Health insurance can be confusing, especially when you’re comparing plans from different providers. EmblemHealth and healthfirst are two popular options in New York, but they have some key differences. This guide examines the pros, cons, coverage, costs, provider networks, and other factors to consider when choosing between EmblemHealth and healthfirst.
A Brief Comparison Table
| Feature | EmblemHealth | healthfirst |
| Type of Insurer | Private insurance | Private insurance |
| Plan Options | HMO, PPO, POS, EPO | HMO, EPO |
| Metal Tiers Available | Bronze, Silver, Gold, Platinum | Bronze, Silver, Gold |
| Provider Network Size | Large metro NYC network | Smaller NYC-focused network |
| Premium Costs | Mid-range | Among lowest in NY |
| Deductible Range | $0-$6850 | $0-$6700 |
| Max Out-of-Pocket Range | $2000-$6850 | $2000-$6700 |
| Prescription Drug Coverage | All plans cover, some tiers | All plans cover, some tiers |
| Customer Satisfaction | Higher ratings | Mixed reviews |
| Pediatric Dental/Vision | Covered on all plans | Covered on all plans |
| Serves NY State | Yes | Yes |
| Serves Other States | No | No |
Overview Of EmblemHealth
EmblemHealth is one of the largest health insurance providers in New York, serving over 3 million members. They offer HMO, PPO, and POS plans for individuals, families and employers. Some key things to know:
- Non-profit with 80+ years experience
- Strong focus on local doctors and hospitals in NY tri-state area
- Range of plan options from bronze to platinum coverage
- Qualified Health Plan provider on NY State of Health marketplace
- Excellent ratings for member satisfaction
Overview Of Healthfirst
healthfirst is another large non-profit health insurance provider in NY with over 1.4 million members. Here’s a quick look at healthfirst:
- Non-profit founded in 1993
- Medicaid Managed Care and Child Health Plus plans
- Marketplace plans comply with Affordable Care Act
- Focus on low-income individuals and families
- Decent range of plans but less selection than EmblemHealth
- Limited provider network compared to EmblemHealth
Plan Options And Coverage
Both insurers offer a spectrum of plans at different metal tiers – bronze, silver, gold and platinum. The higher metal tiers have more comprehensive coverage and lower deductibles, but higher monthly premiums.
EmblemHealth has a much wider array of plans and options to choose from. healthfirst offers sufficient choice, but fewer plan types than EmblemHealth.
For family and individual deductible and out-of-pocket maximums, the plans are quite comparable between the two insurers at each metal tier. The exception is that healthfirst’s bronze plans have very high deductibles.
Both insurers cover all essential health benefits under the Affordable Care Act, including:
- Prescription medications
- Lab tests and imaging
- Hospitalization
- Emergency services
- Pediatric care including vision and dental
- Maternity and newborn care
- Mental health services
- Rehabilitative services
- Preventive care and chronic disease management
Provider Network
The provider network is one of the biggest differentiators between EmblemHealth and healthfirst.
EmblemHealth has a much larger local provider network in New York. They contract with most major hospitals and health systems in the tri-state area. This gives members far more choice in selecting conveniently located in-network doctors, specialists and facilities.
healthfirst has a narrower provider network centered around NYC hospitals and Medicaid providers. With healthfirst you may have fewer local in-network provider options depending on where you live.
Before choosing a plan, check whether your existing doctors are in-network to avoid surprise bills. Both insurers have online provider lookup tools to check coverage.
Costs And Premiums
On the NY health insurance marketplace, EmblemHealth plans tend to be moderately priced relative to other insurers. Premiums are competitive but not the absolute lowest cost.
healthfirst plans are generally on the more affordable end for marketplace shoppers, with some of the lowest premiums available.
However, costs shouldn’t be the only deciding factor – the provider network breadth and coverage details also matter. Side-by-side comparisons on the marketplace can determine the best value based on plan design and premium combination.
Both insurers also offer discounts and financial assistance programs to help qualifying individuals lower premiums and out-of-pocket costs.
Member Satisfaction
EmblemHealth gets higher ratings for member satisfaction based on reviews and surveys. Members praise EmblemHealth’s large local provider network, the selection of plans to choose from, and helpful customer service.
healthfirst receives more mixed reviews. While premium costs are low, some members report issues with billing, claims processing, and poorer customer service versus EmblemHealth.
Ultimately, reading up on other members’ experiences through reviews can provide helpful insight into ease of use and dependent care with each insurer.
Also Read: Choose Between Aetna And Carefirst.
Pros And Cons Of EmblemHealth
Pros:
- Broad provider network in New York tri-state area
- Many plan options and types to choose from
- Competitive premiums and out-of-pocket costs
- High marks for member satisfaction
- Strong coverage for prescriptions, pediatric dental and vision
Potential Cons:
- No plans available outside of NY tri-state region
- Customer service could be more responsive at times
Pros And Cons Of Healthfirst
Pros:
- Among the lowest premiums on the NY marketplace
- Decent bronze, silver and gold plan selection
- Pediatric dental and vision coverage included
- Provider network still includes many NYC providers
Potential Cons:
- Very limited provider network compared to EmblemHealth
- Mixed reviews for billing, claims and customer service
- Bronze plans have high deductibles over $6,000
- Fewer plan options overall versus EmblemHealth
Is EmblemHealth A Better Choice Than Healthfirst?
For most New Yorkers, EmblemHealth is likely the better choice between these two insurers because of the larger provider network, wider range of plan offerings, and higher marks for customer satisfaction.
However, healthfirst can make sense for some individuals, especially if you:
- Only require coverage in NYC boroughs
- Want a low premium bronze or silver plan
- Don’t need extensive provider choice
- Qualify for Medicaid or Child Health Plus
But ultimately, your personal coverage needs should determine which insurer works better for your situation.
Also watch this about EmblemHealth!
Frequently Asked Questions (FAQ)
For most people, EmblemHealth would likely be considered better overall thanks to the larger provider network, wider range of plan options, and better reputation for customer service. But healthfirst can still be a smart choice for certain individuals.
There is no one “best” health insurer for every person in New York. Top insurers besides EmblemHealth and healthfirst include Empire Blue Cross, UnitedHealthcare, and Fidelis. Comparing plans on the NY marketplace can help find the right fit based on premiums, deductibles, doctor choices, and prescription coverage.
EmblemHealth offers private individual and family health insurance. They provide HMO, PPO, POS, and EPO plans at bronze, silver, gold and platinum levels both on and off the NY health insurance marketplace.
Yes, EmblemHealth is typically regarded as one of the top health insurance choices in New York due to its broad provider network, competitive premiums, wide range of plans, and high marks for customer service. It’s a quality insurer for individual, family, and employer-based coverage.
The Bottom Line
When choosing between EmblemHealth and healthfirst in New York, consider your budget, doctor preferences, location, plan types needed, and customer service reputation.
For most residents, EmblemHealth is the better option, but healthfirst can also be a smart money-saving choice for the right situation. Review your options on the NY marketplace carefully before enrolling to find the ideal medical insurance fit.