With the fall open enrollment period almost upon us, now is an excellent time to reassess your health insurance options for 2021. There are four different metal tiers of insurance coverage for individual plans. Those tiers are made up of bronze, silver, gold, and platinum. The latter offers the highest level of coverage with bronze offering the lowest. Here we are going to take a look at two leading health insurance plans in the silver tier.
What Are Silver Health Insurance Plans?
Silver health insurance plans cover the majority of your medical costs, and as a result, they have higher monthly premiums, but lower deductibles than their bronze counterparts. Silver plans are specifically designed to cover around 70% of your medical costs on average.
Is a Silver Plan the Right Fit for Me?
Being one tier up from the bottom rung of insurance options, silver health insurance plans are best suited to those who need a little more medical attention than the average person. For instance, a silver plan may be a perfect fit if you suffer from a mild chronic condition that requires frequent checkups and a prescribed treatment plan. A bronze plan may be a better fit if you rarely need to see a doctor, while a gold plan is better suited for those who need to frequently see a doctor for more serious conditions.
If you are unsure regarding which tier of insurance plan is best suited to your needs, you can learn more by reading our helpful insurance guide here.
EmblemHealth Silver Bold vs. Oscar Health Saver Silver
|Benefits||EmblemHealth Bold Silver||Oscar Health Saver Silver|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||❌||✅|
|Preventative care||$0 pre-deductible.||$0 pre-deductible.|
|Primary care||3 free sick visits then $50 copay pre-deductible.||$30% coinsurance after deductible.|
|Specialty visits||$70 copay pre-deductible.||$30% coinsurance after deductible.|
|Urgent care||$75 copay pre-deductible.||$30% coinsurance after deductible.|
|Prescription drug deductible||$15 copay for Tier 1 - Generic drugs.||$30% coinsurance after deductible.|
|Lab tests||$70 copay pre-deductible.||$30% coinsurance after deductible.|
|Hospital costs||$0 after deductible.||$30% coinsurance after deductible.|
|Hospitals in network||Bellevue Hospital Center, Harlem Hospital Center, New York Presbyterian Hospital.||Beth Israel Medical Center, Montefiore Medical Center, Mount Sinai Hospital.|
|Gym member reimbursement||Up to $200 per 6-month period. Up to $100 per 6-month period for spouse||❌ None provided. However, step tracking rewards for staying active.|
|Family planning||Free counseling on the use of contraceptives, sterilization procedures, and related topics included.||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 silver plans.
The monthly premium for the Emblem Health silver plan is $629.29. Oscar Health‚s price is similar, coming in at $656.87 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 an urgent care facility.
For EmblemHealth there is a broad range of copays offer across a wide range of medical services. By contrast, Oscar Health offers 30% coinsurance across the board once the deductible has been met.
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.
The deductible is extremely high for the EmblemHealth silver plan coming in at $6,100, however, most of the copays kick in before the deductible. By contrast, the Oscar Health silver plan has a much lower deductible of $2,500.
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 engaging with your insurance provider. For reference, an emergency is a situation whereby somebody‚s life is in danger.
The EmblemHealth silver plan will cover 100% of the costs after the deductible has been met. On the other hand, Oscar Health offers 30% coinsurance after the deductible is reached.
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 badly sprained your ankle, you would most probably seek urgent rather than emergency care.
The EmblemHealth silver plan offers a $75 copay pre-deductible for visits to urgent care facilities. On the other hand, once again Oscar Health offers 30% coinsurance after the deductible is reached.
Virtual care for only $5 per visit
Virtual primary care or urgent care visits are only $5. Behavioral health visits are $15.
Lab Test Coverage
You may require lab testing for a number of reasons. For example, your annual blood work will be sent for laboratory testing, or blood samples may require lab testing to detect specific illnesses.
The EmblemHealth silver plan offers a $70 copay pre-deductible for lab tests, whereas Oscar Health offers 30% coinsurance after the deductible has been met.
What Are People Saying?
Bestcompany.com gave Oscar 3.4 stars based on over 5,000 reviews. Some positive things people have to say about Oscar include their great customer service, easy-to-use app and website, and good job navigating telemedicine. On the contrary, some users were unhappy with the wait times to get doctor visits approved and high deductibles.
Expertinsurancereview.com gave EmblemHealth 2 stars. Users seem to be satisfied with internal claim processing. Others, however, complain about difficulty with finding doctors that are covered by their plans and customer service.
Which One is Best?
EmblemHealth's Silver Bold plan and Oscar Health's Saver Silver have several differences that are important to consider when deciding which plan is best. EmblemHealth's $6,100 deductible is significantly higher than the $2,500 deductible for Oscar. Additionally, Oscar does not require a referral to see a specialist while EmblemHealth does.
EmblemHealth offers up to $200 every 6 months for a gym membership while Oscar does not. However, Oscar has a more positive review regarding customer service and user experience. Oscar and EmblemHealth offer coverage at different hospitals in New York City, so it may make sense to get coverage at the hospital that is closest to your residence.
Overall, if you are looking for a plan with a lower deductible that is a bit more flexible in terms of what providers you can see, Oscar Health's Saver Silver is a great choice.