Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Mia’s Simple Fracture (in-network emergency room visit and follow up care) Managing Joe’s type 2 Diabete
Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Mia’s Simple Fracture (in-network emergency room visit and follow up care)
Managing Joe’s type 2 Diabetes (a year of routine in-network care of a well-controlled condition) ??
The plan’s overall deductible $850 ?? Specialist copayment N/A ?? Hospital (facility) coinsurance 20% ?? Other coinsurance 20% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $850 Copayments $10 Coinsurance $2,100 What isn’t covered Limits or exclusions $60 The total Peg would pay is $3,020 ?? The plan’s overall deductible $850 ?? Specialist copayment N/A ?? Hospital (facility) coinsurance 20% ?? Other coinsurance 20% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $850 Copayments $100 Coinsurance $1,100 What isn’t covered Limits or exclusions $20 The total Joe would pay is $2,070 ?? The plan’s overall deductible $850 ?? Specialist copayment N/A ?? Hospital (facility) coinsurance 20% ?? Other coinsurance 20% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $850 Copayments $10 Coinsurance $400.
What isn’t covered Limits or exclusions $0 The total Mia would pay is $1,260?
1) Summarize the components of the health plan including benefits, coinsurance, copayments, and deductibles. Explain how this plan addresses each of the following:
Adverse selection
Moral hazard
Cost control
Cost sharing
Access to care
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