Public Health

EmblemHealth Silver Bold vs. Oscar Health Saver Silver

Mira Research Team07 Oct 2020

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

EmblemHealth Bold SilverOscar Health Saver Silver
Available on ExchangeYes
Monthly premium$629.29
Deductible$6,100
Out-of-pocket Max$6,100
Network typeHMO
No referral needed for specialist
Telemedicine
Direct messaging
Phone support
Preventative care$0 pre-deductible.
Primary care3 free sick visits then $50 copay pre-deductible.
Specialty visits$70 copay pre-deductible.
Urgent care$75 copay pre-deductible.
Prescription drug deductible$15 copay for Tier 1 - Generic drugs.
Lab tests$70 copay pre-deductible.
Hospital costs$0 after deductible.
Hospitals in networkBellevue Hospital Center, Harlem Hospital Center, New York Presbyterian Hospital.
Gym member reimbursementUp to $200 per 6-month period. Up to $100 per 6-month period for spouse
Family planningFree counseling on the use of contraceptives, sterilization procedures, and related topics included.

 

Monthly Premium

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 silverplans.

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.  

Co-pay

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 EmblemHealth there are 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.

Deductible

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 constrast the Oscar Health silver plan has a much lower deductible of $2,500.  

Hospital Coverage

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 insuranceprovider. 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.  

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.

Oscar Review

 

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.

EmblemHealth Review

 

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 deducible 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 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.

 

 

Sources:

https://www.healthcare.gov/choose-a-plan/plans-categories/

https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/79425?county=New%20York&coverageTier=INDIVIDUAL&entityType=INDIVIDUAL&planYear=2020&youPay=

https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/78509?county=New%20York&coverageTier=INDIVIDUAL&entityType=INDIVIDUAL&planYear=2020&youPay=

https://portals.emblemhealth.com/ProviderSearchEHHIP/ProviderFacilitySelection.aspx?mode=results

https://www.hioscar.com/search/facilities?specialty_id=282N00000X&network_id=001&year=2020&zip_code=10013

https://bestcompany.com/health-insurance/company/oscar#reviews

https://www.expertinsurancereviews.com/emblem-health/

U.S. healthcare is expensive and opaque. Mira is changing that!

Mira is a new option for you to get essential healthcare for $45/mo. Urgent care. Free COVID test. STD test. Blood work. Prescriptions. Gym membership discounts.