Open enrollment for 2021 health insurance plans is just a few short months away. Therefore, there is no better time to assess and compare competing health insurance plans. Individual and family plans are broken down into four different metal tiers of insurance coverage, starting with bronze which offers the lowest level of cost sharing. This is the tier are going to be looking at in more detail today.
What do Bronze Plans Include?
Bronze health insurance plans cover a lower proportion of your medical costs, and as a result they have lower monthly premiums than the other metal tiers. However, they have significantly higher deductibles than their counterparts. Bronze plans are designed to cover around 60% of your medical costs on average, with you picking up the remaining 40%.
Is a Bronze Plan the Right Fit for Me?
Being on the bottom rung of health insurance plans, bronze plans are best-suited to those who are fit, healthy and rarely need to visit the doctor. For instance, if you‚re relatively young, have no underlying medical conditions, and very rarely visit a doctor or use medical services, then a bronze plan could be a perfect fit for you.
You can learn more about your which insurance metal tier is best for you with our handy health insurance guide.
|EmblemHealth Bronze||Healthfirst Bronze|
|Available on Exchange||Yes|
|No referral needed for specialist||❌|
|Preventive care||$0 pre-deductible.|
|Primary care||50.00% coinsurance after deductible.|
|Specialty visits||50.00% coinsurance after deductible.|
|Urgent care||50.00% coinsurance after deductible.|
|Prescription drug deductible||$10 copay for Tier 1 - Generic drugs after deductible.|
|Lab tests||50.00% coinsurance after deductible.|
|Hospital costs||50.00% coinsurance after deductible.|
|Hospitals in network||Bellevue Hospital Center, Harlem Hospital Center, New York Presbyterian Hospital.|
|Gym member reimbursement||Up to $200 per 6-month period; up to $100 per 6-month period for spouse.|
|Family planning||Free counseling on the use of contraceptives, sterilization procedures, and related topics included.|
The monthly premium refers to the amount you‚ll pay each month in order to remain covered under the insurance policy. It‚s important to note that these payments do not contribute toward the deductible on either of these bronze plans.
The monthly premium for the EmblemHealth bronze plan is $682.56. By contrast, the Healthfirst bronze plan will set you back $466.16 per month.
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A co-pay is simply a pre-determined amount that you will pay for receiving a specific service from a care provider, such as a visit to a urgent care facility.
For both EmblemHealth and Healthfirst bronze plans, the copay is expressed as a 50% coinsurance across the board, once the deductible has been met. The only exception is prescription drugs, which both companies set at $10 for generic drugs.
A deductible is a specified amount of money that you must pay before an insurance company will start to pay a proportion of your medical expenses. Being bronze health insurance plans, both of the deductibles are fairly high, at $4,425 per year.
Once you exceed the exceed the deductible, both plans will begin to cost share via a 50% coinsurance almost across the board. The out-of-pocket expenditure for both of these bronze plans is capped at $8,150.
In an emergency situation, you should go to the emergency room or call 911 immediately if you are unable to make it there yourself. In an emergency, always focus on seeking medical attention rather than on your insurance. For reference, an emergency is a situation whereby anybody‚s life is in danger.
For both of these bronze plans Emblem Health and and Healthfirst will offer 50% coinsurance once the $4,425 deductible has been met.
Urgent Care Coverage
Urgent care visits refer to instances whereby you may need medical attention, but you are not suffering from severe of life threatening symptoms. For example, if you were suffering from and urinary tract infection, you would most probably seek urgent rather than emergency care.
Both Emblem Health and Healthfirst will provide 50% coinsurance for such a visit after the deductible has been met.
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Lab Test Coverage
You may require lab testing for a number of reasons. For example, the blood work form your annual physical will be sent for laboratory testing. In other cases, blood samples may be lab tested to detect specific illnesses.
Once again, lab tests are charged the same copay by both providers, which is 50% coinsurance after the deductible.
What Are People Saying?
EmblemHealth has an A+ rating with the Better Business Bureau and a 1 star rating on Yelp as well as on other sites.
Healthfirst has a 1.5 rating on Yelp and a D- rating on Better Business Bureau.
Which One Is Best?
EmblemHealth's bronze plan is more expensive and has a monthly premium that is nearly 32% higher than Healthfirst's. Both plans have similar deductibles, co-pays and out-of-pocket maximums.
Healthfirst does not require a referral to see a specialist whereas EmblemHealth does require one. Additionally, Healthfirst does not offer direct messaging but EmblemHealth does.
EmblemHealth also offers more in-network hospital coverage compared to Healthfirst. Reviews indicate the customers are more satisfied with EmblemHealth than Healthfirst.
Overall, these plans are quite similar. If trying to save money, Healthfirst Bronze is best since it has a less expensive monthly premium and does not require a referral to a specialist. If you are interested in more extensive in-network coverage and higher customer satisfaction, EmblemHealth may be best for you.
The Mira Research team conducts original data and medical research on the most applicable topics of today and translates them into easy-to-understand articles to educate the public. Each of our articles is carefully reviewed and curated with interviews and opinions from medical experts, public health officials, and experienced administrators. The team has educational backgrounds from New York University, the University of Virginia, more.