Open enrollment for 2021 is just around the corner, meaning now is an excellent time to review current health insurance plans available on the exchange. Concerning individual and family plans, there are four different metal tiers of insurance coverage, starting with bronze which offers the lowest level of cost-sharing.
However, if you meet specific requirements, you may be able to take out what is known as a catastrophic plan. We're comparing two providers who offer these types of insurance plans.
What Are Catastrophic Health Insurance Plans?
Catastrophic health insurance plans are deliberately designed for individuals who are young, fit, and healthy. These individuals are therefore unlikely to require medical attention unless in case of a catastrophe.
With that in mind, these plans have low monthly premiums and extremely high deductibles. Only after the deductible has been met will the insurer pick up the remaining costs with no further 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. In almost all cases you must be under the age of 30 to take out a plan of this type.
The only other way you can qualify over the age of 30 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. However, even if you do qualify for a catastrophic plan, you should always 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.
Healthfirst Catastrophic Plan vs. Fidelis Care Catastrophic Plan
|Benefits||Healthfirst Catastrophic Plan||Fidelis Care Catastrophic Plan|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||✅||✅|
|Preventative care||$0 pre-deductible.||$0 pre-deductible.|
|Primary care||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Specialty visits||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Urgent care||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Prescription drug deductible||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Lab tests||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Hospital costs||0.00% coinsurance after deductible.||0.00% coinsurance after deductible.|
|Hospitals in network||Beth Israel Medical Center, New York-Presbyterian/Lower Manhattan Hospital, Mount Sinai Hospital||Beth Israel Medical Center, New York-Presbyterian/Lower Manhattan Hospital, Mount Sinai Hospital|
|Gym member reimbursement||Up to $400 during coverage year. Up to an additional $200 during coverage year for spouse.||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.|
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 catastrophic plans.
The monthly premium for the Healthfirst catastrophic plan is $287.57. By contrast, the Fidelis Care catastrophic plan is less expensive, costing just $178.75.
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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. This is the case for both Healthfirst and Fidelis Carecatastrophic plans.
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 Healthfirst and Fidelis Care set their deductibles amounts at the nationally-instituted $8,150.
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 calling your insurance provider. These are events whereby where your life, your child‚s life, or someone else's life is in danger.
Once again, these two catastrophic plans are the same when it comes to hospitals. You will pay 100% of your emergency costs up until the deductible threshold, after which you will qualify for 0% coinsurance.
Urgent Care Coverage
Urgent care visits refer to instances whereby you may need medical attention, but you are not suffering from severe or 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 deductible has been met. Before that threshold, the responsibility of paying all costs lies with you.
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Lab Test Coverage
You may require lab testing for a number of reasons. For example, your annual physical will require blood work to be sent for laboratory testing.
You are responsible for 100% of the costs on both catastrophic plans from Healthfirst and Fidelis Care respectively until the value of the deductible has been exceeded. You are subsequently 100% covered against all costs thereafter.
What are people saying?
Healthfirst received 1.5/5 stars based on 101 reviews on Yelp. People are satisfied with their coordination and customer service experiences at Healthfirst. Others have been unhappy with issues regarding auto payment.
Healthfirst reviews. Yelp.com
Fidelis Care received 1/5 stars based on 105 reviews on Yelp. Users were satisfied with Fidelis reaching out and addressing concerns. Others were frustrated with denying claims and not processing claims.
Fidelis Care reviews. Yelp.com
Which One is Best?
Both Healthfirst and Fidelis Care offer very similar benefits for their catastrophic plans. With either plan, you are responsible for 100% of your medical costs until the deductible of $8,150 is met. Both plans offer partial reimbursement for gym memberships. These memberships cover different hospitals, so you may want to pick the plan with a hospital closer to your residence.
Overall, Fidelis Care's Catastrophic plan requires a monthly premium that is about $100 chapter than that of Healthfirst. Therefore, Fidelis may be a great option, as you can save up to $1,200 in monthly premiums a year.
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.