1. CDPHP Home
  2. Shopping for Health Care Coverage

Shopping for Health Care Coverage

A Health Plan for Your Life

In addition to quality benefits and award-winning customer service, CDPHP members receive free preventive care, nutrition services, gym access, and personalized resources to help you meet your health goals. That’s the CDPHP Difference.

Estimating Health Care Costs

Health care costs can vary depending on a number of factors.

High deductible plans: If you select a high deductible plan, your monthly payment (also known as a premium) will be lower, but you will need to pay out-of-pocket for services until you meet your deductible. Once you meet the deductible, CDPHP will begin paying for the services and you will only pay a copay/coinsurance.

Copayment plans: If your plan does not have a deductible, your premium might be higher, but you will only pay a copay for covered services.

Use the FAIR Health calculator to see what health care providers in your area charge for common procedures. All CDPHP members also have access to CDPHP Price Check™. Price Check offers members a new level of cost transparency by allowing you to search for estimated costs on a variety of health care services BEFORE they’re scheduled. CDPHP members can log in to their online member account or the My CDPHP app to begin running treatment cost estimates in Price Check today!

In-Network versus Out-of-Network

When shopping for health care coverage, note the difference between in-network and out-of-network cost-sharing levels. By seeing an in-network doctor, you pay significantly less than if you see an out-of-network doctor.

Like other health plans, CDPHP has an “allowed amount” or maximum that we will pay for covered health care services delivered by a non-network provider. If a non-participating provider charges more than the allowed amount, you may have to pay the difference between the allowed amount and the provider’s charge, in addition to any cost-sharing requirements.

You should also be familiar with surprise bills and how they work.

Save on Health Care Expenses with a Health Savings Account (HSA)

You may be eligible to enroll in a health savings account (HSA) offered by HealthEquity®. If your silver or bronze individual plan qualifies, simply fill out the Individual Enrollment/Application form* and check the HealthEquity HSA enrollment box.

*Please note, you will only need to fill in your name and address in section C – Subscriber Info, and sign the form at the end. HealthEquity will contact you with your Custodial Agreement separately.

Questions?

Visit one of our local CDPHP Customer Connect service locations or call 1-800-777-2273 Monday through Friday from 8 a.m. to 8 p.m.

2025 Insurance Options for Individuals and Families

What Will The Plan Cost?

Monthly premium rates vary by region, based on the county in which you live: Albany Region Rates, Mid-Hudson Region Rates, Syracuse Region Rates, Utica Region Rates

What Will Be Covered?

Below are the Summaries of Benefits and Coverage (SBCs) for the Individual plans offered by CDPHP. The Glossary of Terms will help you understand some of the language used in the SBCs.

Platinum Plans

Your out-of-pocket share of overall costs for covered services is approximately 10%. No cost-sharing applies to preventive care services.*

Gold Plans

Your out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Silver Plans

Your out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible for most Silver plans, except HDHMO Qualified 33 . No cost-sharing applies to preventive care services.*

Bronze Plans

Your out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

Cost-Share Reduction Plans

Within the Cost-Share Reduction (CSR) category, purchasers must meet certain income requirements, with premium subsidies based on their income level. Out-of-pocket costs are less for those with lower incomes.

Catastrophic Plans

The Catastrophic Plan is available only to purchasers younger than 30 who meet a certain income requirement. It will provide basic preventive care services* and three other primary care doctor visits per year not subject to the deductible. Once the deductible is met, the member has no cost-share for covered benefits for the rest of the year.

 

* Preventive services available at no cost-share.

2024 Insurance Options for Individuals and Families

What Will The Plan Cost?

Monthly premium rates vary by region, based on the county in which you live: Albany Region Rates, Mid-Hudson Region Rates, Syracuse Region Rates, Utica Region Rates

What Will Be Covered?

Below are the Summaries of Benefits and Coverage (SBCs) for the Individual plans offered by CDPHP. The Glossary of Terms will help you understand some of the language used in the SBCs.

Platinum Plans

Your out-of-pocket share of overall costs for covered services is approximately 10%. No cost-sharing applies to preventive care services.*

Gold Plans

Your out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

Silver Plans

Your out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible for most Silver plans, except HDHMO Qualified 33 . No cost-sharing applies to preventive care services.*

Bronze Plans

Your out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

Cost-Share Reduction Plans

Within the Cost-Share Reduction (CSR) category, purchasers must meet certain income requirements, with premium subsidies based on their income level. Out-of-pocket costs are less for those with lower incomes.

Catastrophic Plans

The Catastrophic Plan is available only to purchasers younger than 30 who meet a certain income requirement. It will provide basic preventive care services* and three other primary care doctor visits per year not subject to the deductible. Once the deductible is met, the member has no cost-share for covered benefits for the rest of the year.

 

* Preventive services available at no cost-share.

Small Business Coverage 2025

Small business owners: Review the Summaries of Benefits and Coverage (SBCs) for the Small Group plans offered by CDPHP.

Platinum Plan

Gold Plans

The member’s out-of-pocket share of overall costs is 10%. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

 

Silver Plans

Bronze Plans

The member’s out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible, although the Rx benefit may have its own deductible. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

 

Small Business Coverage 2024

Small business owners: Review the Summaries of Benefits and Coverage (SBCs) for the Small Group plans offered by CDPHP.

Platinum Plan

Gold Plans

The member’s out-of-pocket share of overall costs is 10%. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 20%. Prescription drugs will not apply toward the overall medical deductible. No cost-sharing applies to preventive care services.*

 

Silver Plans

Bronze Plans

The member’s out-of-pocket share for covered services is approximately 30%. Prescription drugs will not apply toward the overall medical deductible, although the Rx benefit may have its own deductible. No cost-sharing applies to preventive care services.*

The member’s out-of-pocket share for covered services is approximately 40%. Prescription drug costs apply to the deductible.  No cost-sharing applies to preventive care services.*

 

Related Links

Find-A-Doc

Find a doctor, specialist, pharmacy, urgent care center, or other care facilities.

Search Now
Fair Health

© 2024 CDPHP. All Rights Reserved | Capital District Physicians' Health Plan, Inc. | 6 Wellness Way | Latham, NY 12110