Oscar Health Insurance is not available in every state or county. However, it’s certainly worth considering if you happen to reside in a location where it is. That’s because this insurance has some of the best offerings in terms of customer service and benefits. While it is a little expensive, it might be right for you or your company if you prioritize quality.
What Is Oscar Health Insurance?
Oscar Health Insurance is a startup insurance company that offers health insurance to both individuals and organizations. It was founded in 2012 with a focus on technological platforms and excellent customer service. In Oscar’s words, the company aims to “behave like a doctor in the family,” providing affordable, accessible, and quality healthcare.
Oscar Health Insurance accomplishes this through a member-first system for individual clients. It started by providing round-the-clock access to virtual care services in its initial launch. Eventually, the insurance enhanced member experiences by providing Care Teams for each Oscar member.
Over the years, Oscar also expanded and created a Small Group and a Medicare Advantage business line. More recently, in 2020, Oscar Health Insurance unveiled its Virtual Primary Care Service and its plans to expand geographically.
As a result of these initiatives, Oscar grew and became one of the largest member-based national insurers for individuals. By 2021, Oscar Health Insurance had already been providing healthcare plans across 291 counties and 18 states. With this overwhelming growth, this health insurance company aims to branch out further into different insurance markets and locations.
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What Does Oscar Health Insurance Offer?
One of the key differentiators that set Oscar Health Insurance apart is its emphasis on technology. Unlike traditional insurers, Oscar Health Insurance provides you with easy access to medical professionals.
For example, it offers 24/7 consultations, doctor visits, and a specialized team of healthcare professionals dubbed “Care Team.” Of course, Oscar Health Insurance provides much more than just these. Here’s everything you can expect by choosing Oscar Health Insurance.
Care Team
With Care Teams, Oscar Health Insurance intends to provide personalized healthcare services for individuals. Each team is comprised of care guides and a nurse. Oscar Health Insurance assigns these Care Teams to different policyholders to answer personalized medical questions. Moreover, each team assists policyholders in finding the highest quality (but most affordable) healthcare around their area.
As a result, you don’t have to depend on generalized Google searches to find answers. If you’re worried about your health, you can just ask the Care Team. The team will provide doctor recommendations best tailored for your needs. Furthermore, the Care Teams help you prepare in case of an upcoming appointment or procedure.
The Care Teams also answer policy-related questions. They can explain and demystify your health plan, coverage, and claims. You can even learn how to take advantage of your plans by discussing every detail including bills, claims denials, etc.
Virtual Urgent Care
Like we previously mentioned, Oscar Health Insurance provides round-the-clock consultations. This means you don’t need to wait for a doctor’s appointment just to ask for medical advice. Instead, as a member, you can message doctors anytime, even during early morning hours.
Of course, Oscar Health Insurance only provides these consultations virtually. However, they can be very handy in case of emergencies or urgent needs. Members can also very easily get a diagnosis or prescription through these virtual consultations. They don’t take a long time, so you can get what you need within just 15 minutes. Best of all, Oscar Health Insurance provides these consultations at no extra cost.
Exclusive Provider Organization
Similar to other insurers, Oscar Health Insurance is part of an Exclusive Provider Organization (EPO) network. Hence, you can access free coverage from any provider in the network. However, this also means that you would pay extra or full price for services outside the EPO.
Oscar App
One of the best features that Oscar Health Insurance has to offer is the provision of a digital app. This makes all its services easily accessible on the go. You can talk to a doctor for virtual care, request refill prescriptions, and message the Concierge team for questions.
If you have questions, you can also use the app to message your designated Care Team. They can find doctors, make appointments, and elaborate on your bills and how your plan works. Moreover, you can easily review your plan information through the app. You can find lab results, details, prescriptions, your digital ID, recent activity, and more.
The Oscar Health Insurance app also provides an easy way to find what you need related to your policy. If you’re already a member, you can easily look up conditions, specialties, service locations, and more. It even includes Oscar Health Insurance’s EPO network options to find the most convenient healthcare services in your area.
In addition, you can also track your steps with the app to earn money. If you meet your daily step count, you’ll earn $1 toward an Amazon gift card. Furthermore, the app can also automatically sync to Apple Health or Google Health if you already use a separate tracker.
Oscar Health Insurance Plans
The abundant benefits and services Oscar Health Insurance provides are certainly unique and useful. However, that doesn’t matter if their plans and policies aren’t a good fit. Hence, it’s important to review their coverages and rates.
Medicare Advantage
Oscar’s Medicare Advantage provides affordable and convenient healthcare to eligible individuals, much like Oscar’s regular plans. This plan takes care of you with low-cost premiums and deductibles, even going as low as $0. In fact, Medicare Advantage lets you pay $0 for primary care visits, copays, vision, hearing, and dental benefits. Also, these come with additional yearly benefits for over-the-counter products.
Medicare Advantage also offers prescription coverage depending on your plan. With it, you don’t have to spend money on 2,300 different tier 1 and tier 2 generic drugs. It also provides for prescription refills with just a quick phone call.
In addition, you gain access to a dedicated Care Team for personalized healthcare services like Oscar’s other plans.
Simple Health Policies
Oscar Health Insurance isn’t exactly the best health insurance provider if you’re looking for affordable rates. However, because it provides many member benefits, the rates are more than justified. Of course, that doesn’t mean you have to pay an arm and a leg just to purchase Oscar’s plans. It does offer some relatively affordable plans in the form of its Simple Health Policies.
The way Oscar’s Simple Health Policies work is simple. Once you’ve reached the deductible amount and out-of-pocket limit, Oscar Health Insurance should cover the rest of your costs. It has four different tiers and different monthly costs and deductibles below:
| Tier | Monthly Cost
(for 30-Year-Olds) |
Deductible | Out-of-Pocket Limits |
|---|---|---|---|
| Secure* | $162.09 | $7,900 | $7,900 |
| Bronze | $459.55 | $7,900 | $7,900 |
| Silver | $647.57 | $7,350 | $7,350 |
| Gold | $797.20 | $5,000 | $5,000 |
NOTEThis table is a sample of plans in New York City, New York.
*The Simple Secure tier is only available for applicants under 30 or those with a hardship exemption.
The Simple Health Policies are affordable plans that are ideal for healthier individuals. They’re designed for people who don’t need too many medical services. If you want Oscar’s benefits but can’t afford high premiums, then Simple Health Policies are the way to go.
Saver Health Policies
While the Saver Health Policies aren’t Oscar Health Insurance’s most affordable plans, they do have significantly lower out-of-pocket maximums. Furthermore, they don’t have the same deductible and out-of-pocket maximum amounts, unlike the Simple Health Policies.
This time, Saver Health Policies offer lower deductible amounts than the out-of-pocket limits. Hence, you should divide medical fees with it once you reach the specified amount for your tier. Moreover, if you meet the out-of-pocket maximum, Oscar Health Insurance should cover all the rest of the health costs.
Of course, this is a big deal because the Saver Health Policies have significantly lower deductibles and out-of-pocket maximums. However, it does have a trade-off because the monthly premiums are higher.
| Tier | Monthly Cost
(for 30-Year-Olds) |
Deductible | Out-of-Pocket Limits |
|---|---|---|---|
| Bronze | $451.70 | $6,650 | $6,650 |
| Silver | $590.44 | $2,500 | $5,500 |
| Gold | $744.49 | $1,500 | $4,500 |
NOTEThis table is a sample of plans in New York City, New York.
As you can see, Oscar’s Saver Health Policies also come in multiple tiers. The higher the tier, the more expensive the monthly premium and the lower the deductibles and out-of-pocket limits. If you’re a Silver or Gold Saver policyholder, you’re eligible for 30% and 20% coinsurance after meeting the deductible amount.
Overall, the Saver Health Policies provide a good middle ground between the Simple and Classic Health Policies. Of course, if you want the best of the best, the Classic Health Policies would be your best option. However, if you’re running low on funds, the Saver plans provide a good compromise between cost and coverage.
Classic Health Policies
Lastly, the highest-end policies Oscar offers are the Classic Health Policies. These also come in multiple tiers, the highest being Platinum with $0 in deductibles. It’s the best of the best but also has the most expensive monthly premium.
In addition, the Silver, Gold, and Platinum tiers provide co-pays for certain drugs before reaching the deductible amount. Hence, Oscar’s classic tiers are worth considering if you expect to spend a lot on drugs monthly.
Overall, Classic Health policyholders should reach the deductible amount much quicker. They should also quickly reach the out-of-pocket limits so Oscar should fully cover their bills much sooner. On the other hand, the trade-off here is that Oscar’s Classic policies have very expensive monthly premiums. Hence, they’re only suitable for people with higher health risks and who expect more long-term medical expenses.
| Tier | Monthly Cost
(for 30-Year-Olds) |
Deductible | Out-of-Pocket Limits |
|---|---|---|---|
| Bronze | $478.58 | $4,000 | $7,600 |
| Silver | $650.31 | $1,700 | $7,500 |
| Gold | $816.91 | $600 | $4,000 |
| Platinum | $1,019.39 | $0 | $2,000 |
NOTEThis table is a sample of plans in New York City, New York.
Business Health Insurance
Some of Oscar’s reviews focus on individual plans. However, Oscar isn’t limited to individuals and also provides plans for organizations. It offers fully customizable insurance plans for small businesses depending on the number of employees. However, these plans are only available in selected locations, namely New York, New Jersey, Los Angeles, Orange County, and Nashville.
Like Oscar’s individual insurance plans, employers can also manage their business’ health benefits online. They can easily pay their dues and add or edit staff members through Oscar’s online tool. As a result, Oscar Health Insurance becomes a very convenient option for businesses located in Oscar’s covered areas.
Oscar Health Insurance’s Availability
Unfortunately, while the insurance provides many benefits, one of its main weaknesses is that it has limited availability. That’s because it only provides health plans to a limited number of states and counties across the USA.
Check out Oscar’s list of covered areas to see if it’s available in your location:
| State | Available Areas |
|---|---|
| Arizona | Phoenix |
| California | Los Angeles |
| Orange County | |
| San Francisco | |
| Florida | Orlando |
| New Jersey | Statewide |
| New York | Statewide |
| Ohio | Cleveland |
| Columbus | |
| Texas | Austin |
| El Paso | |
| San Antonio | |
| Tennessee | Memphis |
| Nashville |
The Verdict: Is Oscar Health Insurance Right for You?
Oscar Health Insurance offers some of the best coverage plans with excellent service and member benefits. In addition, it has a tech-focused approach and uses an app to help policyholders access their services. Whether it’s managing policies, asking questions, or availing of Oscar’s services, policyholders can conveniently do so with their app.
However, the downside is that Oscar’s health plans are very expensive — even more than its competitors offering similar coverage. Moreover, it has limited availability throughout North America. Nonetheless, if you qualify geographically and financially, Oscar Health Insurance is a top-notch choice.
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