Open enrollment is almost in full swing, making it an excellent time to reassess your health insurance options for 2021. There are four different metal tiers of insurance coverage for individual and family plans on the exchange. They are bronze, silver, gold, and platinum respectively. This article will compare and contrast two leading silver plans.
What do Silver Plans Include?
Silver health insurance plans cover the majority of your medical costs, and as a result, they have higher monthly premiums, but lower deductibles than lower-tier plans such as bronze. Silver plans are designed to cover around 70% of your medical costs, on average.
Is a Silver Plan the Right Fit for Me?
Being one tier up from ta bronze plan, silver health insurance plans are best-suited to those who perhaps slightly more medical attention than the average individual. For instance, a mild chronic condition that requires routine appointments with a physician and a regular prescription could mean a silver plan is a good fit for you.
You can learn more about how to choose your specific insurance plan with our useful guide here.
|Oscar Health Classic Silver||United Healthcare Compass Silver|
|Available on Exchange||Yes||Yes|
|No referral needed for specialist||✅||❌|
|Preventative care||$0 pre-deductible.||$0 pre-deductible.|
|Primary care||$30.00 copay after deductible.||$30.00 copay after deductible.|
|Specialty visits||$50.00 copay after deductible.||$50.00 copay after deductible.|
|Urgent care||$70.00 copay after deductible.||$70.00 copay after deductible.|
|Prescription drug deductible||$10 copay for Tier 1 - Generic drugs||$10 copay for Tier 1 - Generic drugs|
|Lab tests||$50.00 copay after deductible.||$50.00 copay after deductible.|
|Hospital costs||$1500.00 copay per stay after deductible.||$1500.00 copay per stay after deductible.|
|Hospitals in network||Beth Israel Medical Center, Montefiore Medical Center, Mount Sinai Hospital.||Brookdale Hospital Medical Center, Lenox Hill Hospital, NYU Winthrop Hospital.|
|Gym member reimbursement||❌ None provided. However, step tracking rewards for staying active.||Up to $200 per 6-month period; up to an additional $100 per 6-month period 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 silver plans.
The monthly premium for the Oscar Health Classic Silver plan is $739.91, where the UnitedHealthcare Compass silver plan costs considerably more at $991.26 per month.
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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. As you can see from the chart above, the Oscar Health and UnitedHealthcare silver plans have copays that are exactly the same across a broad spectrum of medical services.
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 silver health insurance plans, both Oscar Health and UnitedHealthcare have relatively low deductibles of $1,300 each.
Once you exceed the deductible, both plans will begin to cost-share via copays displayed in the chart above. Both plans cap out-of-pocket expenditure at $7,900.
In an emergency situation, you should go to the emergency room or call 911 immediately. In an emergency, always focus on seeking medical attention rather than your insurance. For your information, an emergency refers to a medical situation whereby your life (or somebody‚s else‚s) is in danger.
For these silver plans both Oscar Health and UnitedHealthcare will charge a $1,500 copay per hospitalization (after deductible). Incidentally, both silver plans also charge a $250 copay for emergency room services once the 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 were suffering from painful kidney stones, you would most probably seek urgent rather than emergency care.
Both of the silver plans listed above will charge a $70 copay for such a visit after the deductible has been met.
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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 you may need lab testing as part of trying to attain a diagnosis. Once again, lab tests are charged the same copay by both providers, each coming in at $50 copays after the deductible has been met.
What Are People Saying?
Oscar Health has an A+ rating on the Better Business Bureau and a 90% rating on Value Penguin.
UnitedHealthcare has positive customer reviews on Value Penguin and a 2.7 rating on Wallet Hub.
Which One Is Best?
UnitedHealthcare compass silver has a 25% higher monthly premium when compared to Oscar Health classic silver. However, UnitedHealthCare does not offer direct messaging and you need a referral in order to see a specialist. UnitedHealthcare has more prominent in-network NYC hospitals compared to Oscar Health and UnitedHealthcare also offers gym member reimbursement.
When choosing which one is best in this situation, it would depend if you prioritize higher customer support and if you prefer no referral to see a specialist. Overall, it seems UnitedHealthcare has more to offer, but at a higher price while missing some other factors such as direct messaging.
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.