As the year draws toward the fall open enrollment period, it‚s an excellent time to reassess your health insurance options for 2021. As you may already be aware, there are four different metal tiers of insurance coverage for individual and family plans starting with bronze before progressing to platinum-level coverage. If you are under the age of 30 you also have the option to choose a catastrophic plan.
What do Catastrophic and Bronze Plans Cover?
Catastrophic plans have higher deductibles compared to other metal tiers, after which the insurer will pick up the remaining costs with no co-pay or coinsurance contributions thereafter. They are specifically designed for healthy young adults under the age of 30.
By contrast, bronze plans offer similar amount of coverage, and under the Affordable care act they cover around 60% of your medical costs on average.
It is often a good idea to pair a catastrophic or bronze plan with a supplemental plan like Mira. Having a health insurance helps cover the high cost medical events and adding Mira helps you access basic and routine everyday healthcare without having to pay full price out of pockets for things like urgent care, lab tests, and prescriptions.
Can everybody get a Catastrophic plan?
No. Catastrophic plan provides minimal coverage against serious medical risk. They are lower in monthly premium, but not free in most cases. You may be eligible to purchase a catastrophic plan if:
- You are under 30 years old.
- Are over 30 and meet the guidelines for a hardship exemption.
Is a Catastrophic or Bronze plan the right fit for me?
If you‚re considering a catastrophic plan, you must first make sure that you are eligible. There are only two ways to qualify, either by being under the age of 30 or by qualifying through a financial hardship exemption (based on Marketplace or job-based insurance being unaffordable).
If you‚re over 30 then the Simple Bronze Plan offered by Oscar Health works is almost exactly the same way as a traditional catastrophic plan. Rather than covering around 60% of your medical expenses, you cover the costs of pretty much everything before the deductible (bar a few co-pays), before receiving 100% coverage thereafter. Perfect if you‚re in good shape and rarely make use of any medical services.
You can learn more about the metal tiers, and other important information regarding your health insurance eligibility here.
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Here's A Comprehensive Breakdown Comparing Oscar Health Catastrophic Secure Plan and Oscar Health Simple Bronze Plan:
|Oscar Health Simple Secure Plan||Oscar Health Simple Bronze Plan|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||✅||✅|
|Preventative care||$0 pre-deductible||$0 pre-deductible|
|Primary care||First 3 non-preventive visits are $0, and not subject to deductible.||2 PCP office visits with $50 copayment not subject to deductible. Subsequent visits 0% coinsurance 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.||$100 co-pay pre-deductible|
|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 Copay after deductible||$0 Copay after deductible|
|Hospital cost||$0 Copay after deductible||$0 Copay after deductible|
|Hospitals in network||Kingsbrook Jewish Medical Center, Montefriore Mount Vernon Hospital, White Plains Hospital Center||Kingsbrook Jewish Medical Center, Montefriore Mount Vernon Hospital, White Plains Hospital Center|
|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|
The monthly premium refers to the amount you‚ll pay each month in order to remain covered under the insurance policy. These payments do not contribute toward the deductible.
The disparity between the monthly premium is quite large for these plan considering they offer a similar level of care, which is reflective of the strict eligibility criteria for the Simple Secure Plan. The Simple Bronze Plan from Oscar Health costs just over $350 more in the case of New York, but the gap may not quite be as severe across other states.
A co-pay is a pre-determined amount that you will pay for a specific service from a care provider. In the case of Oscar Health, both of these plans have similar arrangements. For the Simple Secure plan, there are no co-pays as you are responsible for footing the bill for all services (after using up your included allowances) before meeting the deductible threshold.
With Oscar Health Secure, there is a $100 co-pay pre-deductible for urgent care and $50 copayment for primary 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 both of these health insurance plans that proportion is 100%.
That is to say that once you have exceeded the $8,150 deductible on your Oscar Health plan, you will no longer pay for any subsequent medical expenses. The deductible for both plans are $8,150.
In an emergency situation, you should go to the emergency room or call 911 immediately. In an emergency, always focus on seeking medical attention first. For reference, an emergency is a situation whereby where your life, your child‚s life, or someone else's life is in danger.
In case you do indeed require a visit to the ER, you will pay 100% of your emergency costs up until the deductible threshold for both listed plans. After the deductible has been met, Oscar Health will cover the rest.
Both plans have a $0 copay after deductible.
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 were suffering with kidney stones or a bad ankle sprain, you would seek urgent rather than emergency care.
Under the Simple Secure catastrophic plan, you will pay the full bill before the deductible threshold is met. Whereas for the Simple Bronze Plan there is a $100 co-pay, with no coverage for out-of-network care providers.
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. For both plans, you are responsible for the costs of these tests before meeting your deductible ($0.00 Copay after deductible). You won‚t pay anything after passing your deductible threshold.
What Plan Is Best For Me?
There are many similarities between Oscar's Secure Plan and Simple Bronze plan, however, if you are healthy, have no chronic conditions and are not on medications, the Catastrophic plan is less expensive and could be the best option for you. That is as long as you do not get sick or injured. If you're concerned about needing more than three doctor visits annually, the bronze option would likely be the best plan for you.
Additionally, only a small portion of people are eligible for a catastrophic plan, and would then present the Secure Plan as the best option for those who are over the age of 30.