With the fall open enrollment period just a few short months away, it‚s an excellent time to reassess your health insurance options for 2021. There are four different metal tiers of insurance coverage for individual and family plans, starting with bronze which offers the lowest level of cost-sharing. The other tiers are made up of silver, gold, and platinum, the highest level of coverage. Here we are going to take a look at two leading silver plans.
What do Silver Plans Cover?
Silver health insurance plans cover the majority of your medical costs, and as a result, they have higher monthly premiums, but significantly lower deductibles than their bronze counterparts. Silver plans are designed to cover around 70% of your medical costs on average, with you picking up the remaining 30%.
Is a Silver Plan the Right Fit for Me?
Being one tier up from the bottom, silver health insurance plans are best-suited to those who perhaps 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 infrequent but routine checkups as well as a prescription medication for treatment.
You can learn more about your specific suitability for each metal tier through our helpful insurance guide here.
|Benefits||Empire BlueCross BlueShield Silver||Healthfirst Silver|
|Available on Exchange||Yes|
|No referral needed for specialist||❌|
|Preventative care||$0 pre-deductible.|
|Primary care||$30.00 copay after deductible.|
|Specialty visits||$50.00 copay after deductible.|
|Urgent care||$70.00 copay after deductible.|
|Prescription drug deductible||$10 copay for Tier 1 - Generic drugs|
|Lab tests||$50.00 copay after deductible.|
|Hospital costs||$1500.00 copay per stay after deductible.|
|Hospitals in network||Maimonides Medical CTR, NYU Langone Hospitals, St. Vincent’s Hospital.||Lenox Hill Hospital, Mount Sinai Hospital, Metropolitan Hospital.|
|Gym member reimbursement||Partial reimbursement for facility fees every 6 months if member attains at least 50 visits.||Up to $400 during coverage year; up to an additional $200 during coverage year for Spouse.|
|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.|
Comparison of Empire BlueCross BlueShield Silver vs Healthfirst Silver
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 Empire BlueCross BlueShield is $873.85, whereas for Healthfirst it‚s considerably lower at $629.13 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 Empire BlueCross Blueshield and Healthfirst silver plans, almost all copays are the exactly the same across a broad spectrum of medical services.
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 silver health insurance plans, both of the deductibles are fairly low, at $1,300 per year.
Once you exceed the exceed the deductible, both plans will begin to cost share via copays. Both plans cap out-of-pocket expenditure at $7,900.
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 an insurance provider.
For reference, an emergency is a situation whereby somebody‚s life (including your own) is in danger.
For these silver plans both Empire BlueCross BlueShield and Healthfirst will charge a $1,500 copay per hospitalization once the 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 fractured your arm, you would most probably seek urgent rather than emergency care.
Both Empire BlueCross BlueShield and Healthfirst will charge a $70 copay 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, your annual blood work will be sent for laboratory testing, or blood samples may be lab tested to detect specific illnesses.
Once again, lab tests are charged the same copay by both providers, each coming in at $50 copays after the deductible has been met.
What are people saying?
Empire Blue Cross has a 1 star rating across multiple websites, the company also receive a D- rating from the Better Business Bureau.
HealthFirst, on the other hand, receive 1.5 star rating on yelp and also received a D- rating from the Better Business Bureau.
Which one is best?
Empire Blue Cross silver plan is the more expensive option that costs almost 39% more than HealthFirst silver plan.
Both plans have similar deductible amount and copays by design. HealthFirst offers better access to specialists since you would not need a referral while with Empire Blue Cross you would need one from a primary care provider or similar.
Though more expensive, Empire Blue Cross plan does provide access to top-tier research academic medical centers - i.e. NYU Langone. Health First does give you access to Mount Sinai, which is a fine medical institution in the NYC.
Overall, HealthFirst has very similar features but at a lower cost. We advice that you evaluate your specialist need before picking the right plan.
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.