Affordable Care Act Paper: Healthcare Plans Comparison Essay

Comparison of three plans

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The three health plans that will be discussed by this paper include Delta Dental Individual and Family Premier Value. This cover falls under deductible category where individual pays $50 and family pays $150. The maximum charges for a member aged 19 years and over is $750 while the out of pocket maximum fees for a member below 19 years is $350 (Delta Dental Plans Association, 2015). The second plan is Health Net Plan by Boston Medical Center, which provides covers for preventive care. In addition, this plan offers a comprehensive cover for behavioral health services, physician visits, prescription drugs, and hospital care (Massachusetts Health Connector, 2016). The third health plan is Ambetter Essential Care that provides cover for important healthcare demands. This cover is characterized by low monthly premiums and high out of pocket expenses (CeltiCare Health Plan of Massachusetts, Inc., 2016).

A list of 10 items that are useful in comparing the cost of services include laboratory services, preventive and wellness services, prescription drugs, pediatric services, outpatient services, hospitalization, emergency services, different therapy services, mental health services and maternity and new born care (CeltiCare Health Plan of Massachusetts, Inc., 2016). In most cases, health insurance companies categorize applicants in the order of risks. The high risk group comprise of individuals who will require costly healthcare in future. When such a group of people are enrolled in a healthcare program, they are charged high premiums. In some situations, private insurance avoids to provide coverage to ‘high-risk’ people (Beik, 2013).

In this case, the best plan is Ambetter Essential Care, in specific, Ambetter Balanced Care plan because it caters for most of the fundamental healthcare needs of a youth. The hypothetical reasoning of selecting this health plan is based on the fact that I am young and healthy. Mainly, young people of good health status are permitted by private insurance to buy health policies at a considerable low cost (Beik, 2013). From this point of view, I will spend much less on this cover compared to high risk people. In addition, this type of health policy is easily maintained through employment, which implies that there is no need of purchasing a new policy when working in organizations (Patel& Rushefsky, 2014). Employment facilitates payments to private insurance through the contributions made by employees and employers in form of premiums (Jonas et al., 2013).

On the contrary, this policy is also maintained through self-insurance. Self-insurance is preferred by most employers because they are relieved off the burden of administrative and risk charges. Likewise, self-funding is not grouped under insurance and hence employers avoid taxes that are evaluated by the government on premium revenue (Afifi et al., 2013). The two ways of funding this policy, that is, self-insurance and employment proves that this policy is flexible to various circumstances.

From a personal perspective, Ambetter Balanced Care plan gives medical and prescription medication coverage (CeltiCare Health Plan of Massachusetts, Inc., 2016). In addition, it facilitates quality healthcare because healthcare professionals, hospitals and doctors are assured of a stable base of revenue. Moreover, this plan is capable of distributing the risk of costly medical disorders in a large population base. Consequently, there is a reduced risk of personal bankruptcy in the occurrence of serious severe health condition (Afifi et al., 2013).

In conclusion, the choice of Ambetter Balanced Care plan is motivated by the extra benefits that comes along with the policy. For instance, the plan has rewards and special programs. Members earn a maximum of $125 on their Health Pay card. This amount is earned by obtaining an Annual Flu Vaccine, which earns a member $25 and $50 through Annual Wellness Exam. Additionally, the plan has a wellness program reimbursement that provides a gain of $20 a month for paying a visit to a gym of choice for a minimum of eight times. Moreover, Ambetter Balanced Care plan has $0 Medical and Prescription Annual Deductible for family and individual. The plan has a maximum Annual Out-of-pocket of Rx $750 and $1,500 Medical for an individual. On the other hand, Annual Out-of-pocket costs Rx $1,500 and Medical $ 3,000 for family (CeltiCare Health Plan of Massachusetts, Inc., 2015).

References: Affordable Care Act Paper: Healthcare Plans Comparison Essay

Afifi, A. A., Rice, T. H., Andersen, R. M., Rosenstock, L., & Kominski, G. F. (2013). Changing

the u.s. health care system: Key issues in health services policy and management. San Francisco, Calif: Jossey-Bass.

Beik, J. I. (2013). Health insurance today: A practical approach. St. Louis, Mo: Elsevier.

CeltiCare Health Plan of Massachusetts, Inc. (2016). Essential Health Benefits. Retrieved March

16, 2016, from https://ambetter.celticarehealthplan.com/benefits-services/health-benefits.html

CeltiCare Health Plan of Massachusetts, Inc. (2016). Plan Options. Retrieved March 16, 2016,

from https://ambetter.celticarehealthplan.com/health-plans/plan-options.html.html

Delta Dental Plans Association. (2015). Delta Dental Individual and Family Premier Value.

Retrieved March 16, 2016, from http://www.deltadentalma.com/getattachment/Health-Care-Reform/Connector-Indiv/SP980-Premier-Ind-Fam-Val-OON_HC-(10-15).pdf/

Jonas, S., Goldsteen, R. L., Goldsteen, K., & Jonas, S. (2013). Jonas’ introduction to the U.S.

health care system. New York: Springer Pub. Co.

Massachusetts Health Connector. (2016). Helping You Stay Healthy is Our #1 Job. Retrieved

March 16, 2016, from https://betterhealthconnector.com/wp-content/uploads/2015-plan-info/brochures/BMCHealthNet-Brochure.pdf

Patel, K., & Rushefsky, M. E. (2014). Healthcare Politics and Policy in America. Public

Integrity, 17(1), 94-96.

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