With the open enrollment period fast approaching, many of you will find yourself comparing health insurance plans ahead of signing up for coverage through 2021. As you may already be aware, there are four different tiers of insurance coverage, starting with bronze. The next three tiers are made up of metals, silver, gold, and platinum, the latter of which is the highest possible level of individual coverage.
What Does A Gold Plan Include?
Given that a gold insurance plan is just below the highest possible tier, you can rightly expect to have the vast majority of your medical expenses covered by this type of plan. In fact, under the Affordable Care Act, gold plans have to cover about 80% of your medical expenses.
Is a Gold Plan The Right Fit For Me?
The big advantage of a gold plan is that your care costs (e.g. copays and deductibles) remain low. The downside is that your monthly premium will be higher to reflect those increased costs.
If you need frequent access to care, then a gold plan is a good idea for you. This is well suited to individuals who suffer from chronic conditions, as it will help to keep your medical expenses in-check in exchange for a higher monthly upfront fee. You can learn more about the metal tiers, and other information on choosing the best health insurance here.
Here's A Comprehensive Breakdown Comparing Healthfirst's Gold Plan And MVP Health Care's Gold Plan:
|Healthfirst Gold||MVP Health Care Gold|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||✅||✅|
|Preventative care||$0 pre-deductible||$0 pre-deductible|
|Primary care||$25 co-pay post deductible||$25 co-pay post deductible|
|Specialty visits||$40 co-pay post deductible||$40 co-pay post deductible|
|Urgent care||$60 co-pay post deductible||$60 co-pay post deductible|
|Prescription drug deductible||$10 co-pay/30-day prescription (retail) and $25 co-pay/90-day prescription (mail order) for Tier-one generic drugs||$10 co-pay/30-day retail (deductible waived) and $25 co-pay/90-day mail order (deductible waived) for Tier-one generic drugs|
|Lab tests||$40.00 Copay after deductible||PCP: $25 copay*/Spec: $40 copay*|
|Healthfirst Gold||MVP Health Care Gold|
|Hospital Cost||$1000.00 Copay per Stay after deductible||$1,000 copay/continuous confinement deductible applies|
|Hospitals in network||New York-Presbyterian/Lower Manhattan Hospital, Mount Sinai Beth Israel, Mount Sinai Beth Israel, Interfaith Medical Center, Wyckoff Heights Medical Center, University Hospital of Brooklyn, Mount Sinai Hospital, Staten Island University Hosp-North, and more||Montefiore Mount Vernon hospital, SJRH - Park Care Pavilion, New York-Presbyterian Lawrence Hospital, SJRH - St. Johns Division, SJRH - Dobbs ferry Pavillion, Blythedale Children's Hospital, White Plains Hospital Center|
|Gym member reimbursement||✅Up to $400 during coverage year; up to an additional $200 during coverage year for Spouse||✅ Up to $600 in rewards and reimbursements with WellBeing Rewards per contract per calendar year|
|Family planning||❌ No in network cost share||❌ No in network cost share|
The monthly premium refers to the amount you will pay each month in order to remain covered under the insurance policy. It's different than the deductible, which is explained below in more detail.
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The monthly premium for the Healthfirst Gold plan in NYS is $752.21 and the monthly premium for MVP Health Care Gold is $846.69.
A co-pay is a pre-determined amount that you pay for a specific service. As the patient, you will pay this fee to your service provider before receiving the service in question. You‚ll notice that co-pays can vary quite dramatically depending on the type of service being provided. They also apply to prescription drugs.
When it comes to these health insurance plans, the co-pay structure is almost identical, bar the application of the deductible to prescription drugs. The MVP Health Care Plan waives the deductible, whereas the Healthfirst Gold Plan doesn‚t.
Both plans have a $25 co-pay post deductible for primary care, $40 co-pay post deductible for specialists and $60 co-pay post deductible for urgent care.
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 these two gold insurance plans, both Healthfirst and MVP Health Care have set the deductible at $600.
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 phoning your insurance provider. In case you‚re wondering what constitutes an emergency, the term refers to an event where your life, your child‚s life, or someone else's life is in danger, your bodily functions are impaired, or you have disfigured yourself with a physical injury.
Once again, in this case, both Healthfirst and MVP Health Care offer the same coverage, which is a $150 co-pay post deductible. In the case of Healthfirst, this coverage also applies to out-of-network providers.
Healthfirst has a $1000.00 Copay per Stay after deductible in terms of hospital coverage and MVP Health Care has a $1,000 copay/continuous confinementDeductible applies.
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 instance, you may visit an urgent care facility for minor physical injuries (e.g. badly-sprained ankle) or mild but urgent illnesses such as STDs.
Yet again, these specific gold insurance plans are equally matched. Both Healthfirst and MVP Health Care both charge a post-deductible $60 co-pay for visits made to urgent care.
Lab Test Coverage
You may require lab testing for a number of reasons. For example, your annual blood work or STD tests are both instances where you would need the services of a laboratory.
In the case of Healthfirst, tests such as bloodwork are charged at a $25 co-pay post deductible when performed in a primary care physician's office, or $40 co-pay post deductible when performed in an outpatient facility. For MVP Health Care, the gold insurance plan provides the same coverage and fee structure.
What Are People Saying:
1/5 Stars: Reviewed on 5/15/2020 from Boston, MA
"With the current situation, reaching a doctor is very hard. With my grandma being a member of the vulnerable community, I wanted to reach out to the company to find a solution for her pain. I wanted to attempt to find a solution that does not require entering a hospital, however, their customer service proceeds to hang up and redirect me to the number I have just dialed. This is ridiculous and unacceptable customer service. I will be attempting to find my own doctor and I recommend people use a different solution as health first is obviously not a solution." (Original source can be found here)
4/5 Stars: Reviewed 11/17/2017 from New York, NY
"I second the notion that their network database is out of date. Very often (half the time), a provider that shows up on their network do not actually accept their insurance. Then again, aren't all insurance databases outdated though? Their search system is pretty easy to navigate, just takes multiple phone calls to confirm and find a provider that actually accepts it. Their network has been satisfactory for me. Some of the hospital affiliations with a lot of their providers include Bellevue hospital & Mount Sinai. I almost always choose to go with Mount Sinai doctors. You can actually search their database without having to be a member if you want to check it out. As mentioned above though, only half of them are actually part of the network..." (This is an excerpt from a longer review. Full review can be found here)
MVP Health Care
1/5 Stars: Reviewed on 9/5/2019 from Acton, MA
"Our experience with MVP has been a nightmare. Filling a prescription and getting approval for that prescription for an out-of-state student has been nothing but one obstacle after another. It has taken over 6 hours on the phone - no exaggeration- and we still do not have the medication after 8 days of trying..." (This is an excerpt from a longer review. Full review can be found here)
5/5 Stars: Reviewed 11/27/2019 from Highland Falls, NY
"I love MVP! For one MVP has multiple policies. State-funded, Commercial (employer), private... are just examples. Any state-funded insurance (NYS Medicaid, child health plus or essential plans) are just that funded by the state you live in (NYS) therefore, no out of state benefits unless it's an emergency (Emergency Room)..." (This is an excerpt from a longer review. Full review can be found here)
Which Plan Is Best For Me?
The Healthfirst Gold and MVP Health Care Gold memberships are very similar in terms of cost, specifically the deductible, out-of-pocket max, primary care, urgent care, and specialty visits. Members that have both plans have had some trouble regarding customer service and finding an approved provider quickly and easily. One major factor to consider is where these plans cover individuals. While Healthfirst covers individuals in New York, NY, MVP Health Care does not. Alternatively, MVP health care covers many counties in upstate NY that are not covered by Healthfirst.
Although similar, MVP Health Care could be a better plan for you if you prioritize gym member reimbursement. Additionally, Healthfirst may have a lower monthly premium based on your location. Otherwise, contact Healthfirst and MVP Health Care to see which plan best suits your needs.