HA4070D – Regulatory Environment in Health Care Discussion 06: Selecting a Plan Base this discussion on the Problem on page 261 of your text labeled “Choosing Health Insurance”. Defend your plan selection with material from the text. From what you have learned so far, which of the following insurance plans listed below do you personally prefer, assuming each one costs the same? Defend your choice (both your selection and rejections) with reasons drawn from these readings: .Plan A: Covers the full range of medical care, subject to standard medical necessity or experimental exclusions, without any deductibles or copayments, but you must receive all care at an HMO clinic where doctors are paid a bonus for saving money. .Plan B: Excludes mental health and preventative care, and the rest is subject to a $200 deductible and 20 percent copayment up to a maximum of $1,500 per year. Your choice of doctor, but all expensive treatments must be submitted for prior approval by the insurer to determine medical appropriateness. .Plan C: Covers the full range of medical care, with no major exclusions and your choice of doctor, and no prior authorization requirement, but subject to a $3,000 deductible. .Plan D: Coverage is defined in an approach similar to the Oregon plan, only using 5,000 specific categories of inclusion and exclusion taken from the latest practice guidelines based on medical research, as selected by a national panel of politically appointed experts. No other restrictions or financial limitations. Base your discussion on material from the text and your own experience. Cite sources when necessary. Remember to write 150 words in complete sentences. The Law of Health Care  Finance & Regulation-Vitalsource #magicMAN61

When it comes to selecting a health insurance plan, it is important to consider the specific features and coverage options provided by each plan. From the choices presented, I personally prefer Plan C, which offers a full range of medical care with no major exclusions and allows the freedom to choose my own doctor without any prior authorization requirements. However, this plan does come with a $3,000 deductible.

One of the key reasons for my preference towards Plan C is the flexibility it provides in terms of choosing a doctor. The ability to have a choice of doctor allows for the establishment of a trusted and ongoing relationship with a healthcare provider. This can be particularly important for individuals with specific healthcare needs or existing medical conditions, as they may require specialized care from a doctor they trust and are comfortable with.

Moreover, the lack of prior authorization requirements in Plan C further supports my preference. Prior authorization is a process where the insurer must review and approve any expensive treatments before they can be provided. This can create delays and potential barriers to receiving timely and necessary care. By eliminating this requirement, Plan C ensures that individuals can access the medical care they need without unnecessary bureaucratic hurdles.

While Plan C does come with a $3,000 deductible, it is important to note that deductibles are a common feature of many health insurance plans. A deductible is the amount that must be paid out-of-pocket before the insurance coverage kicks in. In the case of Plan C, the $3,000 deductible could be seen as a trade-off for the flexibility and lack of prior authorization requirements. Additionally, the deductible amount may be manageable for individuals who have the financial means to cover this cost.

In contrast, Plan A covers the full range of medical care without any deductibles or copayments, but it requires individuals to receive all care at an HMO clinic. This restrictive requirement may limit the ability to choose a preferred doctor or receive care from specialized providers. Furthermore, the HMO clinic model incentivizes doctors to save money, potentially compromising the quality of care received.

Plan B, on the other hand, excludes mental health and preventative care and imposes a $200 deductible and 20 percent copayment up to a maximum of $1,500 per year. While the choice of doctor is allowed, all expensive treatments must be submitted for prior approval, which can result in delays and potential barriers to accessing needed care.

Lastly, Plan D, which utilizes specific categories of inclusion and exclusion based on medical research, may seem appealing. However, the selection of inclusion and exclusion categories is made by politically appointed experts rather than healthcare professionals. This approach introduces potential biases and may prioritize political interests over medical necessity.

In conclusion, Plan C offers the best combination of benefits for my personal preference. The ability to choose my own doctor, lack of prior authorization requirements, and limited major exclusions make it the most appealing option. While the $3,000 deductible is a consideration, the other features outweigh this potential drawback. Overall, healthcare coverage should be based on individual needs and priorities, and Plan C aligns with my own preferences.