As Open Enrollment season approaches, many individuals are comparing various health insurance options and evaluating the best fit for themselves. There are 4 plan categories (or metal levels) within health insurance, in this comparison, we are analyzing Oscar Health's Classic Bronze plan and Fidelis Care's Bronze plan.
What do Bronze Plans include?
Bronze health plans usually have lower monthly premiums compared to the other medal categories, but the highest costs when you get care (for example, high copays, and coinsurance costs). Bronze plans must include 10 essential benefits.
Is a bronze plan the right fit for me?
With each metal, you'll want to look specifically at what the plan offers. If you choose a bronze plan, overall you'll pay about 40 percent of your health care costs, and your insurance company will pay about 60 percent. Silver, Gold, and Platinum plans cover more costs but also have varied monthly premiums and other costs/benefits.
A bronze plan may be ideal for you if you don‚t seek care very often but want to protect yourself from large bills that may be a result of serious illness or hospitalization.
If you have a bronze plan your monthly premiums will be lower but you will need to pay some healthcare costs that aren‚t covered by the insurance company.
You can learn more about the metal tiers, and other information on choosing the best health insurance here.
Here's a comprehensive breakdown comparing Oscar Health's Bronze plan and Fidelis Care's Bronze plan:
|Oscar Health Classic Bronze||Fidelis Care Bronze|
|Available on Exchange||Yes||Yes|
|Monthly premium||$566||Must inquire|
|No referral needed for specialist||✅||✅|
|Preventative care||$0 pre-deductible.||3 visits are covered pre-deductible.|
|Primary care||You pay 100% pre-deductible||3 visits are covered pre-deductible.|
|Specialty visits||You pay 50% post deductible.||50% coinsurance post deductible.|
|Urgent care||You pay 50% post deductible.||50% coinsurance post-deductible.|
|Prescription drug deductible||$10 copay for Tier 1 - Generic drugs post-deductible.||$10 copay post deductible (retail), $25 copay post deductible (mail order)|
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The monthly premium is what you pay each month to keep the coverage policy, and your deductible is the amount you'll have to pay out of pocket before the insurance kicks in.
Oscar members with the bronze plan will pay $565.63. For Fidelis Care members, you must inquire for the monthly premium as it is provided separately.
A co-pay is is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. Co-pays range for different services and also apply for prescription drugs.
With Oscar Health's Classic Bronze plan, the co-pay is $10 copay for Tier 1 - Generic drugs post-deductible. Fidelis Care is the same with a $10 copay post deductible (retail), $25 copay post deductible (mail order) for prescriptions.
A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim. Both Oscar Health and Fidelis Care have the same deductible, $4425, for the bronze plan.
In an emergency situation, you should go to the emergency room or call 911 immediately.
In an emergency, don't contact your insurance company until you have received medical attention.
An emergency is any 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.
A plan with Oscar covers individuals in the case of a life-threatening illness at your closest hospital.
According to Oscar's website, you may have to still pay part or all of the bill depending on your specific plan. A bronze plan with Fidelis results in a 50% coinsurance after deductible when going to the ER.
Urgent Care Coverage
It is suggested that individuals seek medical attention at urgent care facilities when they are faced with an urgent, but not severe or life-threatening illness. Some problems that bring people into urgent cares are sprains, minor cuts, STDs and UTIs, or minor burns.
Like a hospital visit, a bronze plan with Fidelis results in a 50% coinsurance after deductible when going to an urgent care. If you have a bronze plan with Oscar, you will pay 50% post-deductible. You must see an urgent care provider in-network in order to be covered.
Lab Test Coverage
You may need to get lab testing for a variety of reasons, including annual blood work, STD testing, or testing for an illness. Quest Diagnostics is covered by both Oscar and Fidelis for laboratory testing.
Your payment will depend on your specific plan, where you get tested, and what types of lab tests you need.
What are people saying:
June 21st, 2020 (Brooklyn, NY) 2/5 stars
‚ÄúI love their concierge staff and the staff at their Jay Street medical center in Brooklyn. I am very unhappy with their high rates and high deductibles at the same time. For that reason I will look for more affordable health insurance come this fall."
May 22nd, 2020 (New York, NY) 4/5 stars
"The 2 best things about Oscar is being able to see a specialist without a referral and the price. The 1 thing I don‚t like about Oscar is that a lot of healthcare providers--including my therapist and psychiatrist--are out of network, and these are not easy providers to replace."
December 11, 2019, 5/5 Stars
‚ÄúI had the best experience with Fidelis and my representative helping set up my account. Irma Vega was instrumental, quick and helpful. My son was born early unexpectedly and we needed to set up the account right away so he could have a wellness check-up just days out of the hospital. Irma made what would have been a stressful experience extremely easy and painless. She went above and beyond to make sure my baby boy was ready and able to see a doctor immediately. Plus I received the best rate and insurance plan I could ask for for my son. I would recommend her and Fidelis to anyone!‚Äù
September 16, 2019, 1/5 Stars
I need a Gynecologist and so I searched for a provider on Fidelis' site. Once I reviewed the list I started reaching out to these providers - only to be told they don't participate with Fidelis! I have had to pay almost $500 out of pocket to see my old GYN (who of course doesn't take Fidelis).
Which plan is best for me?
In terms of monthly premiums, deductibles, and out-of-pocket max, there is not much of a difference between these costs.
However, in terms of customer support, Oscar might be the better fit if you need more support as a user. Oscar Health is more tech-enabled and more modern, while Fidelis Care is more traditional.
Both plans cover preventative, primary, specialist, and urgent care and the coverage costs for post and pre-deductible are similar.
In this comparison, Oscar Health's Bronze plan poses more benefits compared to Fidelis Care's Bronze plan.