Health

Health Insurance Plan Research Assignment

For this assignment I researched individual health insurance options. I looked at three insurance plan types, HMO, PPO, and PPO with a health savings account. I received quotes from three different carriers: Kaiser Permanente, Anthem Blue Cross, and Aetna. I considered potential healthcare plans that would cover myself as an individual. I have read in the news that individual insurance can be difficult to obtain, primarily because the recent healthcare reform legislation that would lift the insurance carriers ability to exclude individuals with pre-existing conditions, does not come into play until 2014. Given my age of 28, active lifestyle, I am fortunate to not have pre-existing conditions, and am confident that I can and will be accepted for a plan at a relatively low cost. I considered five factors when evaluating different insurance options; monthly premium cost, deductible amount, out of pocket cost, Rx coverage, and provider network.

The first option I considered was an HMO plan with Kaiser Permanente. This plan was called the Kaiser HMO $25 co-pay plan. This plan was attractive because it had a $0 deductible, $25 office visit co-pays, low out of pocket costs ($2,500), and good Rx coverage. The negative aspect of this plan was that as an HMO, I would be limited to using only Kaiser facilities and seeing only Kaiser doctors. Additionally, the monthly premium cost of $356 was too expensive relative to other options I researched. All things considered, although there are a lot of new Kaiser facilities in Oakland and San Francisco, I don’t use my medical plan enough to need that expensive of a plan.

I felt that a PPO plan was a better option for me because it would allow me more flexibility as far as providers to choose from. Even if my doctor or specialist I wanted to see was not “in-network” I would be able to see them and still receive some level of coinsurance coverage. I researched my primary care doctor, and found that he was included in both the Aetna and Anthem Blue Cross PPO provider networks. Had I selected the Kaiser HMO plan option I would not have been able to see my normal primary care physician as an “in-network” benefit. I looked at two PPO plans, the first was the Anthem Blue Cross Core Guard PPO. This plan was attractive because it had a low deductible amount, $750, and 50% co-insurance after the deductible was reached. The out of pocket costs were $4250, but this plan had really bad Rx Coverage. There was a really high Brand Rx deductible, and at $169 per month, I didn’t think the benefit levels were good enough with this option.

The final plan I looked at ended up being the most compelling option. This plan was a health savings account compatible design with Aetna, called the Aetna H.S.A. Preventative and Hospital $3000 plan. This plan had a significantly lower premium than the other options, at $101 per month. Because of the high deductible amount of $3,000 this plan is considered an H.S.A. compatible plan.

With an H.S.A. compatible plan I am able to open a health savings account at my bank and contribute money into my account tax-free. The money in the account is then used to cover my medical expenses, helping me reach the deductible amount. I can contribute up to $3,100 annually into my H.S.A. plan and take it as a write off on my federal income taxes, plus I the money I contribute rolls over year to year. This money will collect interest and allow me to save for future medical expenses. Additionally I can use the H.S.A. money to cover other qualified medical expenses like dental and vision care, or Rx costs. This plan design also features preventative coverage at 100%.

In the end, the fact that I don’t frequently use my medical insurance plan, I wanted an option that had the lowest possible monthly premiums, not necessarily the best benefit levels. I liked the PPO model better than the HMO because it gave me more flexibility in doctor selection, but would still cover me in the event of unforeseen emergency situation. With the Aetna H.S.A. plan, I liked the fact that with the significantly lower monthly premium cost, I could use the money I was saving each month to fund into my H.S.A. account. Over the course of the year, that account will build up and allow me to have a savings for any future medical expenses.