Open enrollment for 2021 health insurance plans is just about to get underway. Consequently, this is an excellent time to review and contrast plans ahead of signing up. In case you were unaware, individual and family plans are broken down into four different metal tiers (bronze, silver, gold, platinum) of insurance coverage. This post will be focusing on bronze-level plans, the lowest tier of coverage available on the exchange.
What do Bronze Plans Include?
Bronze health insurance plans cover the lowest proportion of your medical costs out of the metal tiers. As a result, they have lower monthly premiums than the other metal tiers but significantly higher deductibles than their counterparts. Under the Affordable Care Act, Bronze plans should cover around 60% of your medical costs on average.
Is a Bronze Plan the Right Fit for Me?
Being the lowest tier of health insurance plans, bronze insurance plans are best-suited to those who are fit and healthy. For instance, if you‚re relatively young, have no known medical conditions, and you very rarely visit a doctor, then a bronze plan provides the ideal level of coverage.
You can learn more about which metal tier you‚re best-suited to with our helpful health insurance guide.
|Benefits||Oscar Health Classic Bronze||Empire BlueCross BlueShield Bronze|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||❌||❌|
|Preventative care||$0 pre-deductible.||$0 pre-deductible.|
|Primary care||50.00% coinsurance after deductible.||50.00% coinsurance after deductible.|
|Specialty visits||50.00% coinsurance after deductible.||50.00% coinsurance after deductible.|
|Urgent care||50.00% coinsurance after deductible.||50.00% coinsurance after deductible.|
|Prescription drug deductible||$10 copay for Tier 1 - Generic drugs after deductible.||$10 copay for Tier 1 - Generic drugs after deductible.|
|Lab tests||50.00% coinsurance after deductible.||50.00% coinsurance after deductible.|
|Hospital costs||50.00% coinsurance after deductible.||50.00% coinsurance after deductible.|
|Hospitals in network||Beth Israel Medical Center, Montefiore Medical Center, Mount Sinai Hospital.||Maimonides Medical CTR, NYU Langone Hospitals, St. Vincent’s Hospital.|
|Gym member reimbursement||❌ None provided. However, step tracking rewards for staying active.||Partial reimbursement for facility fees every 6 months if member attains at least 50 visits.|
|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 maintain your insurance coverage. It‚s important to note that these payments do not contribute toward the deductible on either of these bronze plans.
The monthly premium for the Oscar Health bronze plan is $565.63, which is just under $100 less than Empire BlueCross BlueShield's charge for their monthly premium; $646.06.
A co-pay is simply a pre-determined amount that you will pay for receiving a specific service from a care provider, such as a visit to a primary care facility.
For both Oscar Health and Empire BlueCross BlueShield plans, the copay is expressed as a 50% coinsurance across the board, once the deductible has been met. The only exception is prescription drugs, which both companies set at a starting price of $10 for generic drugs.
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A deductible is a specified amount of money that you must pay before an insurance company will start to pay a proportion of your medical expenses. Being bronze health insurance plans, both of the deductibles are fairly high, at $4,425 per year for the Oscar Health plan, and even higher $5,500 for the Empire BlueCross BlueShield bronze plan.
Once you exceed the deductible, both plans will begin to cost share via a 50% coinsurance almost across the board. The out-of-pocket max for the Oscar Health bronze plan is capped at $8,150. By contrast, the Empire BlueCross BlueShield plan has a lower max of $6,550.
In an emergency situation, you should go to the emergency room or call 911 immediately if you are unable to make it there yourself. In an emergency, always focus on seeking medical attention first rather than on your insurance. For reference, an emergency is a situation whereby anybody‚s life is in danger.
For both of these bronze plans, Emblem Health and Healthfirst will offer 50% coinsurance once the $4,425 (Oscar Health) and $5,500 (Empire BlueCross BlueShield) deductible has been met.
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 badly sprained your ankle, you would most probably seek urgent rather than emergency care.
Both bronze plans will provide 50% coinsurance for such a visit after their respective deductibles have been met.
Lab Test Coverage
You may require lab testing for a number of reasons. For example, the blood work from your annual physical will be sent for laboratory testing. In other cases, blood samples may be lab tested to help with the detection of specific illnesses.
Once again, lab tests are charged the same copay by both providers, which is 50% coinsurance after their respective deductibles.
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What Are People Saying?
Oscar Health has a 90% rating on Value Penguin and an A+ on the Better Business Bureau.
Empire BlueCross BlueShield has a 1.1 rating on Consumer Affairs and 1 star rating on Yelp.
Which One's Best?
EmpireBlueCross BlueShield has a higher monthly premium and deductible when compared to Oscar Health. However, EmpireBlueCross also offers more in-network hospitals such as NYU Langone which is a prominent NYC Hospital. They also offer partial gym reimbursement where OscarHealth does not. However, customers seem to be more satisfied with Oscar Health Classic Bronze according to online reviews.
Due to the additional benefits and more in-network providers, if you can afford to pay a little more for the monthly premium and deductible, EmpireBlueCross BlueShield may be the better option for you.
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.