Introduction
Choosing the type and plan of insurance is a matter of balancing price and covered services. The trend in healthcare management is to shift more responsibility to the insured to minimize costs. At the same time, there are a lot of new plans, the cost of which, with limited services, becomes more accessible to a more significant number of the population. Consumer-Directed Health Plans (CDHP) is a tool to increase user responsibility and insurance affordability.
Health Maintenance Organization and Consumer-Directed Health Plans
A Health Maintenance Organization (HMO) is insurance that ensures coverage through a network of providers. An HMO is an organization or network that provides paid health insurance and consists of several providers who work under contract with the HMO. The HMO’s most significant benefit is lower premiums than other insurance plans (Landon et al., 2023). Billing will also be less complicated, more precise, and more direct. In addition, the HMO provides access to specialist referral services. The disadvantages of an HMO lie in the limitations of the plan itself. It is necessary to appoint a specialist who will be the primary doctor of the insured while being part of the network (Landon et al., 2023). The insured will also be forced to receive all referrals from the doctor and be responsible for unexpected expenses.
Consumer-Directed Health Plans (CDHPs) create mutual benefits for organizations and consumers. The CDHP uses high deductibles and out-of-pocket tax credits to make healthcare consumers more accountable (Ferguson et al., 2021). The reimbursement mechanisms offered by CDHP allow employees to be compensated for expenses considered eligible (Ferguson et al., 2021). However, this healthcare arrangement is also managed by the employer. The main advantage of CDHP is that it remains the tool for effective cost-sharing.
When choosing the best plan, it is necessary to consider whether a PCP, referral, prior authorization, and out-of-network care are needed. Since out-of-network services are not required for my family, I would start choosing between an HMO and an EPO. Both options are cheaper if one stays in the supplier network. At the same time, with EPO, one can consult a specialist without contacting the doctor (Ayu et al., 2023). With this plan, one must choose a provider with a contract (Ayu et al., 2023). Because of its typically lower cost-sharing and low premiums, EPO, for example, UnitedHealthcare EPO, is often one of the most cost-effective health insurance options.
The Impact of the Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act of 2010 required most people to take out health insurance. The act made it possible to simplify, reduce the cost, and improve the quality of the insurance coverage received. The act made insurance more affordable for vulnerable categories of citizens, particularly the elderly (Glied et al., 2020). The Patient Protection and Affordable Care Act of 2010 has become one of the most critical steps in healthcare management. Current and future trends in health management will support these goals. First of all, significant work will be carried out to balance healthcare costs and improve the quality of care provided (Holtz-Eakin, 2021). In particular, health insurance will be available to more people, supporting vulnerable populations.
Conclusion
When choosing the type of insurance, one must be guided by the principle of priority and choose the most important one: low cost or more coverage. Multiple insurance options are a trend in modern healthcare management aimed at increasing the insured’s awareness and involvement. The trend outlined by the Patient Protection and Affordable Care Act of 2010 is in line with this goal, and, in reaching it, the Act seeks to make health insurance more affordable.
References
Ayu, G., Fermansyah, H., & Mahadewi, E. P. (2023). A study of managed care health system during pandemic. International Journal of Science, Technology & Management, 4(4), 802-808. Web.
Ferguson, W., White, B. S., McNair, J., Miller, C., Wang, B., & Coustasse, A. (2021). Potential savings from consumer-driven health plans. International Journal of Healthcare Management, 14(4), 1457-1462. Web.
Glied, S. A., Collins, S. R., & Lin, S. (2020). Did the ACA lower Americans’ financial barriers to health care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care. Health Affairs, 39(3), 379-386. Web.
Holtz-Eakin, D. (2021). Health insurance coverage in America: Current and future role of federal programs. American Action Forum. Web.
Landon, B. E., Zaslavsky, A. M., Anderson, T. S., Souza, J., Curto, V., & Ayanian, J. Z. (2023). Differences in use of services and quality of care in Medicare Advantage and traditional Medicare, 2010 and 2017: Study examines differences in use of services and quality of care comparing Medicare Advantage and traditional Medicare. Health Affairs, 42(4), 459-469. Web.