Have they answered all the questions pertaining to their problem?

What are your arguments against their answers?

Answer Question Above With Information Below

Problem 3

Assume that you have a relatively simple health insurance plan with the following provisions: The annual deductible is $500. The insurance company pays 100% of all costs after deductible and co-payments

Office visits require a co-payment of $25.

Emergency room visits have a $200 co-payment.

Surgical operations have a $1000 co-payment.

There are 6 medical care visits within the year totaling to $8,220 before co-payments and deductibles. The insurance policy states the insurance company will pay 100% of all costs after deductible and co-payments are met. The annual deductible is $500.

The total health care expenses for the year with the insurance policy is $1,970 ($80 Feb + $380 Mar = $40 Apr = $1.970). This is due to the insurance company agreeing to pay 100% of all costs after deductible and co-payments.

Feb -Total before insurance = $100. You pay = $100 ($20 co-payment + $80 deductible)

Mar- Total before insurance = $520. You pay = $580 ($200 co-payment + $380 deductible)

Apr- Total before insurance = $100. You pay = $65 ($25 co-payment + $40 deductible)

May- Total before insurance = $6500. You pay = $1000 ($1000 co-payment + $0 deductible)

Jul - Total before insurance = $100. You pay = $25 ($25 co-payment + $0 deductible)

Sep -Total before insurance = $840. You pay = $200 ($200 co-payment + $0 deductible)

If there was no insurance policy, the total of health care cost is $100 Feb + $580 Mar + $100 Apr + $6500 May + $100 Jul + $840 Sep = $8,220

As of January 2019, it is not longer required for citizens of the U.S.A. to have health insurance. This was in relations of overturning the Affordable Care Act (ACA) that was passed in 2010. The ACA required U.S. citizens to have health insurance coverage or face a tax penalty. When the rule changed in 2019, it is estimated that as many as 4 million Americans have opted not to have health coverage. While it is no longer federally required to have health insurance, some states do require their residents to have health coverage (Lake, 2021).

Goran Ridic and Ognjen Ridic did a study comparing the health care systems in the United States, Canada, and Germany regarding the equity and efficiency. Canada's national health insurance program NHI is called Medicare; not to be confused with U.S. program for the elderly. NHI is a government run health insurance system with universal coverage. Canada citizens are automatically covered for health insurance with the opportunity to go to any primary care doctor of their choosing. Patients are not billed for any additional procedures per the Canada Health Act of 1984. Germany requires its citizens to have health insurance. There are sickness funds for individuals who make less than $35,000; sickness funds are not-for-profit insurance companies who collect premiums from employees and employers. If an individual makes more than $35,000, they are welcome to find private insurance coverage or enroll in a sickness fund. Sickness funds are required to have a comprehensive set of benefits including physician ambulatory care, hospital care, preventive services, and even visits to health spas with patient cost sharing minimal. These countries are different than the U.S. who has no single set system in place. Individuals can purchase private insurance, enroll within their employers' plan, or be eligible for government-run programs such as Medicaid. Each program is different with coverage, payments, and services (Ridic & Ridic, 2012).

The U.S.A.'s health insurance coverage and federal laws affect the various strata of society in different ways. Due to the overturn of ACA, insurance premiums are higher than before due to the lack of requirement of the law. Insurance can be viewed as a luxury rather than a necessity. Upper income persons are not really affected by the health coverage laws as they will be able to afford coverage for themselves regardless if it is out of pocket or not. It would affect business owners who are required to include health coverage amongst their employees. Middle-income folks are influenced by the healthy laws in a significant way. If the law requires health insurance, they must budget for it. If the law does not require it, it is additional money in their pocket. Low-income families are not as affected due to their eligibility to qualify for government programs such as Medicaid.

You pay a monthly premium of $350