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). ...

1. 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

2. 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

3. 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.

4. 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 special ty
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)
CHAPTER 2

5. Clinical Preventive Services and Aging
POWERPOINTS TO ACCOMPANY
1
2
Annual physical: addresses health issues before becoming
problems versus medical screening excess
United States Preventive Services Task Force
Evaluation of medical screenings
Accuracy
Sensitivity
Specificity
Reliability
Effectiveness
Medical Screenings and Prophylaxis
3
#1 killer: lung cancer
23% of nodules identified on CT scan are false positives
Immunotherapy: Checkpoint inhibitors
#2 cause of death in women: beast cancer

6. Three screening tests
Self-examination
Clinical examination
Mammography
Cancer Deaths
4
Recommended at age 40 or 50
Recommended annually versus biannually
Age 75+ consult w/ physician, or no cutoff due to age
Ductal carcinoma in situ
Mammography Controversies
5
Latest evidence-based recommendations
Women without risk factors begin age 50
Women age 50 to 74 without symptoms or risk factors undergo
mammography every other year
Insufficient evidence for or against screenings over
age 75+—consult with personal physician
Physicians should stop teaching breast self-examinations—
engenders false confidence
USPSTF and Mammogram Recommendations

7. 6
Versus benign prostatic hyperplasia
Second to lung cancer in men’s cancer deaths
Cautions with prostate-specific antigen (PSA) screening
Treatment options for malignant prostate
Drug therapy, surgery, radiation, etc.
Side effects and adverse outcomes
Prostate Cancer
7
Third leading cause of death in men and women
Increased risk with age
Screening recommendations for age 50+
Fecal occult blood test, fecal immunochemical test (FIT),
Cologuard
Sigmoidoscopy
Colonoscopy
Colorectal Cancer
8
Skin cancer (most common cancer)
Half of skin-related deaths occur in age 65+
Most common: basal and squamous cell
Most lethal: melanoma; checkpoint inhibitors
Cervical cancer
Why Medicare coverage?

8. Pap test
Human papillomavirus (HPV)
Other Cancer Screenings
9
Thyroid gland
Hyperthyroidism
Hypothyroidism—Synthroid overuse
Thyroid cancer screening
USPSTF versus American Thyroid Association
South Korean National Screening Program
Other Cancer Screenings—cont’d
10
Recommendations
Women 50 to 59 years
Women without a uterus: low-dose estrogen
Women with a uterus: progesterone and estrogen
All women (if necessary): low dose and periodic monitoring
Risks
Increased blood clot risk in legs and lungs
Increased breast cancer risk when taken 5+ years
Menopause: Hormone Replacement Therapy (HRT)

9. 11
Responsible for most deaths
Hypertension
Systolic blood pressure level is age related
Prehypertensive: 121 to 139
Blood pressure threshold
Age 80+ controversy
AHA/ACC recommends 130; USPSTF—140
Treatment
High Blood Pressure
12
Who is affected?
More than 28 million Americans
80% are female
Screening recommendations
Routine densitometry screening beginni ng at age 65 for all
women
Frequency unclear
Routine screening of males at some point?
Osteoporosis
13
Osteopenia versus Osteoporosis
Treatment
Calcium and vitamin D supplements with osteopenia: caution,
kidney stones

10. Bisphosphonates for osteoporosis
FDA cautions against long-term use without physician
monitoring
Weight-bearing exercise for everyone
Osteoporosis—cont’d
13
14
Fatty substance manufactured by the liver, supplemented
through diet
Measurements
Low-density lipoproteins (LDL)
High-density lipoproteins (HDL)
NCEP guidelines
Statins: Benefits and side effects
Cholesterol
15
LDL targets
Cholesterol—cont’d

11. 16
Guidelines for statin use and PCSK9 inhibitors
Guidelines for taking PCSK9 inhibitors: statin intolerance or
goal of LDL level below 70 mg/dL
Statin concerns for primary prevention: age 75+, high dose,
interactions, intolerance
Cholesterol—cont’d
17
Type 2 diabetes (formerly adult-onset diabetes)
Related to obesity and inactivity
Refers to increased resistance to insulin
Diabetes: ≥126 mg glucose/dL
Screening recommendations
ADA recommendation: >45 years: every 3 years
USPSTF recommendation: >45 years + risk factors: every 3
years
Diabetes
18
Prediabetes
Between 100 and 125 mg/dL
Lifestyle changes twice as effective as medication
Diabetes Prevention Program launched in 2018
Medicare's Diabetes Prevention Program launched in 2018

12. Diabetes—cont’d
19
Hearing loss prevalence 50% in 70s; 80% in 80s
Presbycusis is age related
Hearing aid resistance and benefits
Blindness is one of the most feared disabilities
Presbyopia
Cataracts
Glaucoma
Macular degeneration
Oral health and edentulism
Hearing, Vision, and Oral Health
20
Infects 1 in 30 baby boomers
Is a blood-borne virus
CDC screening recommendations
Drug treatment effective, but expensive
Improvements: Sovaldi, Harvoni, Mavyret
Hepatitis C
21
Screening dogs (and cats)
Immunizations
Influenza

13. Pneumonia
Tetanus
Shingles: Zostavax versus Shingrix
Screenings and Immunizations
22
Aspirin prophylaxis
Baby aspirin used as blood thinner for prevention of heart
attack and stroke, recommended as secondary prevention
Insufficient evidence for use as primary prevention for age 70+,
ACC/AHA no longer recommends in 2019
Risk of gastrointestinal bleeding
Polypill and Polymeal
Aspirin Prophylaxis and Polypill
23
Interventions
Annual wellness visit
Cardiovascular and diabetes screenings
Lung, cervical, prostate, and colorectal cancer
Densitometry
Mammogram
PSA
Medicare Prevention

14. 24
Interventions (cont.)
Immunizations
Smoking cessation
Obesity screening and counseling
Depression screening
Alcohol misuse screening and counseling
No deductible or copay
Medicare Prevention—cont’d
CHAPTER 1
Introduction to Health Promotion
and Aging
POWERPOINTS TO ACCOMPANY
2
Surgeon General 1979 report
Healthy People: The Surgeon General’s Report on Health
Promotion and Disease Prevention
U.S. Public Health Service 1980 report
Promoting Health/Preventing Disease: Objectives for the Nation
U.S. Public Health Service 1990 report
Healthy People 2000

15. Healthy People Initiatives
3
Documenting baselines, setting objectives, and monitoring
progress. 2030 objectives are now being established
Health oriented, not disease oriented
Politics of healthcare
Conservatives and libertarians
Liberals and paternalists
Libertarian paternalism: A compromise opting out versus opting
in
Healthy People Initiatives—cont’d
4
What aging Americans have in common
Intensified demand for medical care (healthcare)
Ongoing escalation of medical costs
Health promotion, disease prevention, and chronic disease
management
Screening, education, and intervention costs
Social Security and Medicare support extends lives and service
needs

16. Aging, Health, Social, and Medical Trends
5
Percentage of older adults has increased dramatically over the
past century
And will continue in the future: 2020–2060
More than sixfold increase in those 65+
2030
65+ population projected to reach 20%
Age pyramid versus age rectangle
U.S. Population Growth Over Age 65
6
Born in the United States between 1946 and 1964 (76 million)
Retirement
History of advocacy and future influence on society
Impact on Social Security and Medicare programs
Health and long-term care alternatives will continue to evolve
to meet the needs of the boomers
Baby Boomers
7
Age 85+ is the fastest growing age group
Increasingly a common stage of life
Significantly reduced ability to function fully
Service needs increase accordingly
Disability and chronic conditions

17. Difficulty with hearing, vision, cognition, ambulation, self-care,
or independent living
The Older Old
8
Centenarians
2015 Census: 77,000 people were 100 years or older
More than doubled from 1980
Census projections: 8 times more by 2050
Supercentenarians: 110 years or older
Biogerontology
Centenarians
9
2014—78.9 years; 2017—78.6 years
Rising since 1900—Why a dip?
Contributing factors
Threats
U.S. ranking
Trails 49 other countries in life expectancy
Life Expectancy
10
Closing gender gap
Men: 76.1 years
Women: 81.1 years

18. Decreasing disparity between Blacks and Whites
Top three causes of death
Heart disease
Cancer
Chronic lower respiratory diseases
Life Expectancy—cont’d
11
Fastest-rising causes of death
Diabetes (lifestyle/obesity)
Alzheimer’s disease (advanced age)
Life Expectancy—cont’d
12
Declining hospital stays for age 65+
Increasing medication costs among Medicare enrollees
Advertising of expensive brand-name drugs
Generic drug cost increase
Medicare Part D—Ban on the government negotiating lower
medication costs
Hospital Stays and Medication Use
13
Slightly better health habits than younger adults
Tendency of older men to be married, not widowed
Increased percentage in workforce

19. Education: Increased percentage with degrees
Decreased poverty
Voting clout protects Medicare and Social Security
General Health Habits in Older Adults
14
Public Health Service components
Disease prevention
Health protection
Health promotion
Prevention categories
Primary
Secondary
Tertiary
Healthy Aging
15
Wellness
Alternative activities
Seven dimensions of wellness
Antiaging versus proaging movement
Compression of morbidity
Is it increasing or decreasing?
Healthy Aging—cont’d

20. 16
Health expectancy versus life expectancy
Reciprocal relationship between physical and emotional health
aspects
Leading-edge boomers
Trailing-edge boomers
Intergenerational conflict
Health Perspectives and Aging
17
Medicare
Helps persons age 65+ pay for medical care
Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D
Medicaid
Covers 60% of nursing home care costs
Approximately one-third of each state’s budget
Legislation
18
Medicaid differs from Medicare
Not focused primarily on older adults
State-run

21. Funded jointly by states and federal government
Largest funding source for medical and health services for
people with a limited income
Not entitlement (“welfare”)
Legislation—cont’d
19
Social Security
Federal program
Partial protection from loss of earnings
An entitlement
85-year-old program (in 2020)
Legislation—cont’d
20
Growth of U.S. healthcare spending
United States: 18% of GDP
Other developed countries: between 9% and 11%
WHO ranking of U.S. healthcare versus other countries
Quality: 37th
Life expectancy: 50th
Affordable Care Act reduced percent uninsured
Healthcare and Medical Care

22. 21
Healthcare
60% of early deaths due to behavioral, social, and
environmental circumstances
10% of early deaths due to shortfalls in medical care
3% of expenditures targeted toward health promotion and
disease prevention
Less than 1% spent on helping individuals to change unhealthy
behaviors
Healthcare and Medical Care—cont’d
21