Healthcare Coverage for Families, Reaction Paper Example

Introduction

Healthcare coverage for families typically requires an affordable strategy that will enable them to obtain the services that are required to meet their needs without a cost prohibitive plan. Therefore, it is important for families seeking insurance under the Affordable Care Act to obtain knowledge and guidance from experts in order to ensure that their healthcare coverage is adequate and will support their requirements successfully. For middle class families, this process may be particularly difficult when coverage limits are limited but premiums are very high. As a result, discussing these options with an expert is essential for success and in achieving the desired results that will be affordable for the family in question. This reflects the importance of understanding the different types of coverage that are available and a need to examine the different issues that are likely to impact this decision and its influence on the family over the long term.

Body

For the family in question where the father is making $56,000 annually and the mother is a homemaker, the discussion regarding health insurance coverage must begin with the type of plans that are available, what they provide, and which plans are most supportive of families rather than individuals. This requires an analysis of the different options that are available and to determine which combination of services and related costs will be most affordable for a family of this level, given their specific healthcare needs and how these might be treated by a given healthcare insurance provider and the organizations who support these insurance plans. Each family possesses its own set of needs and therefore, this decision must be based on individual need and preferences in order to accommodate the healthcare concerns of the family in question and to address long-term health and wellbeing at a high level.

It is important to identify a strategy that will include an understanding of the different types of health insurance that include the HMO and PPO plans. To be specific, an HMO is designed with a relatively lower out-of-pocket cost and premium in mind, which requires the following measures for families: 1) a primary care physician (PCP) must be identified and is the point of contact for all coordination of care for a given patient; 2) referrals are required under HMO plans, which are approved and provided by the primary care physician who is responsible for the patient’s care; 3) the HMO does not provide any coverage for physicians or services which are out of network, with the exception of medical emergencies where a network facility is not within close distance; and 4) generally, HMO insurance provisions are offered at a lower cost than other types of insurance, which includes monthly premium costs, lower deductibles, and co-pays for required services (Humana, 2015). Under these conditions, it is necessary to consider that a family may consider the HMO as a more affordable opportunity for health insurance coverage, but it has a number of limitations that may be too restrictive for some families, particularly those who require specialized healthcare services or who have preexisting conditions to manage.

The PPO has its own set of offerings that should also be considered, including the following: 1) this type of insurance plan does not require the selection of a primary care provider, and care is provided as the patient sees fit from a variety of physicians and specialists within the network; 2) referrals for specialty care are not required under PPO plans; 3) out-of-network services are covered by the PPO insurance provider, but this introduces an additional out-of-pocket cost and increased deductible; 4) claims are required for some services that are out-of-network, whereby the patient pays for the services upfront and is reimbursed at a later date; and 5) PPO premiums are typically higher and require a greater out-of-pocket cost for patients under this plan (Humana, 2015). Although the PPO generally requires a higher out-of-pocket cost, it also possesses a greater level of flexibility that is very useful for many patients who require many different types of services and seek these services without significant hassles, delays, or the need for referrals.

Conclusion

For the family in question, it is likely that there will be a difficult decision to make, given that there are three family members who require healthcare coverage. Furthermore, with one income, it is necessary to reach a decision that will be the most affordable for the family in meeting its needs over the long term. Both HMO and PPO strategies possess strengths and weaknesses that must be considered and are likely to fall short in one or more areas in aiming to meet the needs of the family over time. Nonetheless, it is important to make a decision that will be affordable, have a positive and lasting financial impact, will support the family’s health and wellbeing, and will provide cost savings over the long term.

In response to the needs of this family and their current health status, the HMO is likely to have the greatest benefits because it is the most cost effective choice. Although the six year-old son has asthma which likely requires specialty care, this will be managed effectively through a coordinated plan of care with the primary care physician and any specialty care that is recommended. In addition, since the other family members are relatively healthy, it is unlikely that they will require any form of extended care or specialty treatment in the near future. Therefore, care and treatment by the primary care physician will suffice for this family. The HMO option is likely to have the greatest impact on the family’s budget and their ability to access high quality healthcare resources in a timely manner to meet the needs of each family member.

References

Humana (2015). Which one is right for you? Retrieved from https://www.humana.com/individual-and-family/products-and-services/medical-plans/hmo-vs-ppo