1. What are some additional privileges of POS plans that HMO’s do not offer that makes the plan more attractive than the average managed care plan?

2. Read the initial comments posted by your classmates and reflect upon them.

· Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates or restate their comments.

· If the class is small, the discussion will be with your professor.

· NOTE: You are not required to cite sources and include a reference list for the second post if it is simply your opinion. However, if your opinion is based on facts (as it should be), it is good practice to strengthen your position by citing sources.

-TRAY:

I have served in the Air Force for years now on active duty orders. During my entire enlistment, like all active duty service members, my health insurance plan has been supplied TRICARE. TRICARE offers 3 different plans; TRICARE Prime, TRICARE Extra, and TRICARE Standard. Active duty military members fall under TRICARE Prime which is an HMO-type plan. With TRICARE Prime military medical facilities are first in line to provide medical care to the enrollees (Military Hub, n.d.).

My experience with TRICARE has been amazing. My insurance coverage fees are automatically deducted from my check before it reaches my bank account. The costs are so low that many people believe that the military receives free health care. The military installations are wonderful and most offer many different departments, from emergency departments to specialty clinics.

A problem that I have experienced with TRICARE is that not all costs are covered for the military member’s family. Much of the costs are taken care of but there are some stipulations that can arise at times in which the military member must pay out of pocket; such as dental for their family members. Another problem that I have experienced is issues dealing with TRICARE’s different regions. TRICARE is broken up into different regions (north, south, and west), and when working or visiting away from your assigned duty station region it can be difficult to retrieve referrals and find the locations of partnering civilian organizations. As a recommendation, I feel that a military member’s immediate family should be fully covered on all aspects dealing with health care. I believe that military make a huge sacrifice daily and because of that all medical expenses should be covered for their loved ones. Another recommendation would be to grant access for military family members to receive care at military installation specialty clinics and dental clinics, as only active duty has access to such clinics (TRICARE, 2014).

-MARY:

HMO – Health Maintenance Organization (HMO).

I have been married to an active-duty military service member for 18 years now, which I have an HMO insurance policy (Tricare Prime). TRICARE Prime is a voluntary “HMO-type” plan, the military institutions are the main source for military personnel and dependents to receive health services (Military Hub, 2019). I have used the health insurance, mainly for my primary physician needs, annual visits, medications, and dental coverage. I rarely, enjoy the full benefits of HMO, for example, hospitalization, since it is rare that I get sick enough to be hospitalized.

The payments are deducted from my spouse pay every period with low cost out of pocket fees. TRICARE-authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network.

Problems with the HMO

First the number of limited doctors that accept the HMO. Secondly, the extensive appointment dates and difficultly making an appointment. Lastly, paying more money to get non-emergency health care from any TRICARE-authorized provider without a referral.

Recommendations for the HMO

First at hand the standard HMO that could be accepted to all healthcare without high out of pocket fees. Secondly, assess to name brand medication, at a lower cost and lastly, having the Tricare supplements do not qualify as “other health insurance.” Such as Medicaid, Medicare and employer provided insurance benefits, become authorized through the coverage.

-MATEO:

Healthcare Maintenance Organization (HMO) by Mateo Alba Jr.

Introduction

A Healthcare plan is a necessity for everybody. It ensures that if the patient is ill or injured, the healthcare plan will take care of the customer. The healthcare maintenance organization (HMO) is a good healthcare plan that takes care of its beneficiaries.

The healthcare maintenance organization.

The healthcare maintenance organization is a good healthcare plan. The customer must select a primary care provider (PCP). The primary care provider is responsible for healthcare and coordination for specialty care for the patient. If the patient requires a specialty care appointment, the PCP with initiate a referral to an in-network specialty provider. HMOs have a low monthly premium and low co-pay. It is the least expensive healthcare plan.

Experience with the plan.

Overall the plan has been good for the student. The healthcare plan allowed the student to select a primary care provider that is only 10 minutes away from his house. The clinic has a good and responsive staff. Since the COVID 19 pandemic, most of the appointments have been teleconference or virtual. If necessary, the PCP would ask to reschedule for a face-to-face appointment. Low co-pay prescription medications can be picked up at the nearest Rite-aid pharmacy which is five minutes away.

Problems with the plan.

The first problem with the plan is having stability with the primary care providers. They often transfer every two or three years.

The second problem with the plan is trying to find specialty providers within the network. Unless the patient plans on driving two hours just for a specialty care appointment. Dealing with traffic and finding the time to get off work, sometimes it is more cost-effective to see a specialty provider that is outside the network and pay out of pocket. (Heaton & Tadi, 2021)

Recommendation for the plan.

The first recommendation is to require primary care providers to sign at least a five-year contract. It will ensure the longevity of PCPs and continuity of care.

The second recommendation is to reduce the radius of specialty care providers to the patients within the network to a 20-minute drive. Otherwise, authorize the patients for out-of-network specialty care with low co-pay.

Conclusion

In conclusion, the HMO does what it is designed to do, which is to take care of its customers at low monthly premiums and low co-pay. Although it comes down to personal choice, it is the least expensive, most cost-effective healthcare plan for most Americans. (Heaton & Tadi, 2021)