outpatient
MyBlue Bronze 1602 (Bronze) $257 $6,850 $6,850 No charge after deductible No charge after deductible No charge after deductible No charge after deductible 30% Coinsurance $70 copay Really catastrophic coverage-- must pay deductible first
BlueSelect Essential 1452 (Silver) $270 $6,850 $6,850 No charge after deductible No charge after deductible No charge after deductible No charge after deductible No charge after deductible No charge after deductible More coverage than above (because there are no copayments or coinsurance), but must pay deductible first too.
BlueSelect Everyday Health 1443 (Gold) $298 $6,100 $6,100 $600 copay after deductible $30 copay after deductible $65 copay $90 copay after deductible $200 copay after deductible $70 copay after deductible Don't have to pay deductible first if seeing primary care doctor.
BlueSelect Everyday Health 1449 (Platinum) $300 $6,700 $6,850 50% coinsurance after deductible $32 copay $50 copay $85 copay 50% coinsurance after deductible $85 copay Many services available before deductible is met.
Plan You Recommend: Insert Plan Name Here (Indicate metal type) BlueSelect Essential 1452 (Silver)
Rationale for why recommending: Insert rationale here. Remember that the scenario family is price conscientious and are eligible for a cost-sharing subsidy.