Assignment:
Discussion: Cost-Control Measures in Voluntary Health Insurance Plans
If you are not a Medicare or Medicaid beneficiary, then you will either get your health insurance through your employer or buy it yourself through the Health Insurance Marketplace. This type of insurance is referred to as voluntary health insurance.
The way in which health insurance is available for purchase changed drastically with the enactment of the Affordable Care Act (ACA) in 2010. The ACA was "designed to ensure that all Americans have access to quality health care that is affordable and that will ultimately reduce healthcare costs" (Harrington, 2016, p. 93). The ACA transformed healthcare and the health insurance industry in many ways, some of which will be explained in your readings this week.
In this Discussion, you examine different voluntary health insurance plans, including the ACA, and the way in which they use cost-control measures. You will also discuss how participation in these plans impacts healthcare providers. Consider the scenario in this week's Introduction as you prepare your Discussion.
References:
Harrington, M. K. (2016). Health care finance and the mechanics of insurance and reimbursement. Burlington, MA: Jones & Bartlett Learning.
To prepare for this Discussion:
• Review this week's Learning Resources.
• Choose one of the following voluntary health insurance plans:
? Coverage through the ACA
? Health maintenance organization (HMO)
? Preferred provider organization (PPO)
? Point of service plan (POS)
? Exclusive provider organization (EPO)
• Review Harrington (2016).
• Find at least one current, reputable online source (e.g., .org, .edu, .gov, or .mil) that discusses the cost-control measures used by the plan you selected and the impact it may have on providers.
Post a comprehensive response to the following:
• Describe the health insurance plan you selected. Be sure to include key characteristics of the plan, which might include coverage benefits, eligibility requirements, etc.
• Discuss the cost-control measures used by the plan, and explain their impact on healthcare organizations/providers. Share the source that you found and briefly summarize the key points.
• Explain what other challenges (e.g., financial, quality of care, changing rules and regulations, etc.) providers face if they participate in the plan.
Provide specific examples in your response. Support your post with the Learning Resources and at least one outside scholarly source.
Read a selection of your colleagues' postings.
Important Links/Websites:
https://www.medicalbillingandcoding.org/health-insurance-guide/affordable-care-act/
https://marketplace.cms.gov/
https://www.healthcare.gov/
Consider the following scenario:
Wasilla Women's Center accepts Medicare and most insurance plans from the three major health insurance companies operating in the state of Alaska. However, since the initialization of the Health Insurance Marketplace in 2013 as part of the Affordable Care Act (ACA), the clinic has experienced a steady decline in reimbursement paid by some of the plans. Insurance officials explain that the reduced rates in some of their plans are due to the enormous pressure to keep premiums affordable for the consumers buying federally mandated health insurance through the marketplace.
In addition to lower reimbursement rates, the clinic has experienced an increase in patient financial responsibility because of the high deductibles in many insurance plans sold on the marketplace. This shift in patient responsibility has led to an increase in unpaid patient payments.
The two financial issues presented in this scenario illustrate the potential impact that changes in health insurance can have on the financial stability of healthcare organizations. Indeed, understanding the different types of health insurance plans and the laws that affect them is of utmost importance to the healthcare administrator and the organization he or she manages.
As you read through the Learning Resources this week, try to imagine how different voluntary health insurance plans might impact a healthcare organization like the one presented in this scenario. Applying the information to "real-life" situations may help you better understand the complex nature of health insurance and its impact on those who provide health services.