Health Insurance and Managed Care Paper Example

Re-write what the current status is for the Individual Mandate and employers of companies with few employees?

Back in 2010, the Democrats overwhelmingly passed the bill that was part of the Obama care foundation. The bill had several clauses such as the individual mandate. The individual mandate is of the sense that every individual must have a health insurance coverage or else will suffer tax penalty punishment. As of now, the individual mandate clause has been scraped off by the current administration. Many had argued that the clause was a form of modern day slavery. It was a tax burden since it is not all employers and individuals that can access these covers owing to their cost. However, there is no effect on employers with more than 50 employees. They still have to offer their employees the ACA-compliant health coverage. Failure to do this attract some form of punishment. The employers with less than 50 employees are exempted from the covers without having to pay taxes on the same.

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Create a table with the Title: Health Insurance Options in Columns: Insurance company name, level of coverage, cost, coverage type, family or individual. Find at least four different insurance plans, preferably of different levels of coverage.

Health Insurance Options

Insurance company name Level of coverage cost Coverage type Family or individual

Fidelis Care silver $15- $35 Health Maintenance Organization (HMO) Family

Healthfirst New York silver $15-$30 Health and Recovery Plan (HARP) family

Oscar Insurance Corporation platinum $100 Point of Service Plan (POS)

Independent Health

bronze $15- $25 Health and Recovery Plan (HARP) individual

What is the difference between DEFINED BENEFIT and DEFINED CONTRIBUTION regarding insurance?

Defined contribution is a plan which is wholly funded by the employee. A portion of the employee's salary is directed towards the plan. However, it is done at the will of the employee as there are the ones to choose their preferred plans. On the other hand, a defined benefit is purely sponsored by the employer. In many cases, the employees have no extra covers outside those that are specified by the employer.

Why does the ACA mandate defined benefit and not contribution plans?

Defined benefit is more advanced than the contribution plan. The employer picks a plan that they think is most suitable for their employees. When it comes to the contributions plan, the employees will have the option to make their choices. There is a possibility that they can make unadvised choices. Those are the facts behind ACA's order.

What does "medically necessary" mean?

Medically necessary refers to health care supplies and services that are medically accepted for use in the diagnosis, treatment, and prevention of illness. If for example, a disease produces some symptoms that warrant some medication, such a condition can be said to be medically necessary.

Why is ACA coverage typically more affordable than COBRA?

There are many differences between the two. First, COBRA requires a 2% administration fee. On the other hand, there is none in ACA. Similarly, ACA requires lesser amounts in contribution as compared to COBRA which is way above $10,000. ACA can be accessed by anyone provided they are residents of the US.

Why would an employer decide to self-fund their insurance?

Self-funded insurances are gaining popularity. They are said to be cheaper than the hiring of insurance companies. Employers are generating more funds on the same since the cost of processing claims is low. Similarly, there is the improvement in the cash flow. There is no risk of state taxation as well. In short, self-funded insurances are becoming more lucrative. After all, employers pay for the claims that have been submitted, and they do not have to worry about the costs of administration.