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In today’s society many Americans face the fear of having a medical disease and being able to afford paying for treatment. According to "Healthcare.gov" (n.d.), There are different types of Marketplace health insurance plans designed to meet different needs. Some types of plans restrict or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network.” (Comparing health plans). However choosing the best form of medical coverage and being able to pay for it can be stressful to some. Each person and family may need different types of coverage and finding one that suits everyone in the household and accepts all family members due to their medical needs can be hard to find. This case study will look at such a family. A family with multiple medical issues to include, two members having diabetes and being obese, one of which has COPD and a child with asthma. We will look into different health care options and cost, a recommended plan for the family and then take a look at what the family will need within a year. Health care costs & coverage options
Health Maintenance Organization Plans (HMOs) have a low out-of-pocket cost, which makes them a good choice if you want to avoid spending a lot of money. Also, since your co-pay commonly covers services outside the basic office visits, it is rather wide ranging. On the other hand, there are disadvantages for the reason that your choices are much more limited versus other plans such as, having to choose one primary care doctor and receiving referrals to see any specialists. There are some doctor’s offices that may not accept HMO plans, and it is not always easy to acquire a referral every time you need to see a specialist. Additionally, HMOs will typically only pay for visits to doctors that are inside their network therefore, if you visit an out of network doctor, than your HMO most likely will not cover any part of that visit (Gordon, n.d.). Next, Participating Provider Options (PPO) plans commonly have higher premiums however; there is a lot more freedom when it comes to choosing your doctor. Unlike HMOs, PPOs will normally let you see out of network doctors, although you might just have to pay a higher part of the cost than you would through an in network doctor. Also, they do not always need referrals every time from a primary care physician. However, your office co-pays are not as wide-ranging as HMO co-pays. Through a PPO, the co-pay is only for the office visit alone and you might also have to pay additional charges for lab or x-rays. However, those charges would count toward your deductible (Gordon, n.d.). Finally, Consumer Driven Health Plans (CDHPs) are a set of comprehensive plans that place additional control and responsibility in the hands of the consumer. Typically, CDHPs consist of a higher deductible health plan which is known as an HDHP with a savings account, similar to a Health Savings Account (HSA) or Flexible Spending Account (FSA). CHDPs have lower premiums, as you are the one who is responsible for various actual costs of your health care. You have the similar freedom of choice as you do through a PPO plan. In addition, you do not generally have to choose a primary care physician and receive referrals. You will save a lot in taxes and have further responsibility over your personal health expenses. The funds in your HSA are able to be used to put towards retirement. Furthermore, if you are healthy and do not need to go to the doctors frequently, you will have the ability to save a lot of money whereas, if something unfortunate happens you will also be covered. On the other hand, if you are in the situation where you need a few office visits and prescriptions a year, you could possibly end up paying more since most of the costs come out of your pocket and your deductible is very high (Gordon, n.d.). There are numerous pros and cons involved with each type of insurance plan that need to be compared and weighed out before making a decision. It mainly depends on you and your families’ health conditions and how often you require health services.

Recommend the plan for the individuals
Recommended plan for diabetes or any other disease for that matter is to get as much information possible on the disease. Having a better understanding of the disease will help the person be able to manage it better. Diabetes is a serious disease and can cause many other problems if not kept under control. Having routine check-ups with your doctor and keeping track of your levels is one way to help manage diabetes. Healthy diets, exercise, avoiding stress, no smoking and keeping track of your blood sugar levels are other ways to manage diabetes.
Obesity is considered a contributing factor to diabetes. By maintaining a healthy diet and exercise will help manage the weight. Although there are other factors that may contribute to the weight gain, like thyroid disease, that will make managing obesity challenging. Having routine visit with a physician and receiving continuing education on the subject will help manage the issue at hand.
COPD (chronic obstructive pulmonary disease) is deathly and there is no cure for it. As long as the person with COPD takes their recommended medications and follow doctor’s orders, a person can learn to live with COPD. It’s important that the person with COPD protects their fragile lungs the best they can. Quit smoking, if they smoke. Avoid dust, toxic fumes and high levels of air pollutions. For any type of disease or illness, staying active and eating a well-balanced diet will always help improve or manage the disease or illness.
With children it’s important for the parents and those who help take care that child, to understand what is happening to their child and how they can either prevent it from happening again or manage it so it don’t get any worse. Knowing what can trigger an asthma attack and how to manage it can help save the life of a child. Parents need to be aware of the pollen levels each day and to make sure that the child see’s their physician regularly. Keeping inhalers available at all times and taking any medications that are prescribe will help keep the asthma symptoms manageable.
What the family will need during the year
During the year it will be important for the whole family to improve their overall health. The Wife will need to seriously improve her lifestyle choices throughout the year to help control her diabetes. Diet and exercise are a very important part in the treatment of diabetes and will also help with her obesity. She may need diabetes medication and insulin therapy depending on the type of diabetes that she has. It is very important for her to consistently monitor her blood sugar level; there are meter devices that can do this. Throughout the year both the Wife and Husband should work with a team of health professionals such as, a dietitian, behavior counselor, and an obesity specialist ("Mayo Clinic ", 2015). Working with this team will help them make the appropriate lifestyle changes that will treat their obesity and also help improve their other illnesses. While being obese is extremely dangerous to your health it does help with the Husband’s COPD; this is because very thin people with a low BMI tend to have a worse prognosis and more severe stage of COPD ("Patient", 2015). During the year the Husbands COPD will need to be treated with proper medication. The Husband and Child will both need to treat their illness with inhalers. They type of inhaler depends on the severity of the illness. There are short-acting bronchodilator inhalers, long-acting bronchodilator inhalers, and steroid inhalers. It is likely that the Husband will rely on this mediation heavily through out the year. There are a number of bronchodilator tablets that the Husband may have to take to treat his COPD, he will also need extra medication such as steroid tablets and antibiotics to treat flare ups ("Patient", 2015). Chest x-rays, home oxygen, and pain medication are all other things that may be needed for the treatment of COPD throughout the year ("Patient", 2015). The Child will need long-term control medication and short relief medication to treat his asthma throughout the year. This includes inhaled corticosteroids to treat inflammation and swelling that makes the airways sensitive and like his father, the Child will need a bronchodilator inhaler for quick-relief of a flair up ("Nih", 2015). There is no cure for asthma therefore, it will need to be treated and monitored for the rest of the Child’s life.
Overall improvement on health, wiser health choices, and continuing care is important for our case study patients. It is important that they navigate through the choices of health care coverage options that we discussed and choose one that fits their family best. They will need to look at coverage that will accept them, offer them providers for their medical needs, and fits into their budget. It would also be wise for the family to start looking into preventative medicine since some of their medical issues will be life long. The purpose and importance of this paper was to inform the reader on different health care coverage’s and cost and the significance it would have on our case study family. Collectively we explained different health care costs & coverage options available, a recommended plan for our case study family and then considered what they would need during the year. All this information ties into how the family can choose the best health care coverage for their family.
References

American Lung Association. (2015). Retrieved from COPD: http://www.lung.org/lung-disease/copd/

Centers for Disease Control and Prevention. (2015). Retrieved from Asthma Action Plan: http://www.cdc.gov/asthma/actionplan.html

Gordon, W. (n.d.). What's the Difference Between All These Health Insurance Plans?
Retrieved from http://lifehacker.com/whats-the-difference-between-all-these-health-insuranc-1500452519

HealthCare.gov. (n.d.). Retrieved from https://www.healthcare.gov/choose-a-plan/

Mayo Clinic . (2015). Retrieved from http://www.mayoclinic.org/diseases-conditions/obesity/basics/treatment/con-20014834

NIH. (2015). Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment

Patient. (2015). Retrieved from http://patient.info/health/chronic-obstructive-pulmonary-disease-leaflet

U.S. Department of Health and Human Services. (2015). National Diabetes Education Program. Retrieved from I Have Diabetes: http://ndep.nih.gov/i-have-diabetes/LearnAboutDiabetes.aspx

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