With 2021‚s open enrollment period just around the corner, now is the perfect time to start weighing your options when it comes to your health insurance. Individual health insurance policies usually have different tiers of coverage which are based on metals. They include bronze, silver, gold, and platinum levels of coverage.
However, if you meet specific requirements, you may be able to take out what is known as a catastrophic plan.
What do Catastrophic Health Insurance Plans Cover?
Catastrophic plans are deliberately designed for certain individuals that are young, fit, and overall healthy. These individuals are therefore unlikely to require medical attention unless in case of a catastrophe.
With that in mind, catastrophic plans have extremely high deductibles, after which the insurer will pick up the remaining costs with no co-pay or coinsurance contributions.
Is a Catastrophic Plan The Right Fit For Me?
If you‚re considering a catastrophic plan, the first thing you should do is find out whether or not you are eligible. The first criterion is simple: you must under the age of 30 to take out a plan of this type.
The only other way you can qualify is through a hardship or affordability exemption (based on the Marketplace or job-based insurance being unaffordable). If you qualify through these means, you are able to take out this insurance plan at any age. Even if you do qualify for a catastrophic plan, you should consider your family's medical history, your current medical needs, and any underlying conditions. If you have an underlying condition or have a family history of chronic conditions, a catastrophic plan may not be the right choice for you.
You can learn more about the metal tiers, and other important information regarding choosing the best health insurance here.
Here's a comprehensive comparison of Oscar Health Catastrophic Plan vs. Fidelis Care Catastrophic Plan
|Oscar Health Catastrophic Plan||Fidelis Care Catastrophic Plan|
|Available on Exchange||Yes||Yes|
|Monthly premium||Must inquire – varies by state||Must inquire – varies by state|
|No referral needed for specialist||✅||✅|
|Preventative care||$0 pre-deductible||$0 pre-deductible|
|Primary care||First three (3) non-preventive visits are $0, and not subject to deductible.||First three in a year covered in full, then 100% covered after deductible.|
|Specialty visits||You pay 100% of costs pre-deductible. 100% covered thereafter.||You pay 100% of costs pre-deductible. 100% covered thereafter.|
|Urgent care||You pay 100% of costs pre-deductible. 100% covered thereafter.||You pay 100% of costs pre-deductible. 100% covered thereafter.|
|Prescription drug deductible||You pay 100% of costs for all tiers of prescription drugs up to the deductible. 100% covered thereafter.||You pay 100% of costs for all tiers of prescription drugs up to the deductible. 100% covered thereafter.|
|Lab tests||$0.00 Copay after deductible||0.00% Coinsurance after deductible|
|Hospital cost||$0.00 Copay after deductible||0.00% Coinsurance after deductible|
|Hospitals in network||Kingsbrook Jewish Medical Center, Montefriore Mount Vernon Hospital, White Plains Hospital Center||Wykoff Heights Medical Center, Blythedale Childrens Hospital|
|Gym member reimbursement||❌ No in-network cost share||❌ No in-network cost share|
|Family planning||❌ No in-network cost share||❌ No in-network cost share|
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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 the monthly premium does not contribute toward the hefty deductible on these catastrophic plans.
The monthly premium for both Oscar Health‚s and Fidelity Care‚s plans are available on their respective websites. All you need to do is enter some of your personal details such as your zip code and your date of birth to find out what it would cost each month.
Here are some estimates for a 25 year old living in the lower east side of Manhattan, NY. Oscar Simple Secure monthly premium is approximately $191. For more information regarding the monthly premium for Fidelis, you may need to create an account and contact customer service here.
A co-pay is a pre-determined amount that you will pay for a specific service. As the patient, you will pay this fee to your service provider before receiving the service in question. For catastrophic plans, both co-pays and coinsurance are almost irrelevant.
This is because you pick up 100% of the tab before you meet the deductible threshold of $8,150, and your insurance provider picks up 100% of the remaining expenses thereafter.
A deductible is a specified amount of money that you must pay before an insurance company will pay at least a proportion of an insured party‚s medical expenses. In the case of a catastrophic plan, that proportion is 100%. Both Oscar Health and Fidelity Care set their prices at the nationally-instituted $8,150.
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In an emergency situation, you should go to the emergency room or call 911 immediately. In an emergency, always focus on receiving medical attention rather than on phoning your insurance provider. These are events where your life, your child‚s life, or someone else's life is in danger.
Once again, the two plans are the same when it comes to visits to the ER. You will pay 100% of your emergency costs up until the deductible threshold, after which you will be fully-covered for the remainder.
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, an STD or a minor broken bone would constitute a visit to an urgent care facility.
Both of these catastrophic plan providers will cover 100% of your costs after the $8,150 has been met. Before that threshold, the responsibility of paying any costs lies with you.
Lab Test Coverage
You may require lab testing for a number of reasons. For example, your annual blood work will be sent for the laboratory testing. You are responsible for 100% of the costs on both plans from Oscar Health and Fidelis Care until the value of the deductible has been exceeded. It is unlikely that routine laboratory testing will exceed your deductible. You are subsequently 100% covered thereafter.
Which Plan Is Best For Me?
In terms of cost, the Fidelis Care Catastrophic Plan and Oscar Health Catastrophic Plan have the same deductible and out-of-pocket max. Both plans will require you to pay most medical expenses on your own.
Based on customer reviews, a plan with Oscar Health may be the better option for you if you need more technological, customer, and overall user support. Oscar Health also provides more in-network hospitals.
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.