Comparison of Health Insurance Plans Essay

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Commercial Insurance, Medicaid, and MEDICARE

Commercial health insurance provides coverage to individual's medical expenses and groups. An example of individual medical expenses is private health insurance whereas an example of group health insurance is employer group health insurance. However, these insurance programs have varying premiums and benefits depending on the specific kind of plan. Moreover, individual private health insurance plans are usually more costly than group health insurance. There are several commercial insurance companies and plans that offer health insurance to individuals and groups such as Aetna and TRICARE respectively. Aetna is a group of TriWest Healthcare Alliance and Blue plans that differs from TRICARE insurance plans.

One of the similarities between Aetna and TRICARE is their purpose of providing health insurance to individuals and groups. Similar to TRICARE, one of the products and services provided by Aetna is health insurance coverage at low, reasonable prices. However, the commercial insurance company differs from TRICARE with regards to the fact that TRICARE is an insurance plan that specifically focuses on coverage for American military members and their families while Aetna is open to all kinds of customers. These insurance plans differ with regards to benefits offered since TRICARE offers medical appointment and Veterans Choice Program while Aetna offers auto insurance, dental insurance, and Any Drug Order Program. However, they are similar in benefits provided with regards to life and casualty insurance, medication prescription and some aspects of dental coverage.

Eligibility for benefits in TRICARE is based on involvement in the military in any of the seven uniformed services and close blood relationship or ties with an active-duty or retired service members (Green & Rowell, 2013, p.603). On the contrary, Aetna has different eligibility criteria since its services are relatively open to members of the public. Aetna utilizes an online system to determine eligibility by examining the client's financial liability and financial capabilities or status.

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The other major difference between Aetna and TRICARE is in relation to deductibles and copayments. Aetna utilizes an annual deductible, which is the amount an individual has to pay for care services before the commencement of the health plan coverage. These annual deductibles are dependent on the specific type and nature of health plan since this commercial insurance company has varying annual deductible amounts for individuals and families. While TRICARE also has an annual deductible amount depending on the coverage plan, the amount is dependent on the rank of the individual in military unit and the sponsor status i.e. active duty, guard or reserve, and retired. In essence, sponsor status and rank are used as the basis for determining deductible amount in TRICARE health insurance plans. In relation to copayments, TRICARE plans have different policies depending on the specific health plan. However, co-payments are determined based on sponsor status and rank in the military. In Aetna health plans, copayments are determined based on the specific benefits or coverage plans.

Aetna health plans utilize monthly premium payments depending on the specific health plan such as dental plans and programs and Medicare plans. In addition, the firm's average premium is $477, $487, and $356 for a gold plan, silver plan, and bronze plan respectively (Sturdevant, 2013). In contrast, premiums in TRICARE are $50.75 and $205.62 for members and families respectively on a monthly basis. Aetna and TRICARE have similar prescription benefits i.e. medication prescription and depend on the individual, current needs, and safety. Policy exclusions in TRICARE are based on TRICARE regulations, which provide guidelines for health insurance coverage provides in this program. On the contrary, Aetna does not have specific policy exclusions since it's governed by general health insurance policies......

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