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What Is Oscar Health Insurance?
Oscar Health Insurance is a technology-driven health insurance company with headquarters in New York City. Oscar differentiates itself from the competition with simple plans that include free doctor visits, preventive care and generic drug prescriptions. Its customers can also talk to a doctor for free at any time.
Its goal is to “humanize healthcare” and improve the customer experience.1 Based on membership, the company is now the third-largest for-profit national insurer for individual and family policies in the U.S.2 Most Oscar plans are exclusive provider organizations (EPOs), meaning they only cover out-of-network care in the case of an emergency.
Basics on Oscar
Oscar Health Insurance was founded in 2012 by Mario Schlosser, Josh Kushner, and Kevin Nazemi in the era of the Affordable Care Act, or Obamacare. The ACA-compliant company prides itself on its technology, design and data.
The founders say they started Oscar to create the type of health insurance they want for themselves, offering personal, high-quality, affordable health care. Schlosser, the company’s CEO, has a degree in computer science and an MBA, and previously cofounded the largest social gaming company in Latin America. Fast Company has recognized Oscar Health Insurance as an innovative company in the health arena.
Oscar analyzes the data it collects from patient visits to find ways for customers to save money. With analytics, the company claims it is able to better direct patients toward in-network doctors who are best suited for their specific needs.
The company has around 529,000 members3 and operates in 291 counties across 18 states, including:
- Arizona
- California
- Colorado
- Florida
- Georgia
- Iowa
- Kansas
- Michigan
- Missouri
- New Jersey
- New York
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- Tennessee
- Texas
- Virginia
Where to Find Oscar
The company currently provides plans in 291 counties in 18 states.
What Health Insurance Does Oscar Offer?
Oscar Health Insurance started by offering plans for individuals and families and then expanded to group health insurance in 2017 and Medicare Advantage plans in 2020. Customers can find high-deductible plans that include health savings accounts (HSAs), but Oscar health plans for adults do not offer dental or vision coverage, unless it’s a Medicare Advantage plan.4 Pediatric plans, however, do include vision screenings and dental services.5 There are no copays or coinsurance with any Oscar plans.
The company aims to help customers choose the best plan for their individual needs by providing tiers for “frequent,” “occasional” or “infrequent” medical needs. Plans cover the ACA’s 10 essential benefits, including preventive care, surgeries and hospitalizations, mental health, physical therapy, prescriptions, emergency services and lab work, among other services.
Here are examples of plan costs in Houston, TX:
Individual plan:
- Annual out-of-pocket maximum: $5,550 to $8,550
- Deductible: $0 to $7,300
- Monthly Premium: $350.86 to $513.95.
Family of four:
- Annual out-of-pocket maximum: $5,000 to $8,550
- Deductible: $0 to $7,300
- Monthly premium: $1,125.92 to $1,649.18.6
Oscar’s group plans include Cigna + Oscar plans — which feature no-cost, 24/7 urgent care, $3 prescriptions3, and Care Teams, including a nurse. The Care Team helps members understand benefits, find the best local providers who accept Oscar insurance, and coordinate care. (Oscar teamed up with Cigna to provide access to Cigna’s extensive provider network.) The company also offers Oscar for Business plans, where every member also gets their own Care Team, and in most cases, no referrals are required to see a specialist.
The Oscar Medicare Advantage plan has premiums and deductibles as low as $0, $0 primary care visit copays, and $0 dental, vision and hearing benefits. It also includes membership in Silver & Fit fitness facilities nationwide and home fitness kits, which include a FitBit.
EPO Only
Oscar Health Insurance is an exclusive provider organization (EPO), a type of managed care plan that covers services only if members use healthcare providers in the plan’s network — except in the case of an emergency.
What Are Member Benefits for Oscar Health Insurance?
Basic Oscar plans cover all doctor visits, preventive care and generic drugs free of cost. Customers pay for all other expenses, including non-generic drugs, surgeries and emergency care, until they hit their plan’s out-of-pocket maximum. At that point the plan pays for all additional costs for the year.
Through the Oscar mobile app, or by phone, customers can access free advice 24 hours a day. Patients can talk to a board-certified doctor within minutes. The company’s app also syncs with Google Fit and Apple Health. Customers are rewarded up to $100 a year after hitting their step goals and cash out with an Amazon gift card.7
Other benefits that may be available include:
Virtual urgent care. Patients can talk with a provider virtually for free for pressing but not emergency-level issues like bronchitis or pinkeye.
Virtual primary care. Available in certain markets for annual wellness visits, regular chronic care management, or preventive care management.
Care Team of Care Guides. Each Oscar member has their own “Care Team of Care Guides,” as described above.
How Do You Enroll in Coverage with Oscar Health Insurance?
Customers can enroll in coverage online on the company’s website or call 1-855-672-2788. Coverage is also available for purchase through a licensed insurance agent or during open enrollment on the health insurance marketplace.
How Do You File Claims with Oscar Health Insurance?
Customers’ doctors or care providers submit claims. Have claim questions? Call 855-672-2755 to address them.8 Most claims, according to the company, are paid in as few as five days.9
How Is Oscar Health Insurance Rated?
Since Oscar is among one of the relatively new health insurance providers, ratings on the company are sparse. A.M. Best and Standard & Poor’s have yet to rate Oscar Health Insurance, nor has Consumer Affairs. The company, however, has been rated elsewhere on customer satisfaction and on the number of patient complaints.
Oscar Ins Corp had 46 PPO complaints (42 individual and four group) in 2019, according to the National Association of Insurance Commissioners (NAIC).10
Next Steps
Oscar Health recently filed to go public and highlighted partnerships with providers like the Cleveland Clinic and Cigna as a sign of growing interest in their platform and model. The company says it will continue to grow and wants to expand into more states. Customers interested in an Oscar health insurance plan should check the provider’s website for any updates in coverage areas.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.
