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Health Insurance Plan Comparison Guide

The document compares three health insurance plans (HMO, PPO, and POS) for individuals named Ruth, Daniel, and David, detailing their features such as copays, deductibles, and coverage requirements. The author prefers the PPO plan for its flexibility and lack of referral requirements, despite slightly higher costs. A surprising finding was the limitations of HMO plans, particularly their lack of out-of-network coverage and the necessity for referrals to see specialists.

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3 views2 pages

Health Insurance Plan Comparison Guide

The document compares three health insurance plans (HMO, PPO, and POS) for individuals named Ruth, Daniel, and David, detailing their features such as copays, deductibles, and coverage requirements. The author prefers the PPO plan for its flexibility and lack of referral requirements, despite slightly higher costs. A surprising finding was the limitations of HMO plans, particularly their lack of out-of-network coverage and the necessity for referrals to see specialists.

Uploaded by

mauriciotabares2007
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as RTF, PDF, TXT or read online on Scribd

Health Insurance Comparison Project

Directions: Now that you understand the basic terminology and the plans,
we will look at three sample policies for one company and compare what it
offers. Use what you have learned about each type of plan and the health
plan documents in the Study Section of this lesson complete the chart and
answer the questions Ruth, Daniel, and David. Use the Health Plan
Comparison Chart to record your answers.

Individual Name Ruth Daniel David


PCHS Providers
Plan Type HMO 10 PPO
POS
Primary Care Required
Yes No No
Yes or No
Referral Required
for Specialist Yes No Yes
Yes or No
Office Visit In Network $20 copay $25 Copay $30 Copay
Office Visit Out of
Not Covered 40% Coinsurance 30% Coinsurance
Network
Deductible In Network $1,000 $1,500 $1,200

Physical Therapy Out of


Not Covered %40 Coinsurance %30 Coinsurance
Network

Generic Prescription $10 copay $15 copay $12 copay

Home Health Care Covered Covered Covered

Emergency Room $250 copay $300 copay $275 copay

Outpatient Surgery $100 copay 20% Coinsurance 25% Coinsurance

Speech Therapy $25 copay %30 Coinsurance %20 Coinsurance

1. Which Plan would you choose? Why?


I would choose the PPO plan (Daniel’s plan) because it provides flexibility in choosing doctors
and doesn’t require referrals to see specialists. While the deductible and emergency room costs
are slightly higher, the ability to see out-of-network providers with some coverage is a major
advantage. This is useful in case I need a specialist that isn’t available in-network.

2. What did you learn that was surprising?


I didn’t realize how limiting HMO plans could be until I looked into
them. You have to choose a primary doctor and get referrals just to see
a specialist, which could make getting the care you need take longer.
What really surprised me was that they don’t cover out-of-network care
at all, while PPO and POS plans at least offer some coverage. That
makes PPOs a much better option for anyone who wants more freedom
in choosing their doctors.

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