A 25-year-old lady visits the office for a check-up on her type 1 diabetes mellitus. She is on long- and short-acting insulin, has adequate glycemic control, and no diabetic problems. She also has a history of hypothyroidism and takes levothyroxine for it. The patient has been covered by her parents' medical insurance for several years, but she recently began working full-time for a firm that offers a wide range of employee insurance options. She seeks assistance in selecting a health insurance plan. The patient is not disabled and states that her major concern is low monthly payments. Which of the following insurance plans would be best for this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Health insurance plans must restrict total spending (utilization) by enrolled patients in order to maintain expenditures below total income from premiums. The two primary techniques are to increase the patient's portion of the cost of the services they get (e.g., copayments, deductibles) and to limit the variety of services patients may obtain. A health maintenance organization (HMO) insurance plan features cheap monthly premiums, copayments, and deductibles, as well as a low overall cost for the patient. HMOs lower usage by restricting patients to a small panel of physicians, requiring referrals from a primary care provider prior to specialist consultations, and refusing to pay for services that do not match established evidence-based recommendations.
Chronic illnesses necessitate daily prescriptions, regular physician visits, and periodic laboratory tests for this patient. Diabetes can also raise the risk of complications, increase use, and necessitate expert consultation. As a consequence, an HMO plan may offer this patient the lowest monthly cost as long as she is prepared to see just physicians on the plan's limited panel.

A 25-Year-Old Lady Visits the Office for a Check-Up on Her