Healthcare Insurance Discussion

PART A “Health Insurance” Please respond to the following:

Determine two to three (2-3) benefits of having health insurance for a family. Specify two (2) avenues through which families may obtain health insurance.

Compare and contrast two (2) differences between health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Classify the plan that you believe would be most beneficial for the majority of insured patients. Provide support for your rationale.

PLEASE RESPOND TO CLASSMATE DISCUSSION WHETHER YOU AGREE OR NOT & A DETAILED WHY:  In my opinion having health insurance for a family are more than a benefit, is necessary.  Especially when you have kids, they get sick so often, doctor’s offices visits are costly, medications and if need to go to emergency department is even more expensive. Avenues through which families can get health insurance are through their jobs, private companies and government.

The differences between HMO and PPO, is that HMO’s premiums and deductibles are usually lower than PPO, with HMO patient will have to select a primary physician and will need a referral to see a specialist. HMO’s outside network are limited to emergencies only. PPO plans usually have some coverage outside network although is not as generous as if is in-network. Generally speaking, HMO and PPO differences are plan cost, ability to see specialist and coverage outside network.  In my opinion the best plan for an individual will really depends on the individual health needs.

  • Part B – “Health Economics” Please respond to the follwoing:
  • As a Human Resources manager for a mid-sized company in your area, you have been tasked with purchasing the best group health insurance for your organization. Analyze at least two (2) lifestyle choices relative to the effect(s) that these choices could have on the organization’s premiums. Support your rationale with two (2) health economic examples.

Debate It: Take a position that the full implementation of the Affordable Care Act in 2014 will or will not create a market failure for insurance companies. Provide evidence to support your position.

PLEASE RESPOND TO CLASSMATE DISCUSSION WHETHER YOU AGREE OR NOT & A DETAILED WHY: Smoking still is an issue when it comes to medical insurance. That would be the first lifestyle choice that I would analyze because that would effect the premiums offered. Smokers have been proven to have higher smoking related health issues than non-smokers resulting in higher medical costs.Smoking-related illness in the United States costs more than $300 billion each year, including:11,12

*Nearly $170 billion for direct medical care for adults 

*More than $156 billion in lost productivity, including $5.6 billion in lost productivity due to secondhand smoke exposure 

I would offer a a discounted premium for non-smokers and a cessation class for the smokers and upon completion and successful quitting will be able to benefit from the discount as well. Another life-style choice to analyze would be maternity and pediatric benefits. In family plans it is safe to assume that those two benefits would be necessaryto be included in the premium. When people are looking for employment they look at which company will offer family medical benefits so they can provide insurancefor their families. Employees that have coverage for their families tend to stay longer. 

I think the full implementation of the Affordable Care Act in 2014 will create a market failure for insurance companies because there was one example of when United Healthcare withdrew from most of the ACA’s exchange markets because of the massive losses they experienced. Premiums increased more then expected as a result and many new insurers that focused on the individual market have failed and are in financial distress.  

Expert Solution Preview


Having health insurance is crucial for individuals and families to ensure access to appropriate medical care and financial protection from healthcare costs. In this response, we will discuss the benefits of having health insurance for a family and avenues through which families may obtain health insurance. We will also compare and contrast health maintenance organizations (HMOs) and preferred provider organizations (PPOs), and analyze which plan would be most beneficial for the majority of insured patients.


Benefits of having health insurance for a family:
1. Financial protection: Health insurance provides financial protection against high medical expenses. It helps to cover the cost of doctor visits, hospital stays, medications, and other medical services. Without insurance, families may face significant financial burden, especially in case of major illnesses or accidents.

2. Access to preventive care: Health insurance encourages and covers preventive care services, such as vaccinations, screenings, and regular check-ups. This helps to detect and treat illnesses at an early stage, leading to improved health outcomes and reduced healthcare costs in the long run.

Avenues through which families can obtain health insurance:
1. Employer-sponsored insurance: Many families obtain health insurance through their employers. Employers may offer group health insurance plans as part of their employee benefits package. This option is typically more affordable than purchasing insurance individually.

2. Individual market: Families can also obtain health insurance directly from insurance companies in the individual market. This option is suitable for those who do not have access to employer-sponsored insurance or who prefer to choose their own insurance plan.

Differences between HMOs and PPOs:
1. HMOs: Health Maintenance Organizations (HMOs) typically have lower premiums and deductibles compared to PPOs. HMO members are required to select a primary care physician (PCP) who coordinates their healthcare. A referral from the PCP is usually required to see a specialist. HMO plans usually have limited coverage for out-of-network services, except in emergencies.

2. PPOs: Preferred Provider Organizations (PPOs) offer more flexibility in choosing healthcare providers. PPO members can receive care from both in-network and out-of-network providers. In-network services are typically more affordable, while out-of-network services may have higher costs. PPO plans do not usually require referrals to see specialists.

Plan most beneficial for the majority of insured patients:
In my opinion, the plan that would be most beneficial for the majority of insured patients depends on their individual health needs. For individuals who prefer lower premiums and are comfortable with the restrictions of a primary care physician and referrals, an HMO plan may be more suitable. On the other hand, for individuals who value flexibility in choosing healthcare providers and are willing to pay higher premiums, a PPO plan may be a better fit. It is important to consider personal health needs, healthcare preferences, and financial circumstances when selecting a health insurance plan.

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