Last Updated on 09/10/2023 by Admin
Suppose you have been tasked with purchasing health insurance for your organization that has fifty (50) full-time employees.
Use the Internet or Strayer databases to research different types of health insurance.
Write a two to three (2-3) page paper in which you:
1. Suggest one (1) plan that you would use to purchase health insurance for your organization. Determine the extent to which employee lifestyle choices and health economics would factor in to your chosen plan. Provide a rationale for the response.
2. Analyze the implication of the Affordable Care Act on your decision to purchase insurance. Debate two (2) advantages and two (2) disadvantages of purchasing health insurance for your employees, as opposed to having your employees receive governmental insurance.
3. Use at least two (2) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
Expert Answer and Explanation
Health Insurance and the Affordable Care Act
The choice of an insurance plan depends on whether one is looking for a family plan or an individual plan. The two types of health insurance plans include group health insurance and individual health insurance. The main factor that one needs to consider in choosing the insurance plan that is suited best for them is their income and the monthly cost of the specific insurance policy if the deductible will get met if the cost of the drugs for prescriptions that are needed for the treatment.
Some plans do not cover services that involve emergencies like blood work and x-rays. This paper seeks to suggest a plan for insurance that will be most suitable for an organization that has fifty employees that work on a full-time basis and the implications of the ACA on the insurance purchasing decision.
The plan that I will use in purchasing health insurance for the organization is the group insurance plan, which can get purchased by an employee or employer of the organization and are typically cheaper compared to purchasing coverage for each employee in the company. The group health insurance is usually at a cost that is lower because the risk of the insurer gets spread across a group of holders of the policy (Glied et al., 2020).
The insurance plan covers liability that is statutory for an employer for bodily injuries or death that may be suffered by the employee because of the accidents that arise out of and in the course of performing his employment duties in the organization.
A group insurance plan is the most effective for the employees as they will all be covered for the same amount of medical insurance and it will also be more affordable for the organization, unlike the individual health insurance plan which will be more expensive as it will be based on the individual needs of each employee. With the group insurance plan, the organization will have to pay equal premiums for every employee, and the injury type to be covered will be specified.
Health economics and the lifestyle choices of the employees factor into the plan I have chosen in the sense that the coverage gets limited to specific injuries. The employees will not have to have a different insurance plan for their healthcare needs as they will be covered as provided by the group plan. However, the plan does not cover for injuries sustained due to their own negligence or other events that take place outside the place of work. The plan covers what happens in the course of performing duties for the organization.
Affordable Care Act Implication
The Affordable Care Act has a significant implication on my decision to purchase insurance for the organization. The implication of the ACA on this decision is that the premium revenues for health insurers increased by 6.2%, including the enrolment made in groups of people (Siemons et al., 2017). The ACA makes a provision that an employer that does not provide coverage for its employees may face penalties. This ensures that employees at all levels of the organization have access to affordable care.
There are several advantages and disadvantages of purchasing insurance for health for one’s employees. The various advantages include using it as a way of rewarding and attracting talent, it boosts the morale and dedication of the employees to their work and shaping a company culture that is positive (Kumar et al., 2019). Providing health insurance for the employees helps keep them happy and healthy, showing that the employer cares about them.
Also, productivity gets enhanced when the employees are healthy as they will perform their duties efficiently. This is unlike letting them have governmental insurance with which they will be less motivated. Some of the disadvantages of purchasing health insurance for the employees include the fact that costs of healthcare have significantly increased over the years making it difficult for employers that are small to plan their finances as they find it to be an affair that is costly (Cooper & Gardner, 2016). If the employees get governmental insurance, the small businesses will not have to worry about the costs.
Providing health insurance is an essential part of every organization that seeks to achieve quality. If the employees do not have health insurance, they will end up having bad outcomes of health which can negatively affect the organization in terms of productivity. It is critical that every organization should ensure that the healthcare needs of their employees get met to ensure that they are able to achieve optimal outcomes. The numerous benefits that arise from providing employee health coverage outweigh the costs of group coverage for the organization.
Cooper, R. W., & Gardner, L. A. (2016). Extensive Changes and Major Challenges Encountered in Health Insurance Markets under the Affordable Care Act. Journal of Financial Service Professionals, 70(5). Retrieved from http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15371816&AN=117675169&h=HHBE6iENmp%2FtW4fvxb82oCVWGBBeYPwg2U5l51ZWA3Yt8QSYXNmAA9rek%2B02ieN38HjeQ7g2%2BuXQu5MtQ%2BMdgQ%3D%3D&crl=c
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. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01448
Kumar, K., Mahmud, M., Nataraj, S., & Cho, Y. (2019). Employer and Employee Preferences for Worker Benefits: Evidence from a Matched Survey on the Bangladesh Informal Sector. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3335275
Siemons, R., Lucia, L., & Jacobs, K. (2017). California’s Self-Employed and Small Business Employees Experienced Large Health Coverage Gains under ACA. Retrieved from https://laborcenter.berkeley.edu/small-business-self-employed-health-coverage-under-aca/
Rules for offering health insurance to employees
The rules for offering health insurance to employees can vary depending on the country, state, and employer size. Here are some general guidelines:
- Employer size: In the United States, the Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer health insurance to their employees or face penalties. Smaller employers may offer health insurance as a voluntary benefit, but they are not required to do so.
- Eligibility requirements: Employers may have eligibility requirements for their health insurance plans, such as minimum hours worked or length of employment. These requirements must be applied consistently to all employees.
- Coverage options: Employers may offer a variety of health insurance coverage options, including different plan types, deductibles, and co-payments. Employers may also offer wellness programs to encourage healthy behaviors among their employees.
- Cost sharing: Employers and employees typically share the cost of health insurance premiums, although the amount may vary depending on the employer’s policies. The ACA limits the amount that employees can be required to contribute towards their health insurance premiums.
- Compliance with regulations: Employers must comply with all applicable regulations and laws related to health insurance, including the ACA, the Health Insurance Portability and Accountability Act (HIPAA), and any state-specific laws or regulations.
- Communication and education: Employers should provide clear and accurate information to employees about their health insurance options and benefits, including any costs or restrictions. Employers may also offer education and resources to help employees make informed decisions about their health and wellness.
It’s important for employers to understand the rules and regulations related to offering health insurance to their employees and to provide clear and transparent communication about their health insurance policies and benefits. This can help ensure that employees have access to affordable and comprehensive health insurance coverage.
Explain the difference between a premium and a deductible
A premium and a deductible are two different terms used in the context of health insurance.
- Premium: A premium is the amount of money an individual or employer pays to an insurance company to purchase a health insurance policy. This payment is typically made on a monthly basis, and the amount of the premium is based on several factors, including the level of coverage, the type of plan, the age of the insured person, and their overall health status. In other words, the premium is the cost of having health insurance.
- Deductible: A deductible is the amount of money an individual must pay out of pocket for covered healthcare services before their insurance company starts paying. For example, if an individual has a $1,000 deductible and they need to undergo a medical procedure that costs $5,000, they would need to pay the first $1,000 themselves, and the insurance company would pay the remaining $4,000 (assuming the procedure is covered by their plan). The deductible resets each year, and the amount can vary depending on the plan.
In summary, a premium is the regular cost paid to have health insurance, while a deductible is the amount that an individual must pay out of pocket for covered healthcare services before their insurance kicks in.
Here is a table outlining the main differences between a premium and a deductible:
|Definition||The amount paid to purchase health insurance coverage||The amount an individual must pay out of pocket for covered healthcare services before insurance kicks in|
|Payment frequency||Typically paid on a monthly basis||Paid when healthcare services are received and the deductible applies|
|Cost||Based on several factors, such as level of coverage, type of plan, age, and health status||Typically a set amount determined by the insurance plan|
|Coverage||Does not affect the amount of coverage received||Determines the amount an individual must pay before insurance starts paying|
|Yearly reset||N/A||Yes, the deductible typically resets each year|
|Example||$500 per month paid for a health insurance plan||$1,000 deductible on the health insurance plan. If a medical procedure costs $5,000, the individual pays the first $1,000 and the insurance company pays the remaining $4,000 (assuming it’s covered by the plan).|
Can doctors look up your insurance?
Yes, doctors can typically look up your insurance information using your name, date of birth, and insurance ID number. They can use this information to verify your coverage, check your benefits, and determine if you have any out-of-pocket expenses. However, it’s always a good idea to bring your insurance card with you to your appointment to ensure that your information is accurate and up-to-date.
How do I know if i have health insurance through my employer?
The best way to know if you have health insurance through your employer is to ask your HR representative or employer directly. They can provide you with information on the health insurance plan options available to you, including details such as coverage, deductibles, copays, and premiums.
If you are unsure who to contact or do not have an HR department, you can also check your employee benefits package, which should outline the health insurance options provided by your employer. This information can usually be found in the employee handbook or on the company’s intranet site.
You can also check your pay stub or W-2 form to see if there are any deductions for health insurance premiums. If there are deductions, this likely means that you have health insurance through your employer.
If you still have trouble determining whether you have health insurance through your employer, you can also check with your insurance provider directly by calling the customer service number listed on your insurance card.
How to check if your health insurance is active online
The process for checking if your health insurance is active online may vary depending on your insurance provider. However, here are some general steps you can follow:
- Visit your insurance provider’s website. This is typically listed on your insurance card or in the materials you received when you enrolled in the plan.
- Look for a member portal or login section. This is where you can access your account and view your coverage information.
- Enter your login credentials. This may include your member ID, email address, or a username and password that you created when you signed up.
- Once you are logged in, look for a section that displays your coverage details. This should include information such as your plan type, deductible, copays, and coinsurance.
- Verify that your coverage is active. You should be able to see the effective date of your coverage and any upcoming premium payments.
If you are having trouble accessing your account or finding the information you need, you can also try contacting your insurance provider’s customer service department. They can help you verify if your coverage is active and answer any questions you may have about your policy.
What are the challenges faced by medical insurance companies?
Medical insurance companies, also known as health insurers or payers, face several challenges in the ever-evolving healthcare landscape. These challenges can impact their operations, profitability, and ability to provide comprehensive coverage to policyholders. Here are some of the key challenges faced by medical insurance companies:
- Rising Healthcare Costs: One of the most significant challenges is the relentless increase in healthcare costs. The cost of medical treatments, prescription drugs, and hospital care continues to rise, putting pressure on insurance companies to keep premiums affordable for policyholders.
- Complex Regulatory Environment: The healthcare industry is heavily regulated, with frequent changes in laws and regulations at the federal and state levels. Compliance with these regulations, such as the Affordable Care Act (ACA), can be costly and challenging for insurers.
- Healthcare Access and Disparities: Disparities in healthcare access and outcomes persist, and insurers are under increasing pressure to address these issues. Ensuring equitable coverage and access to care for all policyholders remains a significant challenge.
- Administrative Costs: The administrative burden of processing claims, managing policies, and complying with regulations contributes to high administrative costs for insurance companies. Streamlining administrative processes is an ongoing challenge.
- Fraud and Abuse: Insurance fraud, including fraudulent claims and billing schemes, poses a financial threat to insurers. Detecting and preventing fraud requires significant resources and technology investments.
- Technological Advancements: While technology can improve efficiency and customer experience, it also presents challenges in terms of data security and privacy. Insurers must invest in robust cybersecurity measures to protect sensitive patient information.
- Consumer Expectations: Policyholders expect seamless digital experiences, quick claims processing, and personalized services. Meeting these expectations while maintaining cost-effectiveness is a challenge.
- Provider Negotiations: Negotiating contracts with healthcare providers, including hospitals and physicians, can be complex. Balancing fair reimbursement rates with cost containment is an ongoing challenge.
- Risk Management: Accurately assessing and managing healthcare risk is crucial for insurers. Predicting and pricing risk factors while ensuring affordability for policyholders is a delicate balancing act.
- Chronic Disease Management: The increasing prevalence of chronic diseases places a strain on insurers. Effective disease management programs must be developed to control costs and improve patient outcomes.
- Market Competition: The insurance industry is highly competitive, with insurers vying for market share. Differentiating services and products while remaining financially competitive is a constant challenge.
- Public Perception and Trust: Building and maintaining public trust is vital for insurance companies. Addressing negative perceptions of the industry and communicating transparently with policyholders can be challenging.
- Catastrophic Events: Natural disasters, pandemics, and other catastrophic events can result in significant claims payouts. Preparing for and responding to such events require robust risk management strategies.
- Aging Population: An aging population places increased demands on healthcare services and insurance coverage. Insurers must adapt to the changing healthcare needs of older adults.
- Data Analytics: Harnessing the power of data analytics to make informed decisions, identify trends, and improve outcomes is a challenge that requires significant investment in technology and talent.
In conclusion, medical insurance companies face a complex and dynamic set of challenges, from the rising cost of healthcare to regulatory complexities and the need to meet evolving customer expectations. Successfully navigating these challenges is essential for insurers to provide effective coverage and remain competitive in the healthcare market.
What are the barriers to health?
Barriers to health are obstacles and factors that hinder individuals and communities from achieving and maintaining good health. These barriers can be social, economic, cultural, or structural in nature and can vary significantly among different populations. Identifying and addressing these barriers is essential for improving overall public health and ensuring equitable access to healthcare. Here are some common barriers to health:
- Socioeconomic Status: Poverty and low income are significant barriers to health. Individuals with limited financial resources may struggle to afford nutritious food, secure safe housing, access healthcare, or engage in preventive health measures.
- Limited Access to Healthcare: Lack of access to healthcare services, including primary care, specialty care, and mental health services, is a significant barrier to health. This can result from factors such as geographic distance, lack of health insurance, or a shortage of healthcare providers.
- Health Insurance Coverage: Many people, particularly in countries without universal healthcare, face barriers to health due to inadequate or no health insurance coverage. Without insurance, individuals may delay or forgo necessary medical care.
- Language and Communication: Language barriers can impede effective communication with healthcare providers, leading to misunderstandings, misdiagnoses, and inadequate care, especially for non-native speakers.
- Cultural and Social Norms: Cultural beliefs and social norms can influence health behaviors and access to care. Some cultural practices may discourage seeking medical help or adhering to recommended treatments.
- Stigma and Discrimination: Stigma related to certain health conditions, such as mental illness, substance abuse, or HIV/AIDS, can prevent individuals from seeking care or disclosing their conditions. Discrimination in healthcare settings can also deter people from seeking assistance.
- Education and Health Literacy: Limited education and health literacy can make it challenging for individuals to understand health information, navigate the healthcare system, and make informed decisions about their health.
- Geographic Barriers: Living in remote or rural areas can create geographic barriers to health. Limited access to healthcare facilities, transportation challenges, and longer travel times to reach medical services can all be significant barriers.
- Transportation: Lack of reliable transportation can prevent individuals from attending medical appointments or accessing essential services, particularly in areas with inadequate public transportation.
- Housing and Environmental Factors: Unsafe or unstable housing conditions, exposure to environmental toxins, and living in areas with poor air quality can contribute to health problems.
- Food Insecurity: Limited access to nutritious food, known as food insecurity, can lead to poor dietary choices and malnutrition, increasing the risk of chronic health conditions.
- Behavioral and Lifestyle Factors: Unhealthy behaviors such as smoking, excessive alcohol consumption, poor diet, and physical inactivity are significant barriers to health. Addressing these behaviors often requires comprehensive public health interventions.
- Mental Health Stigma: Stigma associated with mental health conditions can deter individuals from seeking mental health treatment, even when needed.
- Lack of Social Support: Lack of a supportive social network or community can hinder individuals from managing chronic conditions or coping with health challenges effectively.
- Health System Barriers: Complex and bureaucratic health systems can create barriers to care, including long wait times, administrative hurdles, and inadequate coordination of services.
Ways to improve health care system
Improving the healthcare system is a complex endeavor that requires coordinated efforts from policymakers, healthcare providers, patients, and other stakeholders. Here are several key ways to enhance the healthcare system:
- Universal Access to Care: Ensure that all citizens have access to affordable and comprehensive healthcare services. Implement universal healthcare coverage to reduce disparities in access to care.
- Primary Care Emphasis: Strengthen primary care by increasing the number of primary care providers, enhancing their training, and promoting the use of primary care as a point of entry into the healthcare system.
- Healthcare IT Integration: Invest in healthcare information technology (IT) infrastructure to improve interoperability, electronic health records (EHR) systems, and telemedicine capabilities. This facilitates seamless data sharing and better patient care coordination.
- Preventive Care and Health Promotion: Shift the focus from treating illnesses to preventing them. Invest in public health programs, promote healthy lifestyles, and encourage regular check-ups and vaccinations.
- Patient-Centered Care: Prioritize patient-centered care that involves patients in decision-making, respects their preferences, and provides clear and accessible health information. Improve the patient experience and communication between providers and patients.
- Payment Reform: Reform payment models to incentivize value-based care rather than fee-for-service. Align reimbursement with patient outcomes and quality of care, encouraging healthcare providers to focus on patient wellness.
- Cost Transparency: Promote transparency in healthcare pricing and costs. Empower patients to make informed decisions about their care by providing clear information on the cost of services and procedures.
- Drug Price Regulation: Address escalating drug prices through legislation and regulation. Encourage competition in the pharmaceutical industry and explore options for price negotiation on prescription medications.
- Telehealth Expansion: Expand access to telehealth services, particularly in underserved rural areas. Telemedicine can improve access to care and reduce healthcare costs.
- Workforce Development: Invest in training and education programs to address healthcare workforce shortages, particularly in areas such as nursing and primary care. Encourage providers to practice in underserved regions.
- Mental Health Integration: Integrate mental health services into primary care settings and promote mental health awareness. Address the shortage of mental health professionals and ensure that mental health receives the attention it deserves.
- Health Equity Initiatives: Develop and implement initiatives to reduce health disparities among different racial, ethnic, and socioeconomic groups. Focus on social determinants of health, such as housing, education, and income.
- Preventing Medical Errors: Implement systems and technologies to reduce medical errors, improve patient safety, and enhance the quality of care. Promote a culture of continuous quality improvement.
- Research and Innovation: Invest in medical research and innovation to advance healthcare treatments, technologies, and therapies. Support medical breakthroughs that can improve patient outcomes.
- Public-Private Collaboration: Encourage collaboration between public and private sectors to drive healthcare innovation, expand access, and improve the overall quality of care.
- Health Literacy Programs: Promote health literacy through educational programs and initiatives. Ensure that patients can understand and act upon health information effectively.
- Community Health Initiatives: Invest in community-based health programs and clinics to address local health needs and reduce healthcare disparities.
- Emergency Preparedness: Strengthen healthcare systems’ readiness to respond to public health emergencies and disasters, such as pandemics, by investing in preparedness planning, infrastructure, and resources.
- Data Analytics and Research: Leverage data analytics and research to identify trends, improve population health management, and inform evidence-based policymaking.
- Patient Advocacy: Empower patients and advocacy groups to participate in healthcare decision-making, ensuring that the patient’s voice is heard at all levels of the healthcare system.
Why is access to healthcare important?
Access to healthcare is critically important for several reasons, and it plays a pivotal role in individual well-being, public health, and societal progress. Here are some key reasons why access to healthcare is crucial:
- Promotes Health and Well-being: Access to healthcare allows individuals to receive timely medical care, preventive services, and health screenings. This helps in identifying and addressing health issues early, preventing the progression of diseases, and promoting overall well-being.
- Reduces Morbidity and Mortality: Timely access to healthcare can significantly reduce the morbidity (illness) and mortality (death) rates associated with preventable and treatable health conditions. Early diagnosis and treatment can be life-saving.
- Enhances Quality of Life: Healthcare services, including medical treatments, therapies, and surgeries, can improve an individual’s quality of life by alleviating pain, managing chronic conditions, and restoring physical and mental health.
- Supports Healthy Aging: Access to healthcare is vital for older adults to manage age-related health issues, chronic diseases, and maintain functional independence. It supports healthy aging and a better quality of life in later years.
- Prevents Spread of Communicable Diseases: Timely access to healthcare is critical for diagnosing and treating infectious diseases, preventing their spread within communities, and protecting public health.
- Ensures Equity and Social Justice: Access to healthcare is a fundamental human right and is essential for achieving social justice. It helps address health disparities and ensures that individuals, regardless of their socioeconomic status, race, or background, have equal opportunities for good health.
- Economic Productivity: Healthy individuals are more productive in the workforce. Access to healthcare helps maintain a healthy and productive labor force, which, in turn, contributes to economic growth and stability.
- Reduces Healthcare Costs: Early intervention and preventive care can often be more cost-effective than treating advanced and severe health conditions. Access to primary care can help reduce the overall cost burden on the healthcare system.
- Improves Maternal and Child Health: Prenatal care, well-baby check-ups, and pediatric care are vital components of healthcare access. Ensuring access to these services promotes maternal and child health, leading to healthier pregnancies and healthier children.
- Promotes Mental Health: Access to mental health services is critical for addressing mental health conditions, reducing the stigma associated with mental illness, and improving overall emotional well-being.
- Health Education and Prevention: Healthcare providers offer health education and preventive guidance to patients. This empowers individuals to make informed choices about their health, lifestyle, and risk factors.
- Emergency Preparedness: Access to healthcare is essential during emergencies and natural disasters. It ensures that individuals can receive timely medical attention and care when needed most.
- Community Resilience: Healthy communities are more resilient to public health challenges and crises. Access to healthcare helps communities respond effectively to health emergencies.
- Medical Research and Innovation: Access to healthcare supports medical research and innovation by providing a platform for clinical trials, data collection, and the development of new treatments and therapies.
- Fosters Trust in Healthcare System: Ensuring access to healthcare builds trust in the healthcare system and promotes healthcare-seeking behaviors. This, in turn, fosters a healthier society overall.