1 Minute Review
Here’s a quick Oscar Health Insurance Review: Oscar Health offers Exclusive Provider Organization (EPO) plans. EPOs are similar to Preferred Provider Organization plans, however, if you visit a specialist, doctor, lab, or hospital that’s not in its network, you’ll have to pay 100% of the costs unless it’s an emergency.
Oscar Health’s Medicare Advantage plans are Health Maintenance Organization (HMO) plans. HMO plans provide health care for a fixed annual fee, with services available within specific regional networks. This chart shows an overview of Oscar’s pros and cons:
- Nationally ranked facilities and specialists
- Free preventive care including annual physicals and most vaccines
- Request prescriptions by phone
- Earn financial rewards for walking goals
- No referrals needed for any plan
- 24/7 doctor on call online visits available
- Concierge program to provide personalized service
- Only serves 9 states
- High deductibles
- No dental or vision coverage
- No Medicaid plans
When you’re looking for affordable health insurance, it’s nice to know you have lots of options. Years ago with just a few companies to choose from, now many are competing to be your health insurance provider. One newcomer generating positive reviews is Oscar Health. Founded in 2012, its membership is 250,000 and growing. We’ve gathered key facts and information about Oscar Health to help you decide if it’s the right plan for you.
Who’s Oscar Health Insurance For?
Oscar Health offers EPO plans and Health Savings Account plans and Medicare Advantage plans for:
- Individuals and family members
- Group members (employer-covered plans)
- Members 65 and above or under 65 and disabled according to the Social Security Administration
Oscar Health offers coverage to most people looking for health care plans except low-income individuals seeking Medicaid. Currently, Oscar’s plans are available in Arizona, California, Florida, Michigan, New Jersey, New York, Ohio, Tennessee and Texas.
Oscar Health Insurance Products
Oscar Health offers 3 types of EPO plans for individuals and families: Classic, Simple and Saver.
- Classic: Higher in cost with lower deductibles and lower copays for prescriptions
- Simple: Affordable copays for routine care and 100% coverage of care after you meet your maximum; copays for brand name drugs
- Saver: You pay full price; once you’ve met your deductible, you split coinsurance costs 50-50 with Oscar. Once you’ve hit your out-of-pocket maximum, in-network services are covered in full.
Classic and Simple plans are offered in bronze, silver, and gold, with gold featuring the highest monthly premiums. When you visit its site and provide a few answers about your age, location, income and other details, you’ll see different plans and levels of coverage available. Here’s a snapshot of plan costs for a 54-year-old living in Michigan earning $60,000 with 3 children:
|Classic||$69 per month||$580 per month||$1,203 per month|
|Simple||$35 per month||$823 per month||N/A|
|Saver||$134 per month||$536 per month||N/A|
All of the above plans feature these benefits:
- Doctor on call: 24/7 online visits available
- Step tracking rewards: Up to $100 per year based on steps recorded
- Oscar concierge: A dedicated team of care specialists and a registered nurse
- Preventive care: Services, tests, and consultations offered to prevent illnesses and keep you healthy
- Full network access: Negotiated prices to hospitals, doctors and specialists who accept Oscar Health
- No referrals necessary: With in-network providers
- Prescriptions by phone: Refill ordering by phone without a doctor’s visit
Deductibles and out-of-pocket maximum amounts vary from plan to plan.
Available Discounts and Tips on Getting the Best Rates
Oscar Health plans offer richer services but those come at a higher cost. If you sign up for its Classic Bronze plan your monthly premium will be $69, but your annual deductible will be $4,500. That’s the amount you’ll have to pay out-of-pocket for covered services before Oscar starts paying a percentage of the bills.
If you choose its Classic Gold plan your monthly premium will be $1,203 and your annual deductible at $1,500. Individuals and family members can save money by enrolling in family plans. Dependents under 26 are eligible for insurance on the family plan even if they’re living away from home.
Here are a few tips for saving money if you choose an Oscar Health plan:
Take advantage of their online doctor visits. You can talk to an Oscar doctor on the phone or via video chat about illnesses like sinus infections, pink eye, bronchitis, allergies, urinary tract infections and more. You can save money and time using this service.
Schedule preventive care appointments. You’re eligible for a free annual physical, free flu shot during flu season, and free well-woman exam with an OB-GYN.
Use in-network labs. If you use one of Oscar Health’s in-network labs for blood work, you won’t be billed.
Choose a higher deductible plan. Plans with higher deductibles have lower monthly premiums. Although you may pay more for some care during the year, you’ll save more in the long run by paying lower monthly premiums.
See if you qualify for help. You may be eligible for government assistance with your health insurance bill depending on your income. If you think you qualify, sign up through healthcare.gov. Open Enrollment runs from November 1st through December 15.
Oscar Health Insurance Coverage Selections
Currently, Oscar Health only offers insurance plans to individuals and families, employers offering group plans, and Medicare Advantage members. Individuals can apply for plans covering themselves, as well as spouses and children under 26. Group plans are offered by employers and may require copays and deductibles depending on the plan. Medicare Advantage plans are available to those 65 and older or under 65 if you’re classified as disabled by the Social Security Administration.
Oscar Health plans received a rating of 8.3 out of 10 from bestcompany.com, an independent and impartial site that reviews companies from 215 categories.
Companies are rated on their performance of these:
- Value for your money
- Quality of product or service
- Customer service
- Company trustworthiness
Bestcompany.com noted several positive aspects of Oscar Health plans including excellent customer support, fast registration process, a wide range of doctors and hospitals in service areas and convenient telemedicine visits. A few negative plan features noted were limited plan availability, no dental or vision insurance (most competitors do offer these) and limited plan types, especially for low-income applicants.
You can read over 450 user reviews of Oscar Health on its site, a good way to gain valuable insight into the company’s plans. Oscar Health is relatively new to the health insurance market and the company hasn’t been reviewed by research groups such as J.D. Power and the Kaiser Family Foundation. If you’re interested in learning more about its plans, visit bestcompany.com, read reviews on Oscar Health’s site and read informational blogs on Benzinga.com.
Signing Up for Health Insurance
You can sign up for an Oscar Health insurance plan or any other plan on healthcare.gov. You can also sign up on Oscar Health’s website and call its customer service number to learn more. Licensed sales agents are available to answer your questions.
If you’re enrolling in Medicare, you can visit Medicare.gov to compare plans. Medicare.gov has lots of resources including information on how to get health insurance, claims and appeals, financial help, coverage info, forms you may need and other resources. It’s a one-stop-shop for all things Medicare. In most cases, you won’t have to leave your home to sign up — you can enroll online or by phone.
Pricing and Value
When you’re looking for the best health insurance plan for you and your family, pricing is important, but so is value. A health plan that is affordable but not flexible isn’t worth your money. Before you enroll in a new health insurance plan or switch plans, consider the following:
- Is my doctor on the insurer’s list of providers? If not, you’ll have to research doctors and choose a new one.
- What medications and services will I receive? If you take several prescription drugs, you’ll want to make sure the new plan covers them with little or no copay. If they’re not covered, you could pay hundreds of dollars more per year.
- How much out-of-pocket expenses will I have to pay? Read the fine print to find out what your annual out-of-pocket max amount and deductible will be. A low premium may be too good to be true if you have to pay thousands before your insurer will cover costs.
If Oscar Health plans pique your interest, make a list of these questions and see how its plan measures up to your needs.
Shopping for a new health plan is just as important as looking for a new home or car. You wouldn’t make a major purchase without considering the pros and cons, your needs, pricing and overall value. Although Oscar Health plans have garnered positive reviews, there are hundreds of other insurance plans on the market, all competing for your business. Talk to family members and friends about their plans and narrow your list down to a few top contenders.
Choosing a new health insurance plan will impact your health and well-being for years to come, so take extra time to decide.