Frequently Asked Questions

More information about sharing your Oscar data with a third party app is available on our Patient Access API page, which you can find here (opens in new tab).

If you have a minor and need to access their account, no problem. First, you need to be their parent or legal guardian. Then just follow these quick and easy steps to create your dependent’s new account (opens in new tab).

Create an account using a valid email address that’s not already in use by another online account.

1. Create an account using a valid email address that’s not already in use by another online account.

2. Follow the prompts including:

• Adding your communciation preferences.
• Inputting minor’s information (Last name, DOB, SSN or Oscar ID).
• Inputting your information (Last name, DOB, SSN or Oscar ID).

3. Confirm your relationship to the member. If you’re a parent you’ll receive immediate access after certifying and clicking “Continue.” If you’re a legal guardian, you’ll need to upload documents that prove legal guardianship. Once you click “Continue” you’ll see a confirmation page. We’ll review your documents and email you within five to seven business days to provide access or request additional proof.

If you need any help with creating an account for a dependent, reach out to your Care Team at (855) 672-2720 or message them through your account or the app.

It’s important that we keep your address up to date. That way we can make sure you get what you need from us.

Here’s how you change your address in your account:

• If you bought a plan through an exchange: Just contact them. You’ll find the number of all state-based exchanges on healthcare.gov (opens in new tab) or on the state's health insurance exchange website.
• If you bought a plan directly through Oscar: And you’re the primary account holder or responsible party, just send us a secure message or contact your Care Team.

You can change your language preference by logging into your account and navigating to the ‘language preference’ (opens in new tab) section in your Oscar account.

Then, just toggle based on your preference of ‘English’ or ‘Spanish.’ That’s it!

It’s easy. Just set your communication preferences in your Oscar account (opens in new tab) to choose how you’d like to hear from us.

We can reach out by email, SMS, direct mail, or phone. We’ll keep you updated on your plan’s benefits, how to save on care, and health reminders.

It’s important that we have your updated information. This helps us keep in touch with you and reach you with important mail.

Here’s how you can update your home address (or other personal information). Keep in mind, the steps are different based on whether you bought a plan through a state-based exchange or if you purchased one directly through Oscar.

• You bought a plan through a state-based exchange: To update your address and other information, contact your state-based exchange. You can get the number of all state-based exchanges on healthcare.gov or on the state's health insurance exchange website. Your exchange will let us know about address updates or other changes. It usually takes a few days, but it can vary based on your exchange.
• You bought a plan directly through Oscar: If you’re the primary account holder or responsible party, you can update your address and other information by sending us a secure message or contacting your Care Team directly. You’ll need to continue to be within Oscar’s existing service area in order to keep your coverage under an Oscar plan.

The Health Survey is a helpful tool that lets us get to know you and your healthcare needs. After you fill out the survey, we’ll send you helpful resources based on your response.

You can fill out the survey here (opens in new tab).

Click here to visit the 2021 American Rescue Plan and Special Enrollment Period (SEP) Resource Center (opens in new tab)

Have questions? We've created a resource page just for you. On this page you'll find:

• Answers to your commonly-asked questions
• Information about the recently-passed American Rescue Plan and Special Enrollment Period
• Information on how to get even more savings on your health insurance

Where can I obtain at-home COVID-19 tests?

Oscar’s Direct Coverage program leverages a national network where pharmacies in the network may adjudicate a claim for OTC COVID tests, without a prescription, and with no up-front out-of-pocket costs to the member, under the plan’s pharmacy benefit. Additionally, many of the pharmacies in the national network offer delivery or shipping direct to members’ homes, offices, or other locations. If you go to the pharmacy counter, you may be able to present your member ID and ask them to bill your insurance just like you would a medication at no cost to you.

(Note: If you’re a Cigna + Oscar or Cigna Administered by Oscar small group member, we’ll share more info soon about how you can obtain COVID-19 tests through Cigna + Oscar’s Direct Coverage program. You won’t be able to access a test through the pharmacy network shared at the link below.)

Please note that many pharmacies are still working to set up this process and may require that you pay out of pocket for now. If that happens please see below for how to get reimbursed.

You can obtain a test through our network of pharmacies. Find one near you (opens in new tab).

I paid for my at-home tests out of pocket. How do I get reimbursed?

Don’t sweat – if you purchased the tests on or after January 15, 2022, you’ll still be able to get reimbursed. Just use the OTC COVID Test Paper Claim form or follow the steps below:

(Note: If you’re a Cigna + Oscar or Cigna Administered by Oscar small group member, we’ll share more info soon about how you’ll be reimbursed. You won’t be reimbursed if you follow the process below.)

• Please visit Caremark.com (opens in new tab) and sign in or register (opens in new tab). Be sure to have your member ID available if you haven’t previously created an account with Caremark. (You can always access your member ID number through your online account here (opens in new tab))
• Select “Plan & benefits”
• Select “Submit a prescription claim” and follow the prompts listed there

What are the requirements for reimbursement?

• Your tests must be purchased on or after January 15, 2022.
• Your tests must be FDA authorized.
• You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn’t apply to Medicare Advantage plans.
• A maximum of eight (8) OTC tests will be covered per individual per 30 consecutive days (test kits that contain 2 tests per kit are counted as two tests towards the eight test limit). This quantity limit applies to OTC tests without a prescription only.
• Ideally, the receipt should only include the purchase of tests and no other items (i.e. a receipt that includes only the at-home COVID test(s) purchased and not other non-reimbursable purchases) is preferred as it will allow us to process your request more quickly. We recommend submitting using the online option noted above in the "I paid for my at-home tests out of pocket. How do I get reimbursed?" section above or using the OTC COVID Test Paper Claim form.

Reimbursement guidelines:

FDA Authorized OTC COVID self-tests will be reimbursed and include the following.

• Abbott BinaxNOW
• SD Biosensor COVID At Home Test
• Siemens’s CLINITEST Self Test
• iHealth COVID-19 Self Test
• Access Bio’s CareStart Self Test
• BD Veritor At-Home Test
• InBios SCov-2 Detect Self Test
• OraSure InteliSwab Rapid Test
• Cellitrion DiaTrust Home Test
• QuickVue At Home Test
• ACON Flowflex Home Test
• Ellume Home Test
• Detect COVID-19 Test
• Lucira Check-it COVID-19 Test
• Cue Covid-19 at home test

Circumstances in which costs could be incurred for OTC Covid-19 tests:

• A maximum amount of $12 per test will be reimbursed to members who do not obtain the test through Direct Coverage. Members must follow the post-service reimbursement process to receive this reimbursement.
• Members will only be reimbursed for up to eight tests per consecutive 30 days. Should members reach that quantity limit based on the claims adjudicated at the pharmacy, any submitted receipts for tests purchased within that same rolling 30-day period will not be reimbursed.
• For members who use the delivery/shipping service offered by pharmacies in the Direct Coverage network, members will be responsible for delivery or shipping costs, if the pharmacy requires a fee for that service.
• For post-service reimbursement (paper claims), receipts must be submitted and must have a date of 1/15/2022 or onwards to receive reimbursement. Tests purchased prior to 1/15/2022 will not be reimbursed. You may also reference the instructions above in the "I paid for my at-home tests out of pocket. How do I get reimbursed?" section to submit using the online option.

At Oscar, we prioritize the emotional wellbeing of our members. Oscar partners with Optum Behavioral Health to offer behavioral health coverage. This team can help you find a behavioral health provider that’s covered by your plan. They can also help answer any questions about your behavioral health benefits.

It’s also easy to learn more about your behavioral health benefits by going online.

To search for behavioral health doctors or facilities:

1. Log into your account (opens in new tab).

2. Navigate to the "Search all in-network" options.

3. Click on "Treatment Options."

4. Search the specialty or reason for visit.

5. Choose the provider that best meets your needs.

Or

1. Go to hioscar.com/care-options (opens in new tab).

2. Enter information to start searching for mental health providers. Mental health providers will have a banner that says "This provider is in network for mental health services only" with the provider's information including phone number and office address.

Or

1. Navigate to liveandworkwell.com (opens in new tab), which is Optum’s provider directory.

2. Use the selection features to explore your provider options. You can also call the Optum phone number on the back of your Oscar ID care for support.

Oscar partners with Optum Health to provide behavioral/mental health coverage for our members. The Optum Health team can assist in finding a mental or behavioral health provider that is covered in your plan and explain your plan benefits in further detail.

You can search for doctors or facilities on your Oscar app by navigating to the "Search all in-network" options and clicking on "Treatment Options." You can search the specialty or reason for visit and choose the provider that best suits your needs. If you don't have the Oscar app, don't worry! You can also go to hioscar.com/care-options (opens in new tab) and enter some quick information to start searching for mental health providers. Mental health providers will be indicated by a banner that says "This provider is in network for mental health services only" with the provider's information including phone number and office address.

Substance Use Disorder Helpline (855-780-5955)

• This free Optum service is available to Oscar members looking for support with Substance Use Disorder (SUD). Members can speak anonymously with a recovery advocate for immediate guidance and help understanding treatment options. Because the helpline doesn’t require eligibility verification, family members can also call if they’re concerned about a loved one. During the call, Optum will outline next steps, inlcuding an assessment and individualized treatment strategy provided by a licensed clinician. When you’re ready, an advocate can guide you to an in network virtual or in-person SUD provider.

Absolutely. This isn't just an English plan with a translation toggle. Every single signature Oscar benefit — from messaging your dedicated Member Services Team to $0 Oscar Virtual Care visits — is completely in Spanish from day one.

Absolutely. There's no diagnosis required to enroll. While the $0 copays for specialists, labs, and key medications are built with COPD, diabetes, and heart conditions in mind, this plan is open to anyone who wants solid care in those departments.

Absolutely. There's no diagnosis required to enroll. While the $0 perks for oxygen, lung specialists, and inhalers are designed to help folks managing asthma or COPD, anyone looking for solid, reliable respiratory coverage can sign up.

Most likely, yes. We partner with two of the biggest, most widely accepted nationwide networks in the country. Want to be 100% sure before you enroll? Look up adult dental providers here, adult vision providers here, and pediatric vision providers here.

We get it — losing a doctor you trust is a dealbreaker. That’s why RetireEase gives you full access to Oscar’s expansive network of premium doctors, hospitals, and specialists. Want to be 100% sure before you enroll? Look up your providers here. It takes less than 60 seconds to lock in your peace of mind.

Most likely, yes! We know how important it is to keep a doctor who already knows you well. That’s why Oscar’s network includes top-rated doctors and medical groups nationwide. Want to be 100% sure before you enroll? Look up your providers here.

Most likely, yes! We know how important it is to keep a doctor who already knows your history. That’s why Oscar’s network includes top-rated endocrinologists and medical groups nationwide. Want to be 100% sure before you enroll? Look up your providers here.

Most likely, yes! We know how important it is to keep a doctor who already knows your history. That’s why Oscar’s network includes top-rated lung doctors and medical groups nationwide. Want to be 100% sure before you enroll? Look up your providers here.

Most likely, yes! We know how important it is to keep a doctor who already knows your history. That’s why Oscar’s network includes top-rated doctors and medical groups nationwide. Want to be 100% sure before you enroll? Look up your providers here.

Your RetireEase plan features fixed, predictable copays, meaning your costs won't suddenly spike just because you moved money around to fund your retirement. While large retirement accounts or income shifts can affect tax subsidies that could lower your monthly premium, your eligibility for the plan itself is entirely secure.

Absolutely. Your family gets Oscar’s comprehensive coverage with day-one perks like $0 virtual care. Then, if you or anyone else in the house needs extra help with asthma or COPD, those specific people get the bonus respiratory perks tacked on. It’s the best of both worlds.

Yes! Breathe Easy includes the same comprehensive, full-body coverage you'd expect from an Oscar plan, plus extra benefits designed specifically for navigating asthma and COPD. The difference? You don’t have to trade regular health insurance for respiratory support. You get both.

Yes! Chronic Care CKM includes the same comprehensive, full-body coverage you'd expect from an Oscar plan, plus extra benefits designed specifically for navigating COPD, diabetes, and heart conditions. The difference? You don’t have to trade regular health insurance for specialized support. You get both.

Absolutely. Your family gets Oscar’s comprehensive coverage with day-one perks like $0 virtual care. Then, if you or anyone else in the house needs extra help with COPD, diabetes, or a heart condition, those specific people get the bonus perks tacked on. It’s the best of both worlds.

Absolutely. Your family gets Oscar’s comprehensive coverage with day-one perks like $0 virtual care. Then, if you or anyone else in the house needs extra help with diabetes, those specific people get the bonus perks tacked on. It’s the best of both worlds.

Yes! Diabetes Care includes the same comprehensive, full-body coverage you'd expect from an Oscar plan, plus extra benefits designed specifically for navigating type I or II diabetes. The difference? You don’t have to trade regular health insurance for that specialized support. You get both.

Yes! HelloMeno includes the same comprehensive coverage you'd expect from an Oscar plan, plus extra benefits designed for navigating perimenopause and menopause. And here’s what’s cool: You're not trading regular health insurance for menopause support. You're getting both.

Your plan includes vision coverage for the entire household, including built-in pediatric vision benefits for routine eye exams, lenses, and frames. Just note that pediatric dental benefits are not covered under this plan.

For virtual outpatient therapy, click on one of the links below to browse, self-refer, and schedule directly. Just make sure to let them know you’re with “Optum through Oscar.”

• Doctor on Demand (opens in new tab)
• Hello Alma (opens in new tab)
• Headway (opens in new tab)

If you’re enrolled in the Diabetes Care Plan (opens in new tab), Chronic Care Plan (opens in new tab), or Buena Salud (opens in new tab), you can earn $50 for healthy groceries (good at over 62,000 retailers) by completing an annual wellness exam.

See the Perks Page (opens in new tab) in your Oscar account for more information.

Select $0 generics are available at Hy-Vee Health Exemplar Care clinics only. So, for example, if a doctor sends your RX to a Hy-Vee Pharmacy, it will not cost $0.

If you’re enrolled in the Breathe Easy Plan (opens in new tab) or Chronic Care Plan (opens in new tab), and complete your flu and pneumonia vaccines in the same calendar year, you will earn a $25 reward.

See your PCP (opens in new tab) or visit an in-network pharmacy (opens in new tab) to get your vaccines.

If you’re an eligible member, we’ll send you more information on how to enroll. Make sure to check your email or your secure messages in your Oscar account for a WellDia signup link, and simply follow the instructions to enroll. (See terms and conditions below.)

If you have questions, learn more here (opens in new tab) or call (855) 672-2755 to speak with a Care Guide.

The Oscar Diabetes Management Program (WellDia) is available to actively-enrolled IFP Oscar members with Type 1 or 2 diabetes living in: AZ, FL, GA, IA, IL, KS, MI, MO, NC, NE, NY, OH, OK, PA, TX, or VA. Members must have or create an Oscar account, agree to the terms of the program, and actively enroll to participate. For members under the age of 18, a parent or guardian, must call Oscar at (855) 672-2755 to enroll them in the program. Members can become ineligible for the program should they no longer have a diabetes diagnosis, or change to an ineligible plan. A prescription is required by a licensed provider to receive diabetes test supplies included as a benefit of this program.

We make it simple. Our provider search tool specifically highlights local, native Spanish-speaking doctors. You can also ask your Care Team to match you with a trusted provider who understands your language and your roots.

If you’d like to know if you need a referral (opens in new tab) to see a specialist (opens in new tab), you can check your ID card. If you need to visit a PCP to get a referral you should see 'Referrals Required' displayed. If you have additional questions please contact your Care Team on your member app.

Your out-of-pocket maximum (opens in new tab) is the most you'll pay for health expenses in a plan year.

What does that mean? It means you'll cover the cost of care throughout the year until you meet your plan's deductible (opens in new tab). Once you hit your deductible, your health plan will pay for a percentage of the cost of services. (This is called coinsurance (opens in new tab).) Then, when you reach your out-of-pocket max, your insurance will cover 100% of the costs for the year.

A family deductible is twice the amount of an individual deductible. But it works a little differently than an individual deductible. Before you've met your family deductible, you'll pay for covered health care services at Oscar's negotiated rates, which are 10 to 60% lower than what you'd pay if you didn't have insurance.

Here’s an example. Let's say one person in your family is sick and needs a lot of healthcare. Don’t worry, you won’t have to pay for their care all the way up to your family deductible. Instead, when one person in your family reaches their individual deductible, your plan will start to cover some or all of that person’s care.

However, if your other family members also need care after that person reaches their individual deductible, you'll pay out of pocket until you reach your family deductible. If you meet your family deductible, then your plan starts covering more, if not all, of everyone’s healthcare.

The exact cost of Breathe Easy depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

Since this plan is tailored to your needs, your total annual costs — including premiums and medical care — are typically lower.

The exact cost of Buena Salud depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%2 of people do!).

The exact cost of Chronic Care depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

Since this plan is tailored to your health needs, your total annual costs — including premiums and medical care — are typically lower.

The exact cost of Diabetes Care depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

Since this plan is tailored to your needs, your total annual costs — including premiums and medical care — are typically lower.

The exact cost of HelloMeno depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

The exact cost of Oscar Vision & Dental depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

Since this plan is tailored to your needs, your total annual costs — including premiums and medical care — are typically lower.

The exact cost of RetireEase depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%¹ of people do!).

Since this plan is tailored to your specific needs, your total annual costs are typically lower than with standard plans.

If you’re on the Breathe Easy Plan (opens in new tab), you can earn $10 by completing a pulmonary function test (well done for staying on top of your health).

Once we receive the claim for the test, we’ll send you a gift card by email or mail. Just so you know, processing claims from your provider may take a few weeks. So, thanks for your patience.

Congrats! Yes, you can enroll today. Leaving a job and losing your employer-sponsored health insurance is what the industry calls a "qualifying life event." This opens up a 60-day special enrollment period just for you, meaning you do not have to wait for the standard fall open enrollment window. That way, there isn't a single gap in your coverage.

No. That is exactly the kind of financial guesswork we built this plan to eliminate. Your insulin out-of-pocket cost is locked in at a hard ceiling of $100 a month, maximum. No matter what.

It’s all included in one plan, and you can choose the right one for you. Many Oscar plans have Vision and Dental as part of the plan, including specialized plans like RetireEase.

That means one single monthly premium, one digital ID card, and one app login. No dealing with three different companies or tracking down random bills in your inbox.

Leaving a corporate safety net can feel daunting. But you're actually trading a rigid employer plan for a local option that works harder for your dollar. This plan outperforms traditional coverage by locking in what matters: $0 routine care, 24/7 virtual doctor visits, and seamless access to local specialists. You get the same employer-grade protection you’re used to — just tailored to your budget and backyard.

Yes, absolutely. In fact, it’s specifically designed to replicate the corporate-grade, all-in-one experience you’re used to. You get the high-end coverage and broad doctor choices you expect, packed seamlessly into a single card and app. It’s corporate-level perks, minus the corporate bureaucracy.

Absolutely. While Buena Salud automatically defaults to Spanish to ensure you never have to ask for a translation, you can toggle your language preference in your account, chat with English-speaking Care Guides on request, and visit English-speaking doctors when you prefer.

Routine dental coverage isn’t covered by Oscar, unless a provider finds a certain type of dental care medically necessary.

You have a variety of behavioral and mental health services available to you through our partner, Optum Behavioral Health. This includes talk therapy, substance abuse services, psychiatry, and autism care.

Here’s how you can start looking for support:

• Visit Optum (opens in new tab) to search for a provider. Then, just enter the access code “OHP” and change up the search options to find the care you need.
• If you need help finding a provider, call Optum’s customer support line at (877)-855-1317 or the state specific phone number on the back of your Oscar ID card.
• Substance Use Disorder Helpline (855-780-5955): This free Optum service is available to Oscar members looking for support with Substance Use Disorder (SUD). Members can speak anonymously with a recovery advocate for immediate guidance and help understanding treatment options. Because the helpline doesn’t require eligibility verification, family members can also call if they’re concerned about a loved one. During the call, Optum will outline next steps, inlcuding an assessment and individualized treatment strategy provided by a licensed clinician. When you’re ready, an advocate can guide you to an in network virtual or in-person SUD provider.

Your pre-deductible expenses are any expenses you pay before you meet your deductible. If your plan has a deductible, it means you need to pay some of your healthcare services out-of-pocket until you reach a certain amount. That amount is your deductible.

To see your pre-deductible expenses go to your Schedule of Benefits in your Oscar account (opens in new tab).

Routine vision coverage for adult members isn’t covered by Oscar, unless a provider finds a certain type of care medically necessary.

Pediatric vision care, though, is available through our Davis Vision partner. Check out the details in the Coverage & Benefits section of your Oscar account (opens in new tab).

It boils down to real-world value. Healthcare costs are skyrocketing by up to 15%2 this year, meaning most plans are charging you more just to get less. So we’re changing the game by giving you $0 care options on day one (no need to meet your deductible first) and hassle-free access to top local specialists. It’s total peace of mind for your health and a serious break for your wallet at the grocery register.

RetireEase is designed to be your permanent bridge to Medicare, not a trap. The exact month you turn 65 and your Medicare coverage kicks in, you can cancel your RetireEase plan instantly. No penalties, no hidden exit fees, and no messy paperwork.

WellDia is our diabetes management program. We’re helping Oscar plan members living with type 1 or type 2 diabetes stay on top of blood glucose testing and overall diabetes care. WellDia is here to provide diabetes support — on top of what is included in your Oscar medical plan.

It’s $0 to enroll in WellDia, and includes $0 Accu-Chek® monthly testing supplies (glucometer, lancets, and test strips) — plus helpful care reminders from our team.

You must enroll in WellDia to participate in the program. Need more info? Click here (opens in new tab).

Some plans have a prescription (also known as pharmacy) deductible. You’ll pay out-of-pocket for your medicines until you reach your deductible amount. Then your insurance plan starts to pay for all or part of the cost of your medicines. Not all insurance plans have a prescription deductible though.

Your individual or family plan medical deductible (opens in new tab), on the other hand, is the amount you must pay out-of-pocket for covered medical services before your plan starts to pay for your care. Remember, medical services are different from pharmacy services.

Your pharmacy deductible works just like a medical deductible, but it’s kept separate. You can learn more about your plan by reading your Schedule of Benefits (SOB) (opens in new tab).

To see your benefits in your account, navigate to your Benefits & Coverage (opens in new tab) page of your Oscar account. Use the search bar to explore a service or coverage topic. You can also browse through coverage topics(A-Z).

If you’d like to view your benefits on an official document, check out one of these on your Coverage page:

• Schedule of benefits (SOB)
• Summary of Coverage (SBC)
• Evidence of Coverage (EOC)

You can use your healthy groceries reward at over 62,000 retailers worldwide – we know, it’s pretty exciting!

This includes CVS pharmacy, Walmart, Family Dollar, Dollar General, Giant Eagle, Walgreens, Duane Reade, and Rite Aid, to name a few.

Visit myOTCcard.com (opens in new tab) or call the OTC Network at (833) 614-3258 to:

• Activate your card
• Check your balance
• See an item’s eligibility

To find info about your deductible, just log into your Oscar account (opens in new tab) and look under “Coverage Status” on your homepage. Here you’ll see the current status of your deductible and out-of-pocket maximum. (By the way: A deductible is the amount you must reach before your plan starts paying for all or part of the cost.)

Want to look up different service types and how they might apply to your deductible or out-of-pocket maximum? Check out the Coverage (opens in new tab) page in your Oscar account.

COBRA is usually the default recommendation because it’s easy for HR to hand you the paperwork on your way out the door. But here’s the catch: COBRA forces you to pay up to 102%2 of the premium for standard corporate insurance out of your own pocket. Translation: It can be really expensive.

RetireEase is built specifically for a retirement budget with features like fixed copays and $0 prescriptions (without the bloated, employer-sized premium).

It’s okay if you’re ready to make a change. We understand. You can cancel your Oscar Individual and Family plan at any time. You can end coverage for:

• Everyone on the application after your coverage has started. The termination of your coverage will take effect at the end of the month. Scheduling ahead can be helpful if you know your new coverage will start on the first day of the following month. Please note that retroactive termination is not possible without proof of overlapping coverage.
• Just some people on the application. In most cases, their coverage will end immediately.

Tip: Try to avoid canceling your plan until you know for sure when your new health coverage begins. Once you end your coverage, you may have to wait until the next annual Open Enrollment Period (unless you qualify for a Special Enrollment Period (opens in new tab)).

It’s easy to talk to your Care Team (opens in new tab) from your account online (opens in new tab) or in the Oscar app (opens in new tab), or call them at (855) 672-2755.

Oscar tip! Make sure you have your Oscar ID card on hand to help get quick access to your information.

Yes, there are. Here are the most common types:

• Employer coverage: Many people have health coverage that’s sponsored by their workplace.
• Medicaid: If you’re not earning a lot or if you just lost your job, you could qualify for free coverage through Medicaid (opens in new tab).
• Medicare: People over age 65 are usually covered by Medicare, which is a government-sponsored insurance.
• Individual insurance: If you don’t get insurance from your job, and you don’t qualify for Medicaid or Medicare (opens in new tab), you should take a look at individual insurance, aka Obamacare plans (ahem, like Oscar (opens in new tab)). We’ve been selling individual plans since day one. You can get one for just yourself or cover your spouse and kids, too.

Yes, these plans can help people living with asthma or COPD save money and manage the condition.

Very likely! This plan is anchored by the MercyOne health network and Hy-Vee Health Exemplar Care, which include many of the region’s top-tier primary care doctors, specialists, and hospitals. On top of that, you have access to all the doctors and specialists in Oscar’s network.

Want to be 100% sure before you enroll? Look up your providers here.

No. HelloMeno is designed for people who are navigating either perimenopause or menopause.

Perimenopause is the transition leading up to menopause. It’s when hormone levels begin to fluctuate and symptoms like hot flashes, sleep changes, brain fog, and mood shifts can start to appear. This transition can last for several years before menopause officially drops. So whether you're in perimenopause, menopause, or somewhere in between, HelloMeno is here to get you the support and care you need.

If you're still on your parent's health insurance, turning 26 is a major adulting moment. It's time to get your own plan!

Depending on where you live, you might lose your coverage in the month of your birthday or at the end of the calendar year. Your parent's insurance company will let you know your last day of coverage.

Now what? It's time to get your own health insurance plan! But don't worry – it's not actually as intimidating as it sounds. Here's what you need to do.

If you can, get insurance coverage from your job.

Talk to HR about when you can enroll and whether your coverage can start right after coverage from your parents' plan ends. This way, you'll avoid a gap where you're not covered.

If you don't have a job that offers benefits...

You have 60 days from when you lose coverage on your parents' plan to purchase your own shiny new individual health insurance policy.

Do I really need health insurance if I'm healthy?

The short answer is: hell yes. Two thirds of personal bankruptcies in the U.S. are because of medical bills, so you need health insurance to protect your financial future. You'll also have to pay a nasty tax penalty if you don't have coverage for more than three months of the year.

Signing up for individual health insurance has never been easier

• First, get a quote (opens in new tab). You'll see a range of options and how much they cost. You'll also find out if you qualify for financial assistance to make your plan more affordable. If you're not earning a lot, you might qualify for Medicaid (opens in new tab) or another low-cost program provided by your state.
• Next, pick a plan (opens in new tab). Not sure which one?
• Check out the Secure plan. It's a lower-priced plan only available to people under 30 years old. It's great if you're generally healthy and just need protection from big medical bills if you get unexpectedly sick or injured. Note: You can't apply tax credits to the Secure plan.
• If you qualify for tax credits, the Bronze plan may be your least expensive option, but don't forget to check the Silver plan to see if you qualify for a lower deductible. If you need a lot of care during the year, take a look at our plans with lower deductibles. Paying a little more up front could save you a lot in the long run.
• If you need help deciding, call one of our enrollment guides at 855-672-2788. They'll help you understand your options and choose the best plan for your needs.
• Then sign up (opens in new tab). If you don't qualify for financial assistance, you can enroll directly on our website (opens in new tab) in about five minutes. If you speak to one of our enrollment guides, they can sign you up over the phone. If you qualify for financial assistance, you'll need to enroll through the Marketplace (opens in new tab) to claim your lower premium.

Check out our buyer's guide (opens in new tab) for more details on how to sign up for insurance, or get a quote (opens in new tab) to explore your plan options.

Not at all! While the plan comes packed with exclusive rewards only Hy-Vee members are eligible for, prepaid debit cards, and $0 care at Hy-Vee Health Exemplar Care clinics, your core coverage works across the entire Oscar health network. Whether you step foot in a supermarket or not.

Yes. HelloMeno is built around menopause support, but the coverage keeps on giving. Our Silver Simple Women's Health plan also includes benefits for eligible family members (like your spouse or dependent children). So you're covered, and they're covered.

First, decide what type of plan is best for you

When it comes to health insurance, you have a few options to choose from. All individual plans have a metal tier in their name. The metal tiers (opens in new tab) (bronze, silver, gold, and platinum) can help you narrow down a plan based on cost and coverage level.

Let’s take a look at an example. If you prefer to pay more money up front but have fewer surprise healthcare costs, you may want to explore a gold- or platinum-level plan. However, if you want a less expensive premium and understand the risks of potentially paying some medical bills during the year, check out a bronze or a silver plan. Finally, if you qualify for a cost-sharing reduction (meaning you are within 250% of the Federal Poverty Level), you may see a super-low deductible in the silver tier, so watch out for that.

Make sure you can access to any doctors and drugs you need

Usually plans only cover your care if you visit a doctor or hospital in their network. It’s important to make sure your preferred providers are in a health plan’s network before you choose that plan. To find out, browse an insurer’s website or call your provider to ask.

As you shop around, remember that there are tradeoffs with bigger networks (opens in new tab). For example, they may have more providers and hospitals in-network, but usually they cost more. And, don’t forget to look up any medications you take to make sure they’re covered too. You can search the doctors, hospitals, and drugs covered by Oscar plans here (opens in new tab).

Look for plans with perks

Comparing two very similar health plans? Look for extra perks like fitness rewards and free telemedicine (opens in new tab) (Oscar plans have both). Then give the insurance company a call to see what their customer service is like. Extra benefits like these can make a big difference in your experience during the year — and if you're paying for coverage, you deserve a good experience!

Get a free personalized quote or give us a call and talk to a licensed Enrollment Guide at (855) 672-2788.

The exact cost of Hy-Vee Health with Oscar depends on where you live, your household size, and whether you qualify for financial assistance (nearly 90%1 of people do!).

LA/OC | Choice Network vs. Select Network

In 2022, we’re offering individuals and families in LA/OC even more options for new and renewing members by offering two comprehensive networks:

• Oscar Choice Network (available off exchange only)
• Oscar Select Network (available on and off exchange)

With a dual network, you can get bigger savings and lower premiums on your plans. !LA/OC Dual Network Comparison 2022

What plans can I choose from in each network?

!2022 CA Dual Network Plans

What hospitals can I choose from in each network?

The Select network is in partnership with Providence, St. Joseph Heritage and St. Jude facilities and affiliated providers. The Choice network is in partnership with Providence, UCLA, and Cedars Sinai facilities and affiliated providers.

!LA/OC Hospital List 2022 Learn more with our 2022 Network Overview in English and Spanish.

• $0 primary doctor, gynecologist, and behavioral health visits
• $0 labs (including metabolic panel, lipids, vitamin D, calcium, and parathyroid hormones which can be affected by menopause)
• $0 prescriptions including hormone replacement therapy, SSRIs (depression/anxiety), and autoimmune
• $0 bone density scan
• Access to menopause experts through Elektra Health or Atrium Health (depending on where you live) at no additional cost

Our plans reward you for treating yourself right. And, we’ll cheer you on along the way. Oscar Members are eligible for rewards upon completion of qualifying activities.

The Breathe Easy COPD Plan includes:

• $10 for completing a pulmonary function test
• $25 for getting flu and pneumonia vaccines
• $30 for switching a qualifying brand name drug from a 30-day to 90-day refill, including inhalers

You can also check our Perks page for additional rewards and incentives that may be available to you.

HelloMeno members in NC can earn:

• $15 each: cervical cancer screening (pap smear), mammogram
• $25 each: bone density (DEXA) scan, colonoscopy
• $25 for visiting an Atrium Menopause Clinic doctor or advanced practice professional
• $15 for getting nutritional counseling anywhere
• HelloMeno members in AZ, FL, GA, IA, MO, NE, OH-B (Buckeye), OH-C (Cleveland), TN, TX can earn:
• $15 each: cervical cancer screening (pap smear), mammogram
• $25 each: bone density (DEXA) scan, colonoscopy
• $15 for using Elektra virtual support services (coaching sessions, education, or virtual events)
• $25 for meeting with an Elektra doctor or advanced practice professional

Members in Oklahoma are not eligible for rewards.

Good news, it’s easy. You can buy a plan through HealthCare.gov (opens in new tab). If you visit HealthCare.gov and enter your zip code, they’ll direct you to the right place based on where you live.

You can also search through your state’s health insurance marketplace like New York State of Health (opens in new tab), Get Covered New Jersey (opens in new tab), and Covered California (opens in new tab).

The marketplace is where you can see all the plans available in your area. You can sign up for a plan through the marketplace website, or you can buy your plan directly from a health insurance company. With Oscar you can get a quote (opens in new tab) and sign up online in minutes, or talk to one of our experienced Plan Guides at (855) 672-2788.

HelloMeno is available in Arizona, Florida, Georgia, Iowa, Missouri, North Carolina, Nebraska, Ohio (Buckeye), Ohio (Cleveland), Oklahoma, Tennessee, and Texas.

Managing a chronic condition can require more frequent checkups, medication, and supplies – and all these costs can really add up. So it's important to choose a health insurance plan that will help keep your monthly costs as low as possible.

The key is estimating how much care you need and comparing the all-in cost (the monthly premium (opens in new tab) + what you pay for care) of the different plans you’re considering. Here's how to do it.

Choosing the right plan to manage a chronic condition

Say, for example, you have a chronic condition like high blood pressure. Your cardiologist wants to see you every three months, and you have three monthly prescriptions (opens in new tab). You look up your cardiologist and see she's in our network (opens in new tab). Your medications are covered by our formulary (opens in new tab) and listed as generic drugs. It looks like Oscar could be a good fit for you, but which plan has the lowest all-in cost?

Let's say the plan with the lowest premium (opens in new tab) is a Bronze plan that costs $342 a month with a $6,850 deductible (opens in new tab). You'd pay your monthly premium plus Oscar's negotiated rate (opens in new tab) for any care you get until you've spent $6,850. Given the cost of your doctor's visits, medication, and lab tests, you might decide to look at a plan that will pay for more of your care.

Next, you take a look at our Silver Simple plan. It costs a little bit more every month, but it has copays (opens in new tab) for specialist visits and generic drugs. So even before you've met your deductible, you're just paying a copay for your cardiologist visits and medication. All-in, your costs on this plan are actually lower than they would have been on the Bronze plan, even though the Silver plan has a higher premium.

As a general rule, the more you pay up front in monthly premiums, the lower your deductible, so your plan starts to cover your care sooner. If you have a chronic condition, plans with affordable copays and/or lower deductibles can help you save money in the long run.

Don't forget to check that the insurance company has your doctor in their network and covers the medication and medical supplies you need. You should also look at the preventive (opens in new tab) and wellness services offered with your health plan. These can be critical to helping you catch issues early.

Once you’ve selected your plan, make sure your plan stays active all year by paying your monthly premiums on time. One easy way to do this is to sign up for auto-pay. If you lose your coverage because you forget to pay your bill, you may not be able to sign up again until the next Open Enrollment (opens in new tab), which could be months away.

Anyone eligible for health insurance can enroll in HelloMeno. It’s designed for women experiencing (or who have experienced) natural or forced menopause. And it covers benefits for the whole family.

Plan names to join the program vary by state: Silver Simple Women's Health with Menopause Benefits and Silver Simple Women's Health with Menopause Benefits Guided Care.

Women, typically age 45+, navigating perimenopause, menopause, or post-menopause. And their families.

HelloMeno plan members in NC.

HelloMeno Plan members in AZ, FL, GA, IA, MO, NE, OH, OK, TN, and TX.

Having the right forms and information on hand can make signing up for a plan easier. Since every business is different, it’s best to talk to your broker (opens in new tab) to find out exactly which documents you need.

But, in general, your business' quarterly wage and tax statement is usually the only legal form that’s needed. (There are some exceptions, depending on group size, where we may need your ownership documentation or an employee's most recent pay stub.)

Enroll during Open Enrollment

Open Enrollment (opens in new tab) is the time of year when anyone can sign up for a health insurance plan or switch plans. In most states, it starts November 1 and finishes up December 15. You’ll also renew your plan every year during this time period. You can evaluate if you want to stay on the plan you have or make a change. During other times of the year, you can only sign up if you’ve recently lost coverage from a job or had another kind of "qualifying life event." (opens in new tab)

Where to sign up

If you're interested in Oscar, the easiest way to sign up is right here (opens in new tab). Start by getting a quote, tell us a little about your health to see which plans we recommend (don’t worry, nothing you say there will impact your price), and follow the enrollment prompts. It takes about five minutes if you don’t qualify for financial assistance and a few more (well worth it) minutes if you do. If you’re qualified for Advance Premium Tax Credits, you’ll finish the enrollment process on the government marketplace website for your state, which might be New York State of Health (opens in new tab), Covered California (opens in new tab), or HealthCare.gov (opens in new tab). You can also apply directly through these marketplaces to see all the plans from all the insurers in your area.

How to sign up

Having the right information at your fingertips during the enrollment process will help things go smoothly once you start your application. Gather the following information for yourself and any family members who are going to be on your health plan:

• Full legal name.
• Date of birth.
• Social Security number.
• Immigration information like visa or green card numbers, if applicable.
• Employment information including the amount each person in your household expects to earn in the upcoming year, employers' names, addresses, and phone numbers. A copy of your most recent tax return is a good place to find a lot of this information.

When estimating your income (opens in new tab), keep in mind that you can update your application during the year if you’re earning more or less than you originally expected. Give your best estimate at the time you apply and check in quarterly if your income is unpredictable.

After you complete your application, you’ll see a confirmation screen that confirms your effective date. This is the date your coverage begins. You don’t owe a payment when you sign up, but you’ll have to pay your first bill in order for your coverage to start on your effective date. If you don’t pay within 10 days of your effective date, your enrollment could be canceled.

You can choose dental or vision insurance separately. You can enroll directly with those insurers or add them on to your application through the marketplace. Keep in mind that you can sign up for dental and vision insurance anytime during the year.

Ready to go? It all starts with getting a free personalized quote (opens in new tab) or give us a call and talk to a licensed plan guide at 855-672-2788.

Managing a chronic condition can require more frequent checkups, medication, and supplies – and all these costs can really add up. So it's important to choose a health insurance plan that will help keep your monthly costs as low as possible. The key is estimating how much care you need and comparing the all-in cost (the monthly premium + what you pay for care) of the different plans you’re considering. Here's how to do it.

Choosing the right plan to manage a chronic condition

Say, for example, you have a chronic condition like high blood pressure. Your cardiologist wants to see you every three months, and you have three monthly prescriptions. You look up your cardiologist and see she's in our network. Your medications are covered by our formulary and listed as generic drugs. It looks like Oscar could be a good fit for you, but which plan has the lowest all-in cost?

Let's say the plan with the lowest premium is a Bronze plan that costs $342 a month with a $6,850 deductible. You'd pay your monthly premium plus Oscar's negotiated rate for any care you get until you've spent $6,850. Given the cost of your doctor's visits, medication, and lab tests, you might decide to look at a plan that will pay for more of your care.

Next, you take a look at our Silver Simple plan. It costs a little bit more every month, but it has copays for specialist visits and generic drugs. So even before you've met your deductible, you're just paying a copay for your cardiologist visits and medication. All-in, your costs on this plan are actually lower than they would have been on the Bronze plan, even though the Silver plan has a higher premium.

As a general rule, the more you pay up front in monthly premiums, the lower your deductible, so your plan starts to cover your care sooner. If you have a chronic condition, plans with affordable copays and/or lower deductibles can help you save money in the long run.

Don't forget to check that the insurance company has your doctor in their network and covers the medication and medical supplies you need. You should also look at the preventive and wellness services offered with your health plan. These can be critical to helping you catch issues early.

Once you’ve selected your plan, make sure your plan stays active all year by paying your monthly premiums on time. One easy way to do this is to sign up for auto-pay. If you lose your coverage because you forget to pay your bill, you may not be able to sign up again until the next Open Enrollment, which could be months away.

If you’re self-employed and have fewer than 50 employees working for you, you can buy individual health insurance for yourself and your family if you don't provide group health insurance (opens in new tab). As a sole-proprietor, there are a few things you'll want to keep in mind.

Choosing not to buy health insurance can cost you.

Getting health insurance for yourself and your family might seem like a big expense, especially if you’re just launching your own small business. But the costs pale in comparison to the tens of thousands of dollars you could find yourself shelling out if you’re suddenly diagnosed with an serious illness or get injured in an accident. What’s more, under Obamacare (opens in new tab), everyone in your household is legally required to have health insurance to avoid paying a tax penalty (opens in new tab).

If your business has 50 or more full-time employees (or a full-time equivalent (opens in new tab) mix of part- and full-time employees), you must offer employee health insurance or you’ll pay a penalty. Some states now offer the SHOP Marketplace (opens in new tab) for employers with up to 100 employees.

Sign up for individual coverage during Open Enrollment or when you lose coverage from your last job.

If you're losing coverage from your job to go out on your own, your loss of employer-sponsored coverage counts as a qualifying life event (opens in new tab), which gives you 60 days to buy a Marketplace plan. Otherwise, you must apply for a plan during Open Enrollment (opens in new tab).

If you need help deciding which plan is best for you and your family, here's how to pick the perfect plan.

You may qualify for subsidies to make your insurance less expensive.

When you get a quote, you'll be asked to estimate your annual household income to determine if you qualify for subsidies (opens in new tab) to help pay for coverage. We've put together some tips for estimating your income (opens in new tab). If you're just starting out, you can make your best guess at what your income will be and update your application later in the year when you get more information.

If you're married and your spouse has a job, you'll need to include that in your household income, as well as any income from kids who are old enough to work. If you're married but filing your taxes separately, you'll be disqualified for financial assistance.

More ways to save

The premiums (opens in new tab) for your individual health insurance are 100 percent tax-deductible when you’re self-employed, as long as the amount doesn’t exceed what you earned for the year and you weren’t eligible for a spouse’s job-sponsored plan. Speak to your tax advisor about whether you can deduct these health care costs from your reported gross adjusted income to pay less in taxes.

You may be able to apply for low- or no-cost health insurance through Medicaid (opens in new tab) or CHIP (opens in new tab) if your income falls below a certain level. You'll be alerted if these are an option for you when you get your quote.

Ready to explore plans? Get a personalized quote (opens in new tab), or speak to one of our enrollment guides at 1-855-672-2788.

If you qualify for subsidies (opens in new tab) to make your health insurance less expensive, it's important that the income you report on your health insurance application is as close as possible to what you report as your modified adjusted gross income (opens in new tab) on your taxes at the end of the year. If you made more than you expected, you may owe taxes, and if you didn't take enough subsidies during the year, you may get a larger refund.

When you apply for health insurance, you'll be asked to share your expected modified gross adjusted income (MAGI). This number is not only used to figure out whether you qualify for subsidies, but also whether you qualify for low- or no-cost insurance through Medicaid (opens in new tab) or CHIP (opens in new tab).

Here’s a step-by-step guide to calculating your MAGI accurately for your health care application.

1. Include everyone in your household. Be sure to count income for everyone in your household who you list on your tax return, including you, your spouse, and any dependents who have a job – whether or not they need health care coverage through the health insurance Marketplace (opens in new tab). That’s because whether you qualify for marketplace health care savings is based on the income from all members of your household, even if they get health insurance through their employers. If you're married, you must file jointly with your spouse to qualify for subsidies.
2. Gather the required documents. You’ll want to have last year’s tax returns on hand for all members of your household, if possible. You may also be asked to submit pay stubs from the past year.
3. Consider next year’s income. While you should use last year’s income as a baseline if your job situation is similar, know that you’re calculating your income for the year you'll be covered by your health insurance plan.
4. Start with your AGI. A good place to start is your adjusted gross income, or AGI, from your most recent tax return. You can find your AGI on Line 37 of Form 1040. If you don’t know your AGI, find the “federal taxable wages” on your paystub, add in any tips you received, then multiply that number by the number of paychecks you expect to take home in the following year. See below if you’re a new freelancer and don’t have an AGI or pay stubs to reference.
5. Add specific tax-exempt income. Take your AGI and add the following income, if any apply to you:

• Tax-exempt social security benefits (including tier 1 railroad retirement benefits).
• Tax-exempt foreign income.
• Tax-exempt interest.
• Retirement or pension income (IRA or 401K withdrawals).
• Unemployment compensation.
• Social Security.
• Social Security Disability Income (SSDI).

You don’t need to include:

• Supplemental Security Income (SSI).
• Worker’s compensation.
• Veteran’s disability payments.
• Proceeds from student, home, or bank loans.

1. Adjust for changes in your income for the upcoming year. If you expect anything about your financial situation in the next year to be different from last year, be sure to include it in your calculation. Consider whether in the next year you’ll likely:

• Get a raise or promotion with your current company.
• Take a job with a new company.
• Quit your job and go freelance (opens in new tab) or start a small business (opens in new tab).
• Earn new income from self-employment.
• Have other changes in your overall income, including alimony payments, financial investments, or Social Security.
• Give birth, adopt a child, or have a child who's no longer a dependent (opens in new tab).

1. Calculate your income if you’re newly self-employed. As a freelancer, it can be tough to calculate your estimated AGI – especially if you’re newly self-employed. Check out the IRS’s tax tips (opens in new tab) for the self-employed. While you should check with your personal accountant to be sure you’re accounting for the right income and expenses in the right amounts, here’s an idea of the main steps to reaching an estimated AGI if you don’t have a similar tax return from last year to reference:

• Calculate your self-employment earnings. This is the total amount you expect to earn.
• Calculate your business expenses. These should be what you’ll report on schedule C of your 1040 and generally include home office, domain and web hosting, advertising, telephone and internet, office supplies, business meals, auto expenses, legal and professional fees, and retirement contributions.
• Reach your net income. Also known as profit, this is your self-employment income minus your business expenses. If what you earn as a freelancer is less than your expenses, you report a profit on the Marketplace; if it’s less, you report a loss.

1. Adjust your application if your income changes. It’s always a good idea to update your Marketplace application after any major income changes so that you pay just the right amount towards your health insurance. If your income drops, you may be able to qualify for more assistance to avoid losing your coverage altogether. You don’t want to end up shelling out more or less than necessary, since it affects how much you’ll get back (or have to pay) when you file your taxes at the end of the year. Once you buy health insurance, you can still make changes to your application throughout the year if your income changes in ways you hadn’t expected.

Keep in mind you can only claim the subsidies you're eligible for if you enroll in a plan through HealthCare.gov (opens in new tab) or your state's Marketplace. If you're interested in Oscar plans, you can get a quote (opens in new tab) and follow the prompts to enroll through the Marketplace for your state.

Okay, we’re not gonna lie: This is the hardest part. After this, the rest is easy. Let's get started and find the best plan to cover you and your family. Here's how.

Pick your metal tier first

All individual plans have a metal tier (opens in new tab) in their name, and if you pick your tier in advance you can narrow down the options right away. Bronze and Silver plans have lower monthly premiums (opens in new tab), but they have higher deductibles (opens in new tab), so you pay more when you need care. Gold and Platinum plans cost more every month, but they have low or $0 deductibles, so the plan pays for more of your care if you get sick. Healthy people tend to choose Bronze or Silver plans to save money every month, while people who need more care during the year usually opt for Gold or Platinum plans to save money on their medical bills.

The best plan for you is the one that limits your costs and manages your risk. The right balance is totally up to you. If you prefer to pay more up front and have no surprises, go Gold or Platinum. If you’re looking for the least expensive premium and understand the risks of potentially having to pay some medical bills during the year, go Bronze or Silver. If you qualify for a cost-sharing reduction, you might see a super-low deductible in the Silver tier, so watch out for that.

After you zero in on the metal tier that’s right for you, there are a few other things to consider.

Make sure you have access to any doctors & drugs you need

Most plans only cover your care if you go to a doctor or hospital in their network (opens in new tab). Look up any of your existing doctors and browse the insurer’s website to find out which hospital systems they work with. Don’t be fooled by big networks. They’re kinda like Las Vegas buffets: expensive and way more than you need. Focus on quality and access to any doctors you feel you absolutely must keep (like a psychologist, pediatrician, or someone you’re in the middle of treatment with). Look up any medications you take to make sure they’re covered. You can search the doctors, hospitals, and drugs covered by Oscar plans here (opens in new tab).

Look for plans with perks

If the plans are similar, the prices are just a few dollars' difference, and the networks cover what you need, look for extra perks like fitness rewards and free telemedicine (opens in new tab) (Oscar plans have both). Give the insurance company a call to see what their customer service is like. Extra benefits like these can make a big difference in your experience during the year—and if you're paying for coverage, you deserve a good experience!

Get a free personalized quote (opens in new tab) or give us a call and talk to a licensed enrollment guide at 855-672-2788.

If you’re planning your retirement, you're probably more excited about taking that long vacation or the sleeping in on weekdays than you are about choosing a health insurance plan. But when you consider the potential cost of being without coverage, it’s hands-down a key item for your to-do list.

Let's start with the basics.

If you’re over 65 and have worked for at least ten years in Medicare-covered employment, you'll qualify for Medicare (opens in new tab). (You can sometimes also qualify if you’re under 65 and have end-stage renal disease or have been receiving Social Security Disability Income for 24 months.)

If you’re not yet eligible for Medicare, individual health insurance might be right for you. You’ll pay for it yourself, but you might qualify for financial assistance (opens in new tab) if you’re earning less during retirement.

First, let's estimate your income.

You can get help paying for health insurance if you qualify based on your expected household income. In general, this means taking your household’s modified adjusted gross income (MAGI (opens in new tab)) from your most recent tax return and updating it based on any big changes you’re anticipating. In your case, there’s an obvious one – you’re retiring, so you’ll want to take out the salary part. However, you’ll want to include any income you’re still getting, such as interest, capital gains, alimony, fees for consulting or project work, and IRA and 401(k) withdrawals.

Next, choose a plan.

In general, the more you pay in monthly premiums (opens in new tab), the less you’ll need to pay for care throughout the year. Premiums increase based on a plan's metal tier (opens in new tab) — Bronze, Silver, Gold, or Platinum. Bronze plans have the lowest monthly premiums, and Platinum plans have the highest. To make the best choice, review your pattern of using services and medications over the past few years. Here’s a quick rundown to help you think about which level is right for you.

• Bronze: If you want some preventive care like an annual physical, but rarely use specialists (opens in new tab), medications, emergency rooms, or hospitals, a Bronze plan can help you save money on premiums. Keep in mind that if you do need care, you'll pay for it out-of-pocket until you reach your deductible (opens in new tab). If you're not comfortable with the potential for unexpected costs, a plan with a lower deductible might be worth considering.
• Silver: If you go to the doctor and get medications several times a year, or if you’re a parent and your children get sick throughout the year, a Silver plan has a slightly lower deductible that may reduce your overall costs. If you qualify for a cost-sharing reduction (opens in new tab), you may find that the Silver plan has a reduced deductible.
• Gold or Platinum: Consider these if you expect to have routine doctor and specialist visits to monitor one or more chronic conditions (opens in new tab). In addition, if you’re planning for blood tests, other diagnostic testing (opens in new tab), and medication costs. Gold or Platinum plan options are likely to give you the most financial protection, but keep in mind that they have higher fixed monthly costs.

The best way to compare plans and find out if you qualify for financial assistance is to get a quote (opens in new tab). You can also talk to an enrollment guide at 855-672-2794. We'll tell you what's included and help you choose the best plan for you and your family.

First, let’s figure out what kind of health insurance to get

There are different kinds? Yep. Most people have coverage from their job. If you’re not earning a lot or just lost your job, you could qualify for free coverage through Medicaid (opens in new tab). People over 65 are usually covered by Medicare (opens in new tab). If you don’t get insurance from your job and you don’t qualify for Medicaid or Medicare, you should take a look at individual insurance, aka Obamacare (opens in new tab) plans (ahem, like Oscar). We’ve been selling individual plans since day one. You can get one for just yourself or cover your spouse and kids, too.

Where to buy individual health insurance

You can buy a plan through your state’s health insurance marketplace (like New York State of Health (opens in new tab) or Covered California (opens in new tab)) or through HealthCare.gov (opens in new tab), which is the federal marketplace used by 18 states. If you visit HealthCare.gov and enter your zip code, they’ll direct you to the right place based on where you live.

The marketplace is where you can see all the plans available in your area. You can sign up for a plan through the marketplace website, or you can buy your plan directly from a health insurance company. With Oscar you can get a quote (opens in new tab) and sign up online in minutes, or talk to one of our experienced plan guides at 1-855-672-2788. They can help you decide on a plan and enroll you over the phone.

How to save on health insurance

Depending on how much you make you might qualify for financial assistance in the form of tax credits (opens in new tab) to make your coverage more affordable. If you qualify, you can apply your tax credits to any plan in the marketplace. To qualify for tax credits, you have to report the income you expect to earn as a household (that means your spouse’s paycheck, your kids' jobs, etc.).

If you’re married, you have to file your taxes jointly to qualify for assistance. If you’re married but filing separately, you won’t be able to claim tax credits. To claim your credits, you have to enroll through the marketplace.

If you don’t qualify for credits, you can skip the marketplace and sign up directly with the insurance company, which is usually faster and easier.

When to sign up

Enroll during Open Enrollment (opens in new tab), which starts November 1 and usually ends in December or January, depending on your state. If you lose coverage mid-year, you might have a qualifying life event (QLE) (opens in new tab), which gives you 60 days to get new coverage. But if you don’t have a QLE and lost coverage because, for example, you forgot to pay your bill (oops) and your plan got cancelled, you won’t be able to sign up again until the next Open Enrollment. So it’s super important to sign up during Open Enrollment and keep your coverage active all year by paying your bill (opens in new tab) on time every month. Most insurers have an auto-pay option so you never miss a payment. With Oscar, you can pay your premium in full up front at any time. If you stop being an Oscar member, you’ll get refunded for your remaining premium.

Ready to get an individual insurance plan? Get a quote (opens in new tab) or give us a call at 1-855-672-2788.

What is a Health Savings Account (HSA)?

A Health Savings Account (HSA) is a long-term savings account you can set up to pay for health care expenses. You can contribute to a HSA pre-tax and post-tax.

Where do I sign up for a HSA?

You can open a HSA through most major financial institutions. Our HSA partner is Health Equity (opens in new tab).

How much can I contribute?

Starting in 2021, you can contribute up to $3,600 ($7,200 for a family plan) in pre- or post-tax dollars during the year.

How much can I save?

Health Equity provides a number of features including guides, tutorials, and a savings calculator (opens in new tab) that can help you determine how much your future balance could be if you contribute to a HSA.

What can I use my HSA dollars on?

You can use your HSA funds to pay for a wide variety of qualified medical expenses (opens in new tab), including, but not limited to:

• Doctor appointments and procedures
• Imaging services (like CT scans/MRIs) and lab tests
• Medical equipment and prosthetics
• Prescriptions and medical supplies
• Physical and occupational therapy
• Dental and vision care
• Psychiatric care and psychotherapy

There’s also a shortlist of things you can’t spend your HSA dollars on, such as:

• Child care
• Cosmetic surgery
• Controlled substances
• Diaper services
• Household help
• Nutritional supplements and non-prescribed drugs.
• Gym memberships or weight loss programs (unless medically prescribed)

View the full list (opens in new tab) of qualified medical expenses on the IRS website.

What happens if I don’t use all of my money by the end of the year?

Unused funds will roll over for the next year so you can use it to pay for future health care expenses.

What if I don’t buy a HSA-compatible plan in the future?

You can still use the money in your account to pay for health care expenses, but you won’t be able to contribute any additional money unless you remain with a HSA-compatible plan.

We've built a better experience for people just like you:

• An entire team dedicated to you: Oscar Care (opens in new tab) gives you personalized virtual care from the comfort of your home, at work, or on-the-go.
• $0 prescriptions: We’ve cut the cost of many common prescriptions to $0 when prescribed through Oscar Virtual Urgent Care (opens in new tab).
• Finding a doctor is easy: Use the search tool (opens in new tab) to get access to top-rated hospitals and doctors in your neighborhood.
• Get Paid to Walk: The Oscar app syncs with Google Fit or Apple Health, so you can earn $1 every day you hit your step goals—up to $100* a year. Learn more (opens in new tab).

If you’re on a Medicare Advantage plan you’re eligible to earn up to $15 a year towards an Amazon® Gift Card with step tracking. If you think you might be unable to participate in this program, you might qualify for an opportunity to earn the same reward in a different way. Contact Your Customer Service team at 1-855-672-2788 and we will work with you (and, if you'd like, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

Note: if you live in California, you can also track and earn rewards for every day you hit your sleep goal.

Before you enroll on HealthCare.gov (opens in new tab) or your state's health insurance Marketplace, here are a few things you can do to prepare that will make the application process easier and faster.

1. Figure out where to apply. Most states use the federal marketplace, HealthCare.gov (opens in new tab). However, some states run their own Marketplace websites, including:

• California (opens in new tab)
• Colorado (opens in new tab)
• Connecticut (opens in new tab)
• District of Columbia (opens in new tab)
• Idaho (opens in new tab)
• Maryland (opens in new tab)
• Massachusetts (opens in new tab)
• Minnesota (opens in new tab)
• Nevada (opens in new tab)
• New York (opens in new tab)
• Rhode Island (opens in new tab)
• Vermont (opens in new tab)
• Washington (opens in new tab)

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1. Estimate your household income. You’ll need an estimate of your total household income before tax for the upcoming year. So if you’re applying during Open Enrollment (opens in new tab) for coverage in 2020, you’ll need an estimate of your 2020 income. Still have the same job? Start with your adjusted gross income from last year’s tax return and make adjustments as necessary to account for raises, bonuses, and any additional income. Be sure to include income earned by all adults in your household, even if they aren’t applying for insurance with you.
2. Make sure an individual health insurance plan is right for you. You may not be able to get a plan through HealthCare.gov (opens in new tab) if you:

• Get insurance through your job. If your employer (or your spouse’s employer) offers health insurance, you can’t buy insurance through the healthcare exchange unless their plans are deemed “unaffordable.” Employer-provided insurance is considered unaffordable if its premiums cost more than 9.78% of your household income for an individual plan.
• Qualify for Medicaid or CHIP. Medicaid (opens in new tab) and CHIP (opens in new tab) are more affordable options for low-income people. You can find out if you qualify for Medicaid in your state (or qualify for subsidies (opens in new tab) on a Marketplace plan) at healthcare.gov/lower-costs (opens in new tab).

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1. Figure out who needs coverage. Maybe you’re the only person who needs an individual health insurance plan because you’re not married or your spouse’s insurance doesn’t cover family members. Maybe you, your spouse, and your kids all need a family plan. Whatever the case, you’ll want to be sure everyone in your household, including your dependents (opens in new tab), is covered one way or another to avoid paying a tax penalty (opens in new tab).
2. Note everyone’s social security number and dates of birth. You’ll need both for everyone who will be on your plan.
3. Gather immigration paperwork, if applicable. If anyone in your family is not a citizen but needs insurance, see HealthCare.gov’s full listing of immigration document types (opens in new tab). You’ll most likely need the following:

• For naturalized citizens: The number from the certificate of citizenship / naturalization (located at the upper right hand corner) and your alien number (located just below, beginning with an “A”).
• For those with a visa / green card / foreign passport: You’ll need the alien/USCIS number and I-94/visa/green card/passport number.

If members of your household don’t need insurance, you don’t need to provide immigration paperwork. <br></br>

1. Jot down everyone’s employer information. You’ll need the employer business names, addresses, and phone numbers for everyone in your household who files a tax return.
2. Grab your tax return from last year. You’ll use this to input your tax information. It also helps you to determine your modified adjusted gross income (MAGI) (opens in new tab), which is used to figure out if you qualify for premium tax credits or any other savings with a Marketplace plan.
3. Pick your plan. Do your research to figure out what kind of plan is best for you and your family. Here's a quick primer (opens in new tab) on how to pick the perfect plan for your needs.

If you’re pregnant or planning to have a baby in the next year, you’ll be seeing the doctor a whole lot more often. And giving birth, even with no complications, can be quite expensive! The good news is, maternity care and birth are considered essential health benefits (opens in new tab), which means all individual health insurance plans are required to cover them. How much you'll spend depends on your plan.

Why should I get health insurance during pregnancy?

Having health insurance can considerably lower how much you’ll pay in maternity care and birth costs. Your plan's out-of-pocket max (opens in new tab) limits your expenses, no matter how much care you need. If your out-of-pocket max with your Bronze plan is $6850, that's the most you could spend on covered health care during the year. The costs for pregnancy and childbirth can mount into the tens of thousands of dollars without insurance.

How should I choose a health insurance plan during pregnancy?

The health insurance that works for you in a normal, healthy year might end up costing you a lot of money in medical bills, copays (opens in new tab), or coinsurance (opens in new tab) related to your pregnancy and the birth of your child. If you plan ahead and choose a health insurance plan with your pregnancy-related costs in mind, you might save in the long run by going with a more expensive plan that has a lower out-of-pocket maximum like a Gold or Platinum plan (opens in new tab). If you qualify for a cost-sharing reduction subsidy (opens in new tab), you may find a Silver plan with a low out-of-pocket max. Get a quote (opens in new tab) to see if you qualify.

Which plan saves you the most?

The best way to tell which plan will save you the most this year is to imagine you're going to hit your out-of-pocket maximum and tally up your spending, including 12 months of premiums.

A Silver plan that costs $431 per month will cost you $5,172 for the year. If you spend $7,150 on medical bills to hit your out-of-pocket max, your total spending equals: $12,322.

A Platinum plan that costs $628 per month will cost you $7,536 for the year. If you spend another $1500 to hit your out-of-pocket max, your total spending comes to: $9,036.

So even though it's a lot more expensive per month, you'd save over $3,000 on a Platinum plan compared to a Silver plan! As a rule, the plan with the lowest out-of-pocket max often saves you the most when you know you're going to have a lot of medical bills in a given year. After your baby is born, you can add your newborn to your plan and switch to a less expensive plan with a higher deductible if you don’t typically go to the doctor very often.

Pro tip: If you qualify for a cost-sharing reduction (opens in new tab), you can find Silver plans with low deductibles and reduced out-of-pocket maximums. In some cases, a Silver plan might be the most affordable option for you.

How do I sign up for health insurance during pregnancy?

With the exception of New York, pregnancy itself is not considered a qualifying life event (opens in new tab) that allows you to enroll for an individual health insurance plan outside of Open Enrollment. However, if you're uninsured and your due date is in the following year, it’s smart to sign up for a plan during Open Enrollment (opens in new tab) to keep your health care costs under control.

Do I qualify for Medicaid and CHIP during pregnancy?

If you qualify for Medicaid (opens in new tab) or CHIP (opens in new tab), you can enroll at any time of the year. Both state-based programs provide low-cost or free health care to pregnant women. Visit HealthCare.gov (opens in new tab) to see if you qualify. You can apply through the Marketplace (opens in new tab) or directly through your state’s Medicaid website.

What's covered when you're pregnant?

Under the Affordable Care Act (opens in new tab), your individual health insurance plan is required to cover many maternity services, including:

• Prenatal and postnatal doctor visits.
• Medications.
• Some screenings and tests.
• Hospitalization.
• Breast pump rental.

Your health insurance plan must also offer some preventative services without copays (opens in new tab) or coinsurance (opens in new tab), even if you haven’t met your deductible. That means the following are available to pregnant women for free:

• Folic acid supplements.
• Hepatitis B screening at your first visit.
• Anemia (a.k.a. iron deficiency, which is more common during pregnancy screenings).
• Urinary tract infection (UTI) screenings.
• Gestational diabetes screening between weeks 24 to 28 of pregnancy.
• Rh incompatibility screening and follow-up testing for those at risk.
• Tobacco education and counseling.

Once your baby is born, he or she will get routine newborn preventative care, and you’ll get breastfeeding support from a trained lactation consultant for free as well. Remember, you’ll need to visit doctors and hospitals that take your insurance to ensure your plan covers these costs (except in certain emergency situations).

If your life looks much the same as it did last year, you might want to keep the Oscar plan you have. But if things have changed, you could save money by switching to a different style of Oscar plan.

Oscar plans are named after metal tiers (opens in new tab) (Bronze, Silver, Gold, Platinum) to make it easy to compare your options. Each plan offers a different level of coverage and one might better suit your needs depending on your circumstances. It’s a good idea to take a moment to review any personal changes that may have occurred throughout the year to see if you need to switch to a different tier of coverage.

Here are four questions to ask yourself to see if you should consider changing plans this Open Enrollment (opens in new tab):

Has your health changed?

Did you recently start treatment for a new condition or receive a new diagnosis? If you go to the doctor regularly or have an upcoming procedure, you may want a Gold or Platinum (opens in new tab) plan. It costs more per month, but covers more of the cost when you get care during the year.

If your health has improved in the last year, you might want to downgrade your metal tier to save some cash. Healthy people generally choose Bronze or Silver (opens in new tab) plans, which have lower premiums (opens in new tab) but have higher deductibles (opens in new tab), so you pay less every month and pay more when you need care.

Look out for plans with copays (opens in new tab) for the types of services you need, as this can help keep costs down. For example, our Simple Silver plans offer a mid-level deductible with copayments for office visits. This means that you can receive routine care without worrying about reaching your deductible first. This type of plan is a great option if you have a chronic condition (opens in new tab) that needs routine management.

Keep in mind that every Oscar plan includes preventive care and will cover the cost your annual physical, a well-woman exam (opens in new tab), preventive screenings, a flu shot, some forms of birth control, and more.

What's in your bank account?

Whether you recently started your own business or are looking for a new job, changes in your finances can impact which plan best suits your needs. Depending on how much you expect to earn this year, you may qualify for one or more forms of financial assistance (opens in new tab) to make your health insurance more affordable. You can contact one of our enrollment guides at 855-672-2788, or get a free personalized quote (opens in new tab) to see if you're eligible for financial assistance. If so, you’ll want to enroll through the Marketplace (opens in new tab) to claim your financial aid. If you’re not eligible for financial assistance, you can save time and money by enrolling directly with Oscar through our website (opens in new tab) or over the phone.

Not sure how to estimate your income? Check out these tips (opens in new tab) on how to add up what you think you might earn.

What box do you check?

Are you single? Married? Divorced? Oscar offers family plans (opens in new tab) for those who are married or in a domestic partnership. If you recently celebrated a union, you might want to consider enrolling in a health plan with your spouse.

Pro tip: If one partner is healthier than the other, you might think about choosing separate individual policies to save. If you got divorced this year, it may be time to switch to an individual plan.

Did you have a milestone birthday?

Anyone over the age of 18 can purchase their own health insurance plan. However, the ACA (Affordable Care Act (opens in new tab)) has made it possible for children to remain on their parent’s plan until they turn 26. If you're turning 26 (opens in new tab) and currently covered under your parent’s plan, you'll need to sign up for your own insurance.

Our members that are under 30 and healthy often opt for a catastrophic plan (opens in new tab), which has the lowest monthly premium. Here’s the catch: you can’t apply financial aid to a Catastrophic plan. So if you qualify for financial assistance, you may find a similar Bronze plan with a lower premium or a Silver plan with a reduced deductible.

Still not sure which plan is best for you? Read more about how to pick the perfect plan (opens in new tab), or give us a call at 1-855-672-2788, and we'll be happy to walk you through your options.

We can only cover international claims (opens in new tab) if your life is at risk or you’re at risk for losing a limb. That’s because communication between different healthcare systems and providers internationally can be very complex.

If you’re ever have to send in an international claim, make sure you to ask your international provider for:

• An untranslated itemized receipt that shows the place of service, services rendered, the name of the provider or facility, the identification number of the provider or facility, and the amount charged for the services.
• An unconverted receipt showing the amount paid in the country’s currency.

Once you gather this information, you can go to hioscar.com/forms (opens in new tab) and select your state, plan year, and language. Then download the “Member Claim Form.” Please fill this out and send this and the documentation listed above to your Care Team via a secure message through your Oscar account. Your Care Team will reach out if they are missing any information.

You can see the status of your claims on the Claims page in your Oscar account (opens in new tab). If a claim is being processed, you’ll see the ‘Processed’ status under the ‘Your Cost’ column.

If a claim has been processed, you’ll see how much you owe in the same column.

If you need more information on the claim, just click into the claim and scroll down to the ‘What to do next’ section.

Claims can be hard to read. Here’s all the info covered in a claim:

• Date of Service: This is the date you received care from the provider or the facility.
• Claim ID: A number that’s assigned to your claim for reference.
• Care received: Info regarding the services, how much was billed to Oscar, how much Oscar covered according to your plan, and the amount that you’re responsible for paying the provider or facility, if any.
• Contribution to plan balances: This shows you how the claim is applied to your plan. It breaks down the amount you owe to show what was applied to your deductible (opens in new tab) and your maximum out-of-pocket (opens in new tab).
• What to do next: Best next steps for the claim based on its status.

Your provider’s responsible for submitting claims directly to us (unless you’ve received emergency international care.)

If your provider is within the Oscar network and won’t submit your claim, reach out to your Care Team right away.

If you see an out-of-network provider and think the services may be covered, fill out a ‘Member Claim Form.’ You’ll find it on this page (opens in new tab). Fill it out and send it to your Care Team by secure message. (Just so you know: this form initiates the claims process, but doesn’t guarantee payment.)

Nope! The explanation of benefits (opens in new tab) (also known as EOB) isn’t a bill. It’s an easy-to-understand breakdown of the services that you received and how Oscar handled payments between you, and your provider or facility.

The bottom line: It’s a helpful document that explains your insurance and how it works for you.

Claims can be denied for a few reasons. They include:

• Network status. In other words, if a routine service is provided by an out-of-network provider. If this happens, we encourage you to reach out to your provider to pay directly.
• Lack of prior authorization. Some services require approval from Oscar before they occur to make sure they’re covered. They’re generally needed for highly-regulated or complex services, care, and medications. Always make sure to get prior authorization (if needed) before you receive care.
• Lack of medical necessity. AKA if there’s not a medical reason for the care. In this case, we’ll likely request more info from your provider. (It’s always a great idea to make sure they sent the info to Oscar.)

If you want to talk to someone about a claim denial, just message your Care Team. They’re here to help.

Here’s how our claims process works:

First, your doctor or a medical facility will send Oscar information about why and when you received care and the type of care you received.

Once we get this info, we’ll:

• Find out if your provider is in-network
• Make sure your services align with the diagnosis you received
• Check to see if your benefits (opens in new tab) cover your care
• Determine what portion of the bill you’ll pay and we’ll pay
• Apply these amounts to your deductible (opens in new tab) and/or your maximum out of pocket (opens in new tab)

Next, Oscar will send any payment that’s needed to the provider or facility, as well as a breakdown of what was paid. We’ll also send you an Explanation of Benefits (opens in new tab) (EOB) with the same information.

The provider or facility will send you a bill for the remaining amount you owe. Please pay the provider or facility directly.

You’ll find them on your Claims page (opens in new tab).

You can separate your claims by medical, mental health, and meds. Plus, you can click any column header (like “Date of Service”) to sort the claims by different terms.

If you don’t see a certain claim right away, just know that it can take time for providers and facilities to send in their claims. So, be sure to check back!

Where can I find my claims?

You can find your claims found by navigating to the "Claims" page under "Quick Links" on your Oscar web profile and mobile app.

What does the PAID status mean?

The PAID status indicates that claim has been finalized and Oscar has paid the provider or facility the negotiated amount. This doesn't necessarily mean that you are not responsible for an additional payment amount to the Provider and/or Facility. The Provider and/or Facility will send a notification regarding any outstanding amount due, if there is one, and how to pay.

I believe I've met my deductible or maximum out-of-pocket. Where would I be able to see if I did?

To see if you've met your deductible or maximum out-of-pocket, click on "Coverage & Benefits" under "Quick links" on your Oscar web profile and mobile app.

The provider sent me a bill. How do I pay it?

All payments should be made to the provider directly and the amount and services should match what is listed in the Explanation of Benefits (EOB) provided to you by Oscar. Your Explanation of Benefits (EOB) can be found by navigating to the "Claims" page under "Quick Links," clicking on the relevant claim, and clicking on the PDF listed besides "Explanation of Benefits" on your Oscar web profile and mobile app.

I don't see an EOB for a claim on my web profile and mobile app? If a claim is not in PAID status, it hasn't been finalized. Once finalized, Oscar will provide the Explanation of Benefits (EOB) for the respective services.

Does Oscar cover international claims?

Oscar only covers international claims for life-or-limb emergencies.

As an Oscar member, what COVID-19 resources do I have access to?

If you are concerned you've contracted COVID-19 and/or need help deciding if you need medical care, the Center for Disease Control (CDC) recommends contacting your primary care physician as a first step. If you are experiencing a medical emergency, please call 911. You can also contact Oscar’s Virtual Urgent Care, available 24/7 at $0 for all members except those on Secure/Catastrophic & Health Savings Account (HSA) plans.

If you are not experiencing emergency symptoms, please use our COVID-19 testing site locator (opens in new tab) to find testing sites in areas where Oscar plans are available.

How much will I be charged for COVID-19 treatment?

Your Oscar plan will cover treatment associated with COVID-19 under your plan's normal cost-sharing rate. There are also some exceptions based on federal and local regulations.

How much will I be charged for the COVID-19 test?

Any COVID testing claim and associated office visit will be covered in full as long as it's the same date of service as the testing claim.

Does Oscar cover the cost of the antibody test?

As long as the antibody test is being used to diagnose or determine a treatment plan, the test will be covered in full.

How much will I be charged for COVID-19 vaccine and booster shots? All doses of the COVID-19 vaccine including booster shots will be covered at no cost for ages 5 and up.

I had to pay for my COVID-19 vaccine and booster shot. How can I get reimbursed?

If you paid for COVID-19 vaccine and booster shot, you can submit a Member Claim Form to get reimbursed. The Member Claim Form can be found by navigating to the "Member Resources" tab on hioscar.com and clicking "Member Forms." Enter your state and plan year and it'll be listed as Member Claim Form under the "Other Documents" section.

What should I know about the COVID-19 booster shot?

In mid-August 2021, the Department of Health and Human Services issued a statement concluding that a COVID-19 booster shot “will be needed to maximize vaccine-induced protection and prolong its durability” as researchers have gathered data noting that protection against COVID-19 infection decreases over time following the initial doses of vaccination. With the spread of new variants, we are seeing reduced protection against mild and moderate disease.

Adults 18 years and older who received two doses of Pfizer or Moderna mRNA vaccines, are eligible to receive a booster shot at least six months after completing their second dose. Adults 18 years and older who received a J&J dose at least two months ago, are eligible to receive a booster shot. A Pfizer or Moderna mRNA booster shot are preferred in most situations. Teens 16-17 years who received two doses of a Pfizer mRNA vaccine at least six months ago are also eligible for a booster shot. It is ok for individuals to mix and match their vaccine and boosters. For example, someone who received two doses of the Pfizer vaccine can receive a Moderna booster.

At Oscar, we will continue to follow the emergency use authorization and FDA approvals related to eligibility for vaccines inclusive of the booster shots. For more information on boosters, please visit the CDC website (opens in new tab).

What is the difference between an additional dose and a booster shot?

Some people who are immunocompromised don’t build adequate levels of protection after receiving their two-dose initial mRNA COVID-19 vaccination. Getting an additional dose can sometimes help them build more protection against the disease. Immunocompromised patients are eligible to get a third dose of Pfizer or Moderna mRNA vaccines at least 28 days after their second dose. These patients should still receive a booster six months after receiving their third dose, as the third dose is considered part of the initial series for immunocompromised individuals and not a booster.

A “booster shot” refers to another dose of a vaccine that is given to someone who built enough protection after vaccination, but then that protection decreased over time.

Where do I go to get tested for COVID-19?

Many reliable over-the-counter COVID tests are available from a variety of retailers. These do not require a deep nasal swab like PCR testing and are generally easy to use.

If you prefer for a healthcare professional to administer testing, use Oscar’s COVID-19 testing site locator (opens in new tab) to find a testing center that is in-network with your Oscar plan. If you are in an area experiencing a surge in COVID cases, there may be testing shortages or long wait times; you can call the testing center ahead of time for more information. Your local board of health may have additional resources for testing in surge situations.

For more information on COVID testing, please see the CDC website.

If you are experiencing a health emergency, such as serious difficulty breathing, please call 9-1-1 immediately and let them know you are concerned you may have COVID-19.

Learn more by clicking here (opens in new tab) to visit our COVID-19 Resource Center.

Treatment for COVID-19 is still covered under your health plan benefits. You’ll just have to pay your plan's normal cost-sharing (opens in new tab) rate, which may include payments up until your deductible is met, or coinsurance or copays*.

*If you have coverage in the state of California out-of-network COVID-19 treatment will be covered with no cost-sharing until 11/11/23. After that date, applicable cost-sharing will apply for out-of-network treatment.

Vaccines and boosters are currently $0, however any associated administration costs will be paid according to your plan benefits. Make sure you visit an in-network location (opens in new tab) to ensure that the care is covered by your plan*.

*If you have coverage in the state of California out-of-network COVID-19 vaccines will be covered with no cost-sharing until 11/11/23. After that date, applicable cost-sharing will apply for out-of-network vaccines.

Learn more by visiting our at home COVID reimbursement page here (opens in new tab)!

Here’s how you create your Oscar online account:

• Visit hioscar.com/register (opens in new tab). Enter your email address and create a password. Then, hit ‘Create account’
• Verify your email, and fill out a few details.
• Set up autopay. (You’ll just need your account holder name, routing number, and account number).
• Sign up for paperless communications.
• Complete your health profile.

Congratulations, you did it!

Having an online account makes it easy to do just about anything related to your health. Like:

• Easily pay your bill
• Review your recent claims
• Message your Care Team (opens in new tab)
• Refill prescriptions
• Find in-network options (opens in new tab) for doctors, providers, and facilities

You can also download the app (opens in new tab) to have care on the go. Pretty great, huh?

Updating your address (or other demographic information) will differ based on whether your health insurance policy was purchased through a state-based exchange or if purchased directly through Oscar.

ON-Exchange:

If you were enrolled through the state-based exchange and there has been changes to your residential address, please contact your state-based exchange and inform them of the address change. The number of all state-based exchanges are listed on healthcare.gov or it can be found on the state's health insurance exchange website. Your respective exchange will provide any address modifications back to Oscar -- this usually takes a few days but varies widely from each exchange.

OFF-Exchange:

If there's been a change to your residential address, only the primary account holder or responsible party can request the changes. Please note that to continue to be covered under an Oscar plan the new residential address must be within Oscar's existing service area. An off-exchange address change will need to be processed by sending a Secure Message or by speaking with your Care Team directly.

To download the Oscar app (opens in new tab):

• Search for Oscar Health in the App store (opens in new tab) or Google Play store (opens in new tab).
• Click Download. Then, open the app.
• Sign in by entering your email address and password.
• If you don’t already have an account, choose Create your account and verify your email address.

Need some help? Check out this step-by-step guide (opens in new tab) and we’ll walk you through the whole app download process. The Oscar app makes managing your plan on the go pretty simple.

If you experience an emergency, it’s important to let us know what happened so we can process your claim.

Here what should happen:

• Your provider will send a claim to your health insurer with a description of which services you received and why.
• Your insurer will review the claim and send you an explanation of benefits showing what’s been covered. Your insurer will also pay your healthcare provider.
• You may also receive a bill from the provider if you owe anything (such as a copay, coinsurance, or a payment toward your deductible).

If you find yourself needing emergency (opens in new tab) care, you should go directly to the nearest ER or call 911.

An emergency (opens in new tab) is any situation where you risk losing your life or a limb if you don’t get medical care right away. If you don’t get fast care, you could:

• Put your life in serious danger.
• Put your baby’s life in serious danger, if you’re expecting.
• Put yourself or others in serious danger due to a behavioral condition (like depression or schizophrenia).
• Impair how your body functions (for example, you lose a finger or have a stroke).
• Seriously disfigure yourself (for example, you break your nose or have second-degree burns).

If you find yourself needing emergency care, you should go directly to the nearest ER or call 911.

In an emergency (opens in new tab), always call 911 or go to the nearest emergency room (ER).

If your symptoms aren't so serious, and you’re not sure if you need to go to the ER, you should speak with a doctor or health care provider through Virtual Urgent Care (opens in new tab). They can help find out what’s going on and decide if you need immediate medical attention.

If you want to see someone in person for an urgent health issue that isn’t an emergency, try visiting an urgent care clinic (opens in new tab). It’s a less expensive and less time-consuming option for when you can’t get an appointment with your doctor and need care.

Search for your closest in-person urgent care clinic (opens in new tab) and save it to your account for easy reference whenever you need care.

We offer several easy ways for members to receive cost estimates for upcoming appointments and services. The best way to get a cost estimate is through entering your upcoming visit information into Oscar’s Standalone Cost Estimate Tool (opens in new tab).

Alternatively, when you browse a provider’s profile, Oscar displays cost estimates for common services offered by the provider in the Cost Estimates tab. Finally, cost estimates are displayed in the search bar when you explore common reasons for visits or provider specialties.

If you need further help with getting a cost estimate for an upcoming appointment or service, contact your Care Team (opens in new tab) via message through your account or call (855) 672-2755.

Check out the Coverage & Benefits page (opens in new tab) in your Oscar account to see how your plan covers visits, procedures, and meds. Just know that costs may vary depending on whether you receive additional procedures or tests during your visit.

You can also get a cost estimate (opens in new tab) to see what you can expect to pay for any type of visit, procedure, or test, just by providing a few details.

To see how much lab work will cost, just check out your Coverage & Benefits page (opens in new tab).

You can also get a cost estimate (opens in new tab) to see what you might expect to pay for a specific lab test. It’ll help to have the procedure name or CPT-10 code (current procedural terminology) handy.

Oscar tip! Make sure your provider uses one of our preferred in-network lab partners — Quest*, Labcorp, or BioReference.**

• Quest Diagnostics is the only lab available in New Jersey

** Ohio Tier 1 have all three partners available, in addition to Cleveland Clinic

You can go to your Coverage & Benefits (opens in new tab) page to see how your plan covers surgeries or procedures. Just know that costs may change depending on any additional tests or care received.

You can also get a cost estimate (opens in new tab) to see what you can expect to pay for any procedure or surgery.

Oscar tip! It’s helpful to have the procedure name or CPT-10 code (current procedural terminology) handy to get an accurate estimate.

When you see a doctor we don't have a relationship with, you've gone "out-of-network (opens in new tab)," and your care may not be covered except in certain situations. Not only will you be paying higher prices, but your care may not be covered by Oscar. That means you’ll probably be responsible for the entire bill, and your payments won't be credited toward your deductible or out-of-pocket max.

You can search for your medication by name in the search bar at the top of your Oscar homepage (opens in new tab). Then, just select a specific drug variation (dosage and/or form) to see your estimated cost.

That’s it. Pretty simple, huh?

Sometimes (but not always), you need to pay for part of your bill. Oscar will help pay another part. Your explanation of benefits (opens in new tab) (EOB) will show you what you owe versus what Oscar pays.

To pay this part of your bill, you should reach out to your provider directly. Oscar doesn’t collect payments from providers. The only time you owe money to Oscar is for your monthly insurance premium (the amount you pay to keep your insurance).

Keep in mind, Oscar can’t see what payment you’ve made to your provider. It’s important to keep records with your provider and talk to them directly about your questions.

An explanation of benefits (EOB) (opens in new tab) explains your claim and how payments work. Plus, it’s done in an easy-to-understand way.

When you first open your EOB, you’ll see a page that says “Recent Care.” This page shows the date you received medical services, who the care was with, and if needed, the page where those dates begin.

When you look at your EOB, you’ll see:

- A date: This date is the date that the medical services were performed.

- You had care with…: This shows the provider or facility that performed the medical services.

- Price charged by provider: This is the amount that the provider submitted to Oscar.

- Discount for Oscar members: This amount is based on a private contract between Oscar and the provider.

- Amount Oscar paid: This is the amount that the Oscar paid directly to the provider.

- You owe: This shows the amount the provider may bill you if you haven’t already paid.

The next page gives you an in-depth breakdown of the way that this information was paid. You will find each of the above items broken down by each procedure.

If your provider is charging you more than your EOB (opens in new tab) shows, we encourage you to talk to your provider directly and ask that your bill be adjusted.

If you’ve already paid more than your EOB says that you owe, you will need to request a refund from your provider or facility directly. If you need help with this, talk to a member of your Care Team right away. Your Care Team can advocate for you.

On your EOB, it’s easy to see the cost breakdown for your claim. Just go to the “Care Received” section. It breaks down the amount that has been billed for each service that was performed. You’ll be able to see the amounts your provider billed, what Oscar paid, and the amount you owe if you haven’t already paid.

Check out your Drug Formulary (opens in new tab). It lists all the meds your plan covers, including maximum dosage, quantity, and whether pre-authorization is required.

You can also search for your medication by name in the search bar at the top of your Oscar homepage (opens in new tab). On the drug details page, just select a specific drug variation (dosage and/or form) to see the estimated cost.

*Cost is subject to change. Cost estimates are based on pricing for retail fills at most in-network pharmacies. Costs may differ for mail-order fills or fills at different pharmacies. Cost shown is for 30 days supply, and might be higher for longer durations.

We have a list of all prescription drugs that we cover (Oscar’s formulary).

You can find it by:

1. Going to the “Member Resources” tab on hioscar.com.
2. Clicking "Member Forms (opens in new tab)."
3. Entering your state and plan year.

You’lll see it listed under the "Drug & Formulary Information" section.

Just go to your Oscar account (opens in new tab) homepage and use the search bar at the top of the page.

Then:

• Enter the type of facility you need
• Adjust the filters (for things like distance)
• Click on the facility you’re interested in
• Call them directly for open appointments

Need more help? Search for care using this step-by-step guide (opens in new tab).

Absolutely! You can change your PCP right in your online account (opens in new tab).

Here’s how you do it:

1. Click on ‘edit’ in the primary care provider section of your home page.
2. Click on ‘view all providers near you.’
3. Search for your PCP by name. If you don’t have one, you’ll see a list of PCPs we think you’ll like.
4. Once you find your provider or a new one, click on that PCP to go to their profile.
5. Select ‘Add as a primary care provider.’

That’s it! You changed your PCP.

Yes, you sure can!

One thing to note: if you have a TX Guided Care HMO plan, you’ll need to see your PCP on file to get a specialist referral. If they’re not available, reach out to their office – another PCP in their practice may be able to help you.

It’s easy to choose a primary care provider (opens in new tab). Just pop onto your online account (opens in new tab). Then:

1. Search for your PCP by name in the search bar.
2. If you don’t have a PCP, type ‘primary care provider’ into the search bar. You’ll see a list of PCPs we think you’ll love.
3. Once you find your provider or new provider, click on that PCP to go to their profile.
4. Then, select ‘Add as a primary care provider.’

That’s it. You’ve selected a PCP!

You can search for in-network providers and facilities by name, type, or specialty by using the search bar at the top of your Oscar homepage (opens in new tab).

You can also search for your reason to visit or condition (for example, ‘skin allergy’). You can even apply filters to find options that best suit your preference on gender or language.

For a little more help on searching for care use this step-by-step guide (opens in new tab).

You only need a referral to visit a specialist if you’re on a TX Guided Care HMO plan.

To get a referral, all you need to do is book an appointment with your primary care provider (PCP) on file.

If your PCP is busy, you can always reach out to their office — another PCP in their practice may be able to help you. In a pinch, you can also get a referral from a Virtual Urgent Care provider.

Staying in-network (opens in new tab) can help you save money. So naturally, you may want to check if your doctor is in the Oscar network before a visit.

To find out, simply log into your account online (opens in new tab) or in the Oscar app (opens in new tab), and type the provider’s name into the search bar. The results will only show you the names of providers and facilities that are within Oscar’s network, so if you see their name, then you’re probably in luck!

That said, even if their name appears, we encourage members to call the provider or facility beforehand to double check their network status. That’s because providers can leave Oscar’s network at any point.

To check if your provider is in-network (opens in new tab), just search for them by name in the search bar at the top of your Oscar account homepage (opens in new tab). Only providers who are in-network will show up in our search results.

Pro-tip: While our care router shows network status for providers at different locations, you can also call the provider to confirm their network status. Although it's rare, providers can join or leave a network in the middle of a plan year.

If a specific provider does not show up in our search results, they’re likely out-of-network (opens in new tab).

You can find other great in-network options by searching for the provider’s specialty (for example, ‘dermatologist’), or by searching for what you need help with (for example, ‘skin condition’).

It means that someone other than your primary care provider (PCP) on file or an approved PCP in their office submitted your referral.

Here are two ways to make your referral status valid:

• (1) Change your PCP on file to the provider who submitted your referral. You can do this right in your account.
• (2) Go see your PCP on file for a new referral. If they’re not available, check in with their office – another PCP in their practice may be able to give you a referral, too.

No worries! We’ll choose a PCP for you that we think you’ll love. You can check out the network and change providers at any time if you’d like right in your account.

If you’re in an emergency (opens in new tab), always go to the nearest emergency room or call 911. Sometimes time isn’t always on your side, so it’s important to get care as quickly as possible. If you find yourself needing emergency care, you should go directly to the nearest ER or call 911.

Oscar tip! It’s important to only go to the emergency room for true emergencies.

In an emergency (opens in new tab), always call 911 or go to the nearest emergency room (ER).

If your symptoms aren't so serious, and you’re not sure if you need to go to the ER, you should speak with a doctor or health care provider through Virtual Urgent Care (opens in new tab). They can help find out what’s going on and decide if you need immediate medical attention.

If you want to see someone in person for an urgent health issue that isn’t an emergency, try visiting an urgent care clinic (opens in new tab). It’s a less expensive and less time-consuming option for when you can’t get an appointment with your doctor and need care.

Search for your closest in-person urgent care clinic (opens in new tab) and save it to your account for easy reference whenever you need care.

You’ll find your PCP on file right on the homepage in your Oscar account. Want to pick someone else? No problem! You can make a switch at any time right there.

Just note: if you’re on a TX Guided Care HMO plan, you’ll need to see your assigned PCP to get a specialist referral. If they’re not available, just reach out to their office – another PCP in their practice may be able to help you.

Having a PCP means that you’ll have someone on your side who can connect all the dots for you — keeping track of your health history and baseline information. That way you’re not jumping from specialist to specialist and missing the big picture.

Your PCP is also your go-to in getting specialist referrals if you have a TX Guided Care HMO plan. If your PCP isn’t available when you need a referral, just reach out to their office — another PCP in their practice may be able to help you.

Having a primary care provider, or PCP, is important. They help you manage your health for the long term. And they take the time to get to know you and make sure you get the right care for you.

Having a PCP means you’ll have someone on your side to help you connect all the dots. That way you’re not jumping from specialist (opens in new tab) to specialist trying to find answers.

If you’re on a TX HMO Guided Care plan, you’ll need a referral from your assigned PCP to see a specialist. If your assigned PCP isn’t available, an office staff member may schedule you with another PCP in the same practice.

At Oscar, you also have the option of choosing a virtual primary care provider with Oscar Primary Care. It's the same as having an in-person PCP, you just don’t have to go anywhere to keep on top of your health.

Learn more about why having a primary care provider matters here (opens in new tab).

A primary care provider (opens in new tab), or PCP, is a healthcare professional who helps you manage your health. So when something comes up, they’re the first person you’ll talk to when it’s not an emergency (opens in new tab). And you’ll have someone who knows you so they can give you personalized care.

Having a primary care provider means you’ll have someone on your side who can connect all the dots for you. And you want that, especially when it comes to your health. Because if you jump from specialist (opens in new tab) to specialist trying to find an answer, who’s going to put all the pieces together and take a look at the big picture? That’s where your PCP comes in. When it comes down to it, they can quite literally become a lifesaver.

Learn more about why having a primary care provider matters here (opens in new tab).

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Absolutely! Receiving care from doctors that are in-network (opens in new tab) is the smart way to get care.

In-network providers have already agreed to our negotiated rates (opens in new tab), which are 10% to 60% lower than full price, depending on the service. Even if you have a deductible (opens in new tab) and have to pay out-of-pocket for some care, you'll still get the benefit of paying Oscar's lower rates. Also, any payments you make for covered services with in-network doctors will be credited toward your deductible and out-of-pocket max.

When it comes to labs, it’s important for you to make sure your labs are being sent to Quest Diagnostics*, Labcorp, BioReference Labs, or any of our in-network lab partners**. All preventive labs sent to these locations (or another in-network lab in your state) will be $0. When sent out-of-network, your labs likely won’t be covered by your Oscar plan, which means you’ll be responsible for the cost.

*Quest Diagnostics is the only lab available in New Jersey

*Ohio Tier 1 have all three partners available, in addition to Cleveland Clinic

Where can I find an in-network provider?

Finding an in-network provider is easy! Just login to your account (opens in new tab) via our website or mobile app and then search the facility type or provider's specialty using the search textbox at the top of the homepage. You can even apply filters to provide results that best suit your preference! Don't have an account? No fear, you can also go to hioscar.com/care-options (opens in new tab) and enter some quick information to start searching for in-network providers. We promise, it's simple!

I've searched for a Doctor and I don't get any results. What does that mean?

If a specific Doctor that you are searching for is not found via our search methods it is likely that the doctor is out-of-network. Continue to check back as they may become in-network with Oscar in the future.

What will my cost share be if I received care from an out-of-network provider or facility?

Only in-network care is covered by Oscar and any out-of-network care received would default to the amount the provider or facility would charge if you didn't have insurance coverage.

There are no restrictions to types of purchases.

Yes, digital eGift cards be redeemed both online and in person.

Yes, the gift card can be used at any Walmart store.

No, the gift card will not expire.

Depending on your income, you may be eligible for cost savings on your health insurance or even a $0 Oscar Bronze plan. To get started, you will need to follow these steps to calculate your modified gross adjusted income (MAGI) which you can estimate through our guide here (opens in new tab). A general rule of thumb: If you’re a single person making less than $51,520, then you’re probably eligible for a subsidy. If you’re a family of two making less than $69,680, then you’re also probably eligible for a subsidy. Visit Healthcare.gov (opens in new tab) for more details. If the size of your subsidy is larger than the premium – or the monthly cost – of your health insurance plan, then you’re eligible for a $0 plan.

You can learn more about financial assistance and subsidies by giving us a call and speaking to a licensed enrollment guide at 855-672-2794.

This is an annual reward. Each year eligible members who complete all the steps listed above will receive this $100 Walmart gift card.

If a member has completed an action in the year(s) prior that can only be done once and is still actively signed up (i.e., account creation, downloading the app, or setting up autopay or paperless billing) it will count again each new plan year as it is completed.

The completions of the HRA survey and one primary care visit (virtual, in person, wellness, etc.) with an in-network provider for their plan year must be be done every year and do not roll over.

This Walmart gift card is digital and will be sent via email.

Note: For "opt-in" actions, the Walmart gift card will be sent if the member meets the criteria at the time action was verified (i.e., if a member opted in and then immediately opted out prior to running the reward eligibility logic, the action would be considered incomplete).

Finding a health insurance plan when you’re new to health insurance can get confusing pretty quickly when strange new industry terms are being thrown left and right. A great way to start out is by understanding the most commonly used health-insurance terms in our handy Plan Basics Guide (opens in new tab). Give us a call at 855-672-2794 or speak to your local broker to understand your options. Here are some good questions you should be asking to get the conversation started:

• I really like my doctor and I don’t want to give them up. Can you help me find a plan that covers them?
• I have a monthly prescription that I need to be covered. Can you help me find a plan that covers it?
• I have a chronic condition that requires me to visit the doctor frequently. What should I be looking for in a plan to know if it’s right for me?
• I have a family that also needs health coverage. What type of plan would fit the needs of my entire family?
• I rarely visit the doctor and I don’t have any prescriptions. What plan is right for me?

You can call your Care Team for help at (855) 672-2755.

Any member who loses their Walmart gift care can call their Care Team at (855) 672-2755.

Typically, you can only enroll in health coverage during the Open Enrollment period that takes place from November 1 to December 15 every year, unless you experience a major life event. This year is a little different.

In response to the coronavirus pandemic, the President has issued an executive order to reopen Healthcare.gov for a special, three-month enrollment period from February 15 to May 15, 2021 in order to give uninsured or underinsured individuals another opportunity to sign up for health care coverage. This means that if you are currently without health insurance or unhappy with your current coverage, you now have the opportunity to enroll and find out if you qualify for financial assistance to help pay for your coverage.

Before you sign up, it’s important to talk to your local broker or an enrollment guide to help you understand your current health care needs. Depending on what you’re looking for in a health plan, there may be many plans to consider. The process can be complicated, but that’s okay – you can call 855-672-2794 to speak to an enrollment guide who can help you find a plan that’s right for you.

You can also sign up through the health insurance marketplace (often referred to as ‘the exchange’) — for many, this will be Healthcare.gov, but some states run their own state-based marketplaces (opens in new tab).

If you are currently without health insurance or unhappy with your current coverage, you now have another opportunity to enroll. Here’s a short list of people who are eligible:

• Anyone who is uninsured
• Anyone who is currently insured but interested in better coverage
• People who are working part-time jobs
• People who are recently unemployed and have lost their employer-based coverage

All Individual and Family Plan members in the state of Florida regardless of new or renewing status, except for minor children.

Note: For renewing members who have already completed a task that can only be done once (i.e., creating an account), the task completion will automatically roll over and count in the new plan year.

When it comes to your health, having great doctors and health care experts in your corner can make a huge difference.

Here’s a list of doctors everyone should have on hand for preventive care, day-to-day issues, and emergencies (opens in new tab). Taking the time to identify your doctors in advance can help save time and frustration when you need care.

Once you find the best options for you, click the “save for later” heart icon shown at the top of the provider or facility profile page and it will automatically save that profile to your account. This way, no matter when or where you are, you’ll know who to see and where to go whenever you need care.

Primary care provider (PCP)

Consider your primary care provider (opens in new tab) the MVP of your health care squad. You'll want to pay them a visit at least once a year to get your free annual physical (opens in new tab) to check your overall health. Your PCP will serve as your first line of defense whenever you get sick or injured. They can often treat you on the spot or recommend a specialist who can help. While you don’t need a referral to see a specialist with your Oscar plan, going straight to a specialist could mean overpaying for care. That’s why it’s best to always start with your PCP.

If you are an Oscar member, remember to check and see if Virtual Primary Care (opens in new tab) is available in your market. You can book an appointment through your account online (opens in new tab) or in the Oscar app (opens in new tab).

OB-GYN

If you’re a female, you probably know an annual visit to your OB-GYN is a key part of staying healthy. Your annual well-woman exam (opens in new tab) is covered-in-full by your health plan. During the visit, your doctor will talk to you about your plans for birth control, fertility, maternity, and screening for STIs and cancer. They’ll also help advise you about other care and preventive services that you may need, such as routine mammography.

Thanks to the Affordable Care Act (opens in new tab), most forms of birth control are now paid for by your health insurance plan. There are many options for preventive birth control like the pill, IUD, or diaphragm, to name a few, and you can talk with your OB-GYN about what might work best for you.

If you are an Oscar member, you can search for an in-network OB-GYN near you that meets your needs by logging in to your account online (opens in new tab) or in the Oscar app (opens in new tab). You can also use the search tool to check and see if your birth control or other prescriptions are covered by Oscar.

Virtual Urgent Care

With Oscar, your health care squad also includes doctors and health care providers you can text or talk to on the phone through Virtual Urgent Care (opens in new tab).

You can chat through your symptoms or send a photo (great for rashes or eye issues) and the provider can help determine if you need to make a trip to your doctor’s office, urgent care, or the ER. It’s great for things like UTIs, pinkeye, sinus infections, and the flu. In some instances, the provider can call in a refill for certain prescriptions (opens in new tab), like birth control, if you're in a pinch.

Emergency room (ER)

ER visits can be time consuming and expensive. If you’re not sure whether or not you should go to the ER, you can always call Virtual Urgent Care. It’ll take a few minutes, but could end up saving you hundreds or thousands. But if it’s a true emergency, it’s important to know what in-network ER is closest to you in case you find yourself having a true health emergency.

Every insurance company has a different network of hospitals, and choosing an ER that is in Oscar’s network can help reduce costs and eliminate hassles with follow-up care.

That being said, your plan covers emergency care at a hospital outside of our network, so if you have a life-threatening emergency, go to the closest hospital, and you'll be covered by your Oscar plan. Keep in mind that any follow-up care you receive must be with a provider and facility in our network. You can search for in-network providers and hospitals from your account online (opens in new tab) or in the Oscar app (opens in new tab).

Urgent care center

Before heading to an urgent care (opens in new tab), consider speaking with a doctor or health care provider through Virtual Urgent Care (opens in new tab) first. It’s available to all Oscar members, however, if you prefer or need to go in-person, an urgent care clinic or center is a great alternative to the ER.

Many centers can get you in-and-out faster than the hospital when you receive care for conditions that are non-life-threatening. They often have basic x-ray equipment and can usually perform lab tests. Sometimes they can even treat a broken limb.

Overall, urgent cares are super convenient and it’s likely that there are multiple locations nearby. Log in to your account online (opens in new tab) or in the [Oscar app] to easily find in-network options in your area.

Your Care team

With Oscar, you’re supported by a Care Team – care guides and nurses – who can help answer your questions and save you money by finding the most affordable, highest quality care in your area. And when you need us most, the Care Team will be there for you in a way that’ll make you forget we're a health insurance company.

If you’re managing a chronic condition, receiving treatment, or have an upcoming procedure, your nurse can also help coordinate your care so you can feel better faster.

You can always message your Care Team from your account online or in the Oscar app, or call them at 1-855-672-2755.

Ready to start the search for the doctors on your health care squad? Log in to your Oscar account online (opens in new tab) or in the Oscar app (opens in new tab) to find the best doctors and health care providers near you that meet your personal needs.

If you’re a parent or legal guardian you can create an account for members who are minors (< 18 years old). Check out this link that walks you through the step by step process for creating your dependent’s new account (Versión en Español).

Step 1: Create an account (opens in new tab) using a valid email address that is not already in use by another online account.

Step 2: Follow the prompts including

• Adding your communication preferences
• Inputting minor’s information (Last name, DOB, SSN or Oscar ID)
• Inputting your information (Last name, DOB, SSN or Oscar ID)

Step 3: Confirm your relationship to the member. If you’re a parent you will receive immediate access after certifying and clicking “Continue”. If you’re a legal guardian, you’ll need to upload documents that prove legal guardianship. Once you click “Continue” you’ll see a confirmation page. We’ll review your documents and email you within 5-7 business days to provide access or request additional proof.

If you need any help with creating an account for a dependent please don’t hesitate to reach out to your Care Team at 1-855-672-2755 or message them through your account (opens in new tab) or the app (opens in new tab).

With an account you can easily pay your bill, message your Care Team, view your digital ID card and more! Click here (opens in new tab) to activate your account or login. Click here for a step by step guide to create your account (Versión en Español).

To learn about other ways to make the most out of your Oscar plan, click here to see how to navigate your account.

Say you burn your hand while cooking. Do you need to see a dermatologist or a primary care doctor? Or is it serious enough for urgent care?

At Oscar, we’re here to help you find the right doctor to treat your symptoms quickly and easily. Click here for a step-by-step guide on how to search for providers, specialists, hospitals, meds, or even symptoms! Versión en Español.

Log into your account online or in the Oscar app.

Once you’re logged in (opens in new tab) you can search for doctors, drugs, and facilities that are covered by your Oscar plan without worrying about out-of-network costs.

You can search by provider specialty and filter the results by distance, hospital affiliation, gender, language, availability, and more, so you can find providers that best meet your needs. You can even search by condition or treatment to discover your options when you’re unsure of where to go or who to see.

Keep in mind, the search results automatically use the zip code from your account to give you options closest to you, however, if you ever want to change the location, simply adjust the zip code for results in that area. If you already have a doctor or know who you are going to see, simply search their name to confirm they accept your Oscar plan before your next appointment.

Connect with a doctor virtually.

With every Oscar plan, members get access to Oscar Care — an integrated approach to health care. Oscar Care includes Virtual Urgent Care (opens in new tab) and, in some markets, Virtual Primary Care*.

Virtual Urgent Care

If it’s not an emergency, but you need care fast, your best first step is to talk with a provider or doctor using Virtual Urgent Care. You can get treated for common issues like bronchitis, sinus infections, pinkeye, allergies, UTIs, and more. They can often call in a prescription to your neighborhood pharmacy, and can help guide your next steps for care if you’re not sure if your symptoms warrant a visit to a specialist, in-person urgent care, or the ER. Consultations are available via phone and messaging and don’t need to be booked ahead of time. Request a consultation through your account online (opens in new tab) or in the Oscar app (opens in new tab).

Virtual Primary Care

Virtual Primary Care is only available in certain markets and is great for annual wellness visits, regular chronic care management, preventive care management and for forming a long term relationship with a provider who can help you manage your health for the long run. Appointments are available via video chat and phone calls and should be booked ahead of time through your account online (opens in new tab) or in the Oscar app (opens in new tab).

*Oscar's Virtual Primary Care offerings vary by market and may not be available in your area. Oscar's Virtual Primary Care offerings are only available for members ages 18 and over. Learn more (opens in new tab).

Call or message your Care Team.

With Oscar, you’re supported by a Care Team – care guides and nurses – who can help answer your questions and save you money by finding the most affordable, highest quality care in your area. And when you need us most, the Care Team will be there for you in a way that’ll make you forget we're a health insurance company.

Got a chronic condition or complex case? Your Care Team can help coordinate tests, imaging, labs, physical therapy, and can even help bridge communication gaps between provider offices.

You can contact your Care Team by calling 1-855-672-2755 or messaging them through your account online (opens in new tab) or in the Oscar app (opens in new tab).

Other helpful hints.

Before you see your new doctor, take note of any signs, symptoms, or changes in your health so you can have a productive visit. Remember to bring your Oscar ID card or download the Oscar app (opens in new tab) for access to your digital ID card. This will help the billing process run smoothly after your visit.

Want to see if your prescriptions and doctors are covered by Oscar? This video (opens in new tab) walks you through how to do that in your account online (opens in new tab) and in the Oscar app (opens in new tab).

By now, you've signed up, paid your first bill, and received your welcome kit (yay!). If you read your welcome booklet, you know there are tons of perks to being an Oscar member. You'll want to take a few extra steps, if you haven't already, to take advantage of them. You've got powerful tools, free services, and rewards waiting for you. Let's get you set up.

1. Activate your account

With an account you can easily talk to doctors for $0, get prescription refills, find in-network care, pay your bill, message your Care Team, view your digital ID card, and more! Click here (opens in new tab) to activate your account, and Click here to see how to navigate your account (Versión en Español).

2. Download the Oscar app

The Oscar App for iPhone (opens in new tab) and Android (opens in new tab) has everything you need to manage your health this year. Want to talk to a doctor at 3am? Just request a call through Virtual Urgent Care (opens in new tab) in the app and you'll be on the phone with a doctor or provider, in as little as 30 minutes. Did we mention it's $0*?

3. Set up autopay

Check out this link that walks you through how to set up autopay and pay your bill online (Versión en Español). If you don’t pay your monthly premiums on time, you risk losing your coverage and going uninsured for the rest of the year. Set up autopay on the Oscar app (opens in new tab) or in your account (opens in new tab) using the link above, and your payments will happen automatically on the last day of the month so you won’t have to worry about missing a payment.

If you prefer, you can also pay your full premium up front at any time. If you stop being an Oscar member, you’ll get refunded for your remaining premium.

4. Schedule your annual physical.

You’ll want to take advantage of your $0 annual physical (opens in new tab) benefit to get a baseline on your overall health and talk to your primary care provider (opens in new tab) about any concerns. Your primary care doctor can help you manage your health throughout the year. If you’re looking for someone new, login to your account (opens in new tab) online or in the app (opens in new tab) to search for an in-network doctor in your area. You’ll save money by going to doctors in-network with Oscar and the search tool will only surface in-network doctors. If you need help, just call your Care Team at 1-855-672-2755, and we'll help you find you someone great.

5. Complete your health profile

Completing your health profile unlocks access to Oscar Care. Once you fill out your health profile you’ll be able to request a call with a doctor or provider for $0 24/7. It’s great for common health issues like rashes, UTIs and cold symptoms. They can help diagnose and prescribe you medication when necessary. Click here (opens in new tab) to log in to your account and complete your health profile.

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure/Catastrophic plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Make sure you’re covered when it matters most and pay your bill on time. Set up autopay through your account (opens in new tab) or through the Oscar app (opens in new tab). Check out this link that walks you through how to set up autopay and pay your bill online. If you’re having any trouble, you can reach out to 1-855-672-2755 (Versión en Español).

There are a few ways to pay your bill:

• Pay online (opens in new tab) with your checking account or debit card (sorry, we can’t accept credit cards).
• Pay by check or money order using the mailing address on the bill you’ll get in the mail.
• If your spouse is on your plan, they are also able to make payments on behalf of the family.

Members can also pay their full premium up front at any time. If they stop being an Oscar member, they’ll get refunded for their remaining premium.

Here are five ways to get the most out of your Oscar membership and take powerful steps toward better, healthier living (opens in new tab).

Start off with a clean slate.

If you want to have a healthy year, it’s important to get a pulse on where you’re at right now. The best way to get the low-down on your health is to schedule an annual physical with your primary care doctor (opens in new tab). Your health insurance plan covers one annual physical each year, which includes an exam, blood test, and vaccines (opens in new tab), at no cost.

If you’ve already got a primary care doctor in the Oscar network that you like, give ‘em a call and book your appointment. If you’re new to Oscar or want to try a different doctor, you can search for doctors (opens in new tab) in your neighborhood from your account (opens in new tab) or the Oscar app (opens in new tab). If you need help finding a doctor, just give your Care Team a call at 1-855-672-2755. Also, it’s a good idea to give us a call before your appointment. We can review with you what’s covered and help you avoid surprise charges.

Build a comprehensive care plan.

If you're dealing with a chronic condition (opens in new tab) and need help managing your care, check in with your Care Team, and they can help you create the right program for your care. If you’re generally healthy, you might want to choose a team of doctors to see for routine care during the year, such as a primary care doctor, OB-GYN, and dermatologist.

Create an emergency plan.

You never know when you might need care in an emergency (opens in new tab), so it’s a good idea to make a plan in advance. Identify the hospital and urgent care clinic (opens in new tab) that's closest to your home and/or work and takes Oscar. These places will be your go-to facilities if you have an emergency, so it’s a good idea to add their info to your contacts and click "save for later" to add it to your account (opens in new tab) for easy reference.

Not sure where to go? Give us a call, and we can help you locate your neighborhood emergency facilities. If you’re away from home, don’t worry. Your plan covers emergency care at a hospital outside of our network (opens in new tab), so if you have a life-threatening emergency, go to the closest hospital, and you'll be covered by your Oscar plan. Keep in mind that any follow-up care you receive must be with a provider and facility in our network. We can always help you find one!

Get moving.

Start a healthy habit in the new year and set some activity goals (opens in new tab) to get moving. Want to know the fastest way to get in shape? Walk more. Studies (opens in new tab) have shown that low-intensity cardiovascular exercise increases fat burn. It also produces endorphins, natural mood elevators that make you feel good! Whether you enjoy a retro speed-walk with your friends or are training for the NYC Marathon, we recognize that a little healthy competition is good!

Don’t stress.

Stress (opens in new tab) is bad for your health, so as your health insurer, the last thing we want to do is stress you out. Health care can be complicated, but you can turn to your Oscar Care Team via the Oscar app (opens in new tab), account (opens in new tab) or phone anytime you need help. The Oscar app has everything you need to know about your plan, claims, benefits, and doctors. There’s even a digital copy of your ID card! Use the Oscar app to message your Care Team with questions, or talk to a doctor for $0 24/7 whenever you’re not feeling well.

Feel free to save our digits (1-855-672-2755) in your contacts so you can give us a shout whenever you need something. We look forward to hearing from you!

Oscar Virtual Primary Care (opens in new tab) is a virtual doctor’s office that comes to you. You’ll see the same team every time, and they’re with you for the long term. That way you can skip the waiting room and stay safe.

Currently, Oscar Virtual Primary Care is only available in certain markets and is great for annual wellness visits, regular chronic care management, preventive care management, and for forming a long term relationship with a provider who can help you manage your health for the long run.

Appointments are available via video chat and phone calls, and should be booked ahead of time through your online account (opens in new tab) or via the Oscar app (opens in new tab).

Virtual Primary Care is available in 2022 to Oscar members ages 18 and up on Bronze, Silver, and Gold individual & family plans in all of Texas, Miami, FL, Fort Lauderdale, FL, Palm Beach, FL, and Denver, CO. Virtual Primary Care is also available to Oscar members enrolled in non-standard Silver, Gold, and Platinum plans in New York, and to Cigna + Oscar members in Georgia and Tennessee on select Bronze and Silver plans.

Completing your health profile unlocks access to Virtual Urgent Care. Once you fill out your health profile you’ll be able to request a call with a doctor or provider for $0 24/7.* It’s great for common health issues like rashes, UTIs and cold symptoms. They can help diagnose and prescribe you medication when necessary. Click here (opens in new tab) to log into your account (or create one) and complete your health profile.

To learn about other ways to make the most out of your Oscar plan go to “How do I get set up with my new Oscar plan?” (opens in new tab)

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure/Catastrophic plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Check out this link that walks you through how to set up autopay and pay your bill online. If you don’t pay your monthly premiums on time, you risk losing your coverage and going uninsured for the rest of the year. Set up autopay on the Oscar app (opens in new tab) or in your account (opens in new tab) using the link above, and your payments will happen automatically on the last day of the month so you won’t have to worry about missing a payment (Versión en Español).

If you prefer, you can also pay your full premium up front at any time. If you stop being an Oscar member, you’ll get refunded for your remaining premium.

To learn about other ways to make the most out of your Oscar plan go to “How do I get set up with my new Oscar plan? (opens in new tab)”

The Oscar App for iPhone (opens in new tab) and Android (opens in new tab) has everything you need to manage your health this year. Want to talk to a doctor at 3am? Just request a call through Virtual Urgent Care (opens in new tab) in the app and you'll be on the phone with a doctor or provider, in as little as 30 minutes. Did we mention it's $0*?

To learn about other ways to make the most out of your Oscar plan go to "How do I get set up with my new Oscar plan?" (opens in new tab)

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure/Catastrophic plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

In order for someone else to view your health information (including claims data, dates of service, and care provided to you) you’ll have to give permission first. This is because of the Health Insurance Portability and Accountability Act or HIPAA, which protects your medical records and personal health information from being accessed by anyone else without your consent. This means your loved ones may be left in the dark in the event you’re unable to give permission during a medical emergency.

Click here (opens in new tab) to sign your HIPAA authorization. It only takes a few minutes.

If you need a physical copy sent to you or help with filling out the form reach out to your Care Team at 1-855-672-2755 or message them through your account (opens in new tab) or the app (opens in new tab).

Staying in-network (opens in new tab) is the first step to saving money when it comes to health care visits. By going out-of-network, you’re risking surprise bills and paying unnecessary and, often, avoidable costs.

To check and see if your doctor or health care provider is in-network, simply log in to your account online (opens in new tab) or in the Oscar app (opens in new tab) and type the provider’s name into the search bar.

The results will only show you the names of providers and facilities that are within Oscar’s network, so if you see their name, then you’re probably in luck! That said, even if their name appears, we encourage members to call the provider or facility beforehand to double check their network status, since they can leave Oscar’s network at any point.

If you think your provider is out-of-network, don’t worry! We’re here to help you find the care you need at the price you deserve — and sometimes there are even exceptions to getting out-of-network care.

To find out more, reach out to your Care Team by messaging them from your account online (opens in new tab) or in the Oscar app (opens in new tab), or by calling 1-855-672-2755, and they can help point you in the right direction.

Want to see if your prescriptions and doctors are covered by Oscar? This video (opens in new tab) walks you through how to do that in your account online (opens in new tab) and in the Oscar app (opens in new tab).

Being prepared for when you need care is an important step for saving time, money, and hassle. That’s why we created the ability for you to save your favorite providers and facilities to your Oscar account (opens in new tab), so you can prepare in advance and easily pick up right where you left off whenever you need to pay the doctor a visit.

Saving doctors & facilities

To start, simply log in to your account online (opens in new tab) or in the Oscar app (opens in new tab).

Once you’ve found a provider or facility you like, simply click the heart icon that says “save for later” at the top of the profile. It’s now saved to your account and can be quickly found when you’re logged in online or in the Oscar app.!Save a Doc Gif

Viewing your saved doctors & facilities

If you’re online, you can find your saved favorites by following these few steps:

• Log in to your account
• Click “Care” in the navigation at the top of the page
• Click “Your doctors & places”
• Review your saved profiles

If you’re using the Oscar app:

• Log in to the app
• Tap “Care” at the bottom of the screen
• Tap “Saved doctors & facilities”
• Review your saved profiles

Whether you want to check if your prescriptions (opens in new tab) are covered or are looking for a new doctor that accepts your plan, you’ll find everything you need using Oscar’s search tool.

To start, we’ve outlined a few quick steps and tricks to get the most out of the feature that will soon be your best friend for finding care and getting your health care questions answered in a matter of clicks.

Log in to your Oscar account.

To start, log in to your account online (opens in new tab) or in the Oscar app (opens in new tab). Don’t have an account yet? No worries, setting one up (opens in new tab) is easy and only takes a few minutes.

Type into the search bar.

Once you’re logged in (opens in new tab), begin typing what you’re looking for into the search bar. You can type in the name of a medication, doctor, or facility, and can even search by provider specialty (ie. primary care provider, dermatologist), condition, or specific treatment to learn more about your in-network options.

You can even use the search tool to help you find other health care resources and information, such as your benefits, Oscar’s drug formulary, your health survey, and more.

Narrow your results by what matters.

Once you’ve found what you’re looking for, you can browse the results and use our customizable filters to help you narrow down the options by what matters most. This is particularly helpful when trying to find a provider that is accepting new patients or has upcoming availability, along with finding facilities within a certain mile radius from your location.

For instance, if you’re searching for a primary care provider (opens in new tab), the results will show providers closest to your home, which you can then use the filters to get more specific results based on what matters most to you.

Save your favorites.

It’s always a good idea to use the search tool and get to know your in-network options even before you need care. That’s why we created the ability for you to save your favorites to your account, so you can easily find your top picks when the moment comes.

When viewing a provider or facility profile, simply click the heart icon that says “save for later” at the top of the page. The profile is now saved to your account and can be accessed online (opens in new tab) or in the Oscar app (opens in new tab).

What to know before you go.

Staying in-network (opens in new tab) is important to avoid surprise bills and unnecessary costs. While Oscar’s search tool only shows you in-network results, we still encourage members to call the provider or facility ahead of time and double check, as they can leave the Oscar network at any point over the plan year.

Still can’t find what you’re looking for?

We built the search tool to help you quickly and easily find answers and solutions to your health care needs. But, we know this doesn’t always happen like we intend. That’s where your Care Team comes into play.

Contact your Care Team (opens in new tab) any time by messaging them from your account online (opens in new tab) or in the Oscar app (opens in new tab), or by calling 1-855-672-2755. They can send you a list of recommendations that best suit your needs and help you find a new doctor or provider right away. They’re always there to help.

Check out this video (opens in new tab) that explains how to check if your prescriptions and doctors are covered by Oscar.

If it’s not an emergency, but you need care fast, your best first step is to talk with a health care provider or doctor using Oscar Virtual Urgent Care (opens in new tab).

You can get treated for common issues like bronchitis, sinus infections, pinkeye, allergies, UTIs, and more. In some cases, they can call in prescriptions to your neighborhood pharmacy, and can also help guide your next steps for care if you’re not sure if your symptoms warrant a visit to a specialist, in-person urgent care, or the ER.

Consultations are available via phone and messaging (opens in new tab) and don’t need to be booked ahead of time.

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure/Catastrophic plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Different from diagnostic care, preventive care (opens in new tab) is care you receive to prevent illness or disease and to keep your body and mind healthy!

Like most insurance plans, your plan with Oscar comes with $0 preventive care (opens in new tab) and benefits. Some examples include exams, screenings, counseling, and supplements that can help you stay healthy and catch potential issues early on.

Review your Schedule of Benefits (opens in new tab) to get a full overview of the type of health care services and treatments that are considered preventive care. You can find this by logging into your account (opens in new tab) on hioscar.com or via the Oscar app and searching “Schedule of Benefits” using the search tool.

With Oscar, you’re supported by a Care Team – care guides and nurses – who can help answer your questions and save you money by finding the most affordable, highest quality care in your area. And when you need us most, the Care Team will be there for you in a way that’ll make you forget we're a health insurance company.

You can consider your Care Team your go-to experts for any questions you have about your benefits, claims, or if you need help finding care within the Oscar network. They can also help bridge communication gaps between you and your providers, so if you’ve got a billing issue or run into any other problems, they can usually help!

You can contact your Care Team from your Oscar account online (opens in new tab) or in the Oscar app (opens in new tab), or by calling 1-855-672-2755.

Consider your primary care provider (opens in new tab) (aka PCP) the MVP of your health care squad. You'll want to pay them a visit at least once a year to get your $0 annual physical (opens in new tab) to check your overall health. Your PCP will serve as your first line of defense whenever you get sick or injured. They can often treat you on the spot or recommend a specialist who can help. While you don’t need a referral to see a specialist with your Oscar plan, going straight to a specialist could mean overpaying for care. That’s why it’s best to always start with your PCP.

If you are an Oscar member, remember to check and see if Oscar Virtual Primary Care (opens in new tab) is available in your market. You can book an appointment through your online (opens in new tab) or in the Oscar app (opens in new tab).

Depending on where you live, you might lose your coverage in the month of your birthday or at the end of the calendar year. Your parent's insurance company will let you know your last day of coverage.

Now what? It's time to get your own health insurance plan! But don't worry – it's not actually as intimidating as it sounds. Here's what you need to do.

If you can, get insurance coverage from your job.

Talk to HR about when you can enroll and whether your coverage can start right after coverage from your parents' plan ends. This way, you'll avoid a gap where you're not covered.

If you don't have a job that offers benefits...

You have 60 days from when you lose coverage on your parents' plan to purchase your own shiny new individual health insurance policy.

Do I really need health insurance if I'm healthy?

The short answer is: hell yes. Two thirds of personal bankruptcies in the U.S. are because of medical bills, so you need health insurance to protect your financial future. You'll also have to pay a nasty tax penalty if you don't have coverage for more than three months of the year.

Signing up for individual health insurance has never been easier

• First, get a quote (opens in new tab). You'll see a range of options and how much they cost. You'll also find out if you qualify for financial assistance to make your plan more affordable. If you're not earning a lot, you might qualify for Medicaid (opens in new tab) or another low-cost program provided by your state.
• Next, pick a plan (opens in new tab). Not sure which one?
• Check out the Secure plan. It's a lower-priced plan only available to people under 30 years old. It's great if you're generally healthy and just need protection from big medical bills if you get unexpectedly sick or injured. Note: You can't apply tax credits to the Secure plan.
• If you qualify for tax credits, the Bronze plan may be your least expensive option, but don't forget to check the Silver plan to see if you qualify for a lower deductible. If you need a lot of care during the year, take a look at our plans with lower deductibles. Paying a little more up front could save you a lot in the long run.
• If you need help deciding, call one of our enrollment guides at 855-672-2788. They'll help you understand your options and choose the best plan for your needs.
• Then sign up (opens in new tab). If you don't qualify for financial assistance, you can enroll directly on our website (opens in new tab) in about five minutes. If you speak to one of our enrollment guides, they can sign you up over the phone. If you qualify for financial assistance, you'll need to enroll through the Marketplace (opens in new tab) to claim your lower premium.

Check out our buyer's guide (opens in new tab) for more details on how to sign up for insurance, or get a quote (opens in new tab) to explore your plan options.

If you’ve hit your mid-20s, you’re probably wondering how long you can stay on your parent’s health insurance plan. The short answer: Under the Affordable Care Act (opens in new tab), you can stay until the age of 26. After that, you have to get your own plan.

Whether you’re looking to get insurance through your employer, university, or the insurance Marketplace (opens in new tab), here’s what you need to know to be prepared.

Staying on a parent’s health insurance plan

Up until the age of 26, you can stay on a parent’s plan as a dependent even if you:

• Start or leave school.
• Live in or out of a parent’s home.
• Are no longer claimed as a tax dependent.
• Get married.
• Have or adopt a child.
• Turn down employer-based coverage.

Your timeline to choose a new health insurance plan

When you’ll be kicked off of your parent’s health insurance plan depends on whether your parents are covered through the health care Marketplace or an employer:

• If your parents have a Marketplace plan: You have until the end of the year you turn 26 to sign up for your own health insurance plan. In order for your new individual coverage to start on January 1 of the following year, plan to enroll by the 15th of December. (Remember to tell your parents to take you off their Marketplace application, too.)
• If your parents have a job-based plan: You’ll no longer be eligible for your parent’s health insurance plan at the end of the month when you turn 26.

Getting an age 29 health insurance rider

If you live in New York state, a health insurance rider (opens in new tab) can allow you to stay on your parent’s plan through the end of the year you turn 30. You’ll need to apply for this rider during Open Enrollment, after turning 26 and before turning 29. You may be eligible for an age 29 rider if you live in New York and are:

• Not married.
• Under 29.
• Not eligible for comprehensive insurance through an employer.

Don't live in New York? Your state might still offer an extension on health insurance for young adults. Check out your state's laws here (opens in new tab).

No matter where you live, aging out a parent’s plan qualifies you for a Special Enrollment period, which allows you to choose a plan outside of Open Enrollment. Your Special Enrollment period starts 60 days before you lose coverage and ends 60 days after you lose coverage. Your plan will begin on the first day of the month after you sign up. So if you want to be insured the whole time, be sure to pick a plan before or during your birthday month. However, you won’t qualify for a Special Enrollment period if you voluntarily drop your parent’s insurance plan or if you or your parent fails to pay your insurance premiums.

Your health insurance options as a 20-something

If you’re aging out of a parent’s plan soon and need to get your own health insurance, you have a few options:

• Job-based coverage: If you’re a full-time employee, you may be eligible for health insurance through your job.
• School-based coverage: If you’re a full-time student, you may be able to get affordable health insurance through your university.
• Marketplace coverage: If you can’t get affordable health coverage through your school or your job, you can sign up through HealthCare.gov (opens in new tab) or your state's Marketplace. You may even qualify for subsidies (opens in new tab) that make health insurance more affordable.
• Medicaid or CHIP: When you sign up for health insurance, you’ll find out if you qualify for Medicaid (opens in new tab), which is low- to no-cost health insurance for people who earn less than a certain amount of money. If you’re pregnant, you may qualify for CHIP (opens in new tab), a similarly low-cost option.

What to look for as a 20-something in a Marketplace plan.

Opting for a Marketplace plan? Here are the best options by metal tier (opens in new tab) if you’re in your 20s:

• Catastrophic plan ('Secure' plans with Oscar): If you’re making great money, you may not qualify for financial assistance – but that still doesn’t mean you have to pay as much as older people who may have more health problems. A Catastrophic plan (opens in new tab) is available only to people under 30. This plan assumes that you probably won’t be spending a lot on health care, so it has a high deductible (opens in new tab)(the amount you need to pay out-of-pocket for things like medicine and doctor appointments), which translates into very low monthly costs (premiums (opens in new tab)). You can't apply subsidies to Catastrophic plans.
• Bronze plan: Similar to the Catastrophic plan, Bronze plans have high deductibles and low premiums. If you qualify for subsidies, you can apply them to get a Bronze plan for a low monthly rate.
• Silver or Gold plan: If you have a chronic condition (opens in new tab) or planned procedure and know you’ll have medical expenses throughout the year, you might consider a Silver or Gold plan. These plans have higher premiums, which means they cost more every month, but they have lower deductibles, which means you’ll owe less for each doctor or hospital visit. If you qualify for a cost-sharing reduction (opens in new tab), you may be able to get a Silver plan with a reduced deductible.

Getting health care financial assistance as a 20-something

If you’re still working your way up and won’t be listed as a tax dependent (opens in new tab) of your parents returns this upcoming year, you may qualify for financial assistance (opens in new tab) to help reduce your health plan costs. If you qualify, you’ll enroll through HealthCare.gov (opens in new tab) or your state's Marketplace for the plan of your choice, and you’ll be able to claim your subsidies there. Depending on how much you make, you may be able to get a Silver or Gold plan for less than a full-price Catastrophic plan. If your parent does claim you as a tax dependent, however, you won’t qualify for these savings based on your income.

If you lose your job or your company stops offering health insurance, you may be offered COBRA health insurance (opens in new tab) to continue your health coverage through your company’s group plan at your own expense for a limited period of time.

After you lose coverage through your employer, you have 60 days to choose a new insurance plan. If you enroll in COBRA, you can't switch to an individual health insurance plan until the next Open Enrollment (opens in new tab) period. So it's best to evaluate your options up front.

Here are five important things to do before you sign up for COBRA:

• Explore the cost of other plans (individual health plans, Medicaid (opens in new tab), etc.), including monthly premiums and out-of-pocket costs.
• See if you qualify for financial assistance. Depending on how much you expect to earn during the year, you may qualify for Medicaid (opens in new tab) or tax credits (opens in new tab) to get an individual plan at a lower price. You may also qualify for a Silver plan with a lower deductible.
• Understand the rules for applying. When you lose your job, you qualify for a Special Enrollment (opens in new tab) Period (generally for 60 days after the event) to choose an individual health insurance plan. Your coverage can start as early as the first day of the month after you lose your insurance.
• Check if the plan covers the doctors you want to see. You can do this by calling either your insurance company or your doctor's office.
• Check if the plan covers your prescriptions. Make sure your medications are covered in the insurer's formulary (opens in new tab), which is the list of drugs they cover. Look at the cost difference between your insurance options and factor that into the plan you choose.

Need help? No problem. Get a quote (opens in new tab) to explore your health insurance options, or talk to an Oscar enrollment guide at 1-855-672-2788. They can help you evaluate your options, choose the best plan, and sign up.

Individual health plans like Oscar’s cover you without any annual limits. We think that's a good thing, because the only thing worse than being sick is being sick and getting stuck with huge medical bills. But it means plans can get pricey, so we spend a lot of time helping our members save money and avoid big bills. A few smart strategies can make a big difference in the long run.

Here are our top tips.

Use the $0 stuff.

With Oscar plans, you can talk to a provider or doctor (opens in new tab) on the phone for $0 using Virtual Urgent Care (opens in new tab).* It’s great for things like bronchitis, sinus infections, pinkeye, allergies, UTIs, and more. They can often call in a prescription to your neighborhood pharmacy. You can also call 1-855-672-2755 to be connected directly with your Care Team (opens in new tab) - or just shoot them a message if you're not sure what kind of doctor to see or need help managing your care.

Take advantage of preventive care.

This includes routine wellness exams that help spot issues in advance and keep your health on the right track. For everyone, preventive care includes a $0 annual physical with a primary care doctor (opens in new tab), a $0 flu shot during flu season (opens in new tab) as well as other immunizations.

Women can get a $0 well-woman exam (opens in new tab) with an OB-GYN as well as some forms of birth control, which are available free of charge.

Avoid getting billed by making sure you see a provider who takes Oscar insurance (opens in new tab) and make sure any blood work you get done goes to an in-network lab. You'll also want to be sure the provider only performs services that are covered-in-full (opens in new tab).

We're here to help. The best way to avoid surprises is to call us before your appointment to review what’s covered. You can also log in to your account online (opens in new tab) to view our annual physical page (opens in new tab) for more information.

Log in or call us when you need care.

When you’re sick or injured, our online tools and Care Team can recommend lower-cost options for care. You can search for doctors by specialty or ask us to find you a specialist (opens in new tab). We can also help you understand what's covered and what's not so you don't end up getting surprised by a bill.

Don’t over-insure yourself.

If you're generally healthy, consider a plan with a higher deductible (opens in new tab) to get a lower monthly premium (opens in new tab). It can seem scary to have a deductible, but it may cost less in the end to pay for some care during the year rather than paying a high premium every single month.

Get help paying for your coverage.

Depending on your household income, the government might offer you financial aid (subsidies (opens in new tab)) to pay part of your monthly bill. If you think you might qualify, make sure to sign up through HealthCare.gov (opens in new tab) or your state Marketplace (opens in new tab).

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure/Catastrophic plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

You'll get a 1095-C or 1095-B form if you have insurance through your employer. If you have coverage through HealthCare.gov or your state's Marketplace, or buy your own insurance, you will have a 1095-A or 1095-B.

• 1095-A is for anyone who bought health insurance through a Marketplace. Your state or federal Marketplace should send you this form directly in the mail. Visit the IRS Form 1095-A page to learn more. Need tax advice? You may qualify for free tax assistance through the Volunteer Income Tax Assistance (VITA) program. Learn more and locate a VITA site near you. If there are any issues with your form please contact the Exchange directly.
• 1095-B (opens in new tab) is the form for people who purchased their health plans directly through an insurer. Reference these forms when you file your taxes or submit them with the rest of your paperwork to your tax preparer. As a health insurance company, Oscar does not provide tax advice, so if you have questions, contact a local tax professional.

You may cancel your Oscar Individual and Family plan at any time. You may need to do this if you get other health coverage, or for another reason.

You can end coverage for:

• Everyone on the application after your coverage has started. The termination of your coverage will take effect at the end of the month. Scheduling ahead can be helpful if you know your new coverage will start on the first day of the following month. Please note that retroactive termination is not possible without proof of overlapping coverage.
• Just some people on the application. In most cases, their coverage will end immediately.

Questions?

• Visit healthcare.gov (opens in new tab) or your state's Exchange if you enrolled directly through the Marketplace
• If you enrolled with a broker, contact them to understand your options
• If you enrolled directly with Oscar, call your Care Team at 1-855-672-2755 for more information

Tip: Try to avoid canceling your plan until you know for sure when your new health coverage begins. Once you end your coverage, you may have to wait until the next annual Open Enrollment Period (unless you qualify for a Special Enrollment Period).

As an Oscar member, what COVID-19 resources do I have access to?

If you are concerned you’ve contracted COVID-19 and/or need help deciding if you need medical care, the CDC recommends contacting your primary care physician as a first step. If you are experiencing a medical emergency, please call 9-1-1. You can also contact Oscar’s Virtual Urgent Care (opens in new tab), available 24/7 at $0 for all members except those on Secure/Catastrophic & HSA plans.

If you are not experiencing emergency symptoms, we strongly recommend you take our COVID-19 risk assessment survey (opens in new tab) to get your personalized action plan. You can also use our COVID-19 testing site locator (opens in new tab) to find testing sites in areas where Oscar plans are available.

How much will I be charged for COVID-19 treatment?

We don't want our members to worry about the cost of the care if they are diagnosed with COVID-19. Oscar will waive cost-sharing for its Individual and Small Group members for the treatment of COVID-19, and for diagnostic testing for COVID-19, including any FDA-approved at-home COVID-19 diagnostic tests. This includes the cost of the visit associated with the test and the test itself.

You need to have a positive diagnosis for COVID-19 for your care to be covered. The cost share for COVID-19 care will be waived when delivered by in-network providers. At out-of-network facilities, the cost share will be waived if the member has obtained prior authorization. There are some exceptions, such as in emergency situations, as well as based on federal and local regulations and the type of Oscar plan you have. Oscar will assess these policies as needed and as regulations change. Please visit this page for the latest updates.

What is an antibody test and does Oscar cover the cost of the test?

Oscar is following guidance from the CDC and World Health Organization as information about the SARS-Cov-2 virus (opens in new tab)-and-the-virus-that-causes-it) and antibody testing develops. According to the CDC, at this time it is not clear if those antibodies can provide immunity against getting COVID-19 again. You can learn more about how antibody testing works on the CDC’s website (opens in new tab).

Oscar covers COVID-19 antibody tests at a $0 cost-share to the member when they are administered in the following service settings for diagnostic purposes or for determining a course of treatment: emergency room, observation setting, or inpatient setting. Oscar does not cover COVID-19 antibody tests if they are administered outside of these settings, because they are not used to diagnose COVID-19 or determine a course of treatment. You will be responsible for any testing costs related to non-diagnostic COVID-19 tests, and the cost of the visit associated with the test will be covered according to your plan’s normal cost-share. Tests are only covered for members experiencing late complications of COVID-19 illness when administered in an emergency room, observation setting, or inpatient setting.

This could change if there’s more evidence about antibody testing, but we’re currently only covering antibody testing for the uses listed above.

Learn more here (opens in new tab) and visit our COVID-19 Resource Center (opens in new tab).

Lab services are one of the most common surprise bills. But, they’re easy to avoid! Whether you’re getting preventive or diagnostic (opens in new tab) tests, it’s important to remember that not all laboratories are partners of Oscar.

Oscar’s in-network lab partners include Quest, Labcorp, and BioReference Labs, which means your preventive labs will only be $0 if they’re processed at those locations or at any of our in-network labs in your state. Preventive labs sent out of network may be expensive and won’t be covered by your Oscar plan, which means you’ll be responsible for the cost.

In other words, the next time you’re scheduled for an appointment, be sure to ask your doctor’s office to send your labs to Quest, Labcorp, and BioReference Labs!

Pre-deductible benefits are benefits (opens in new tab) you get when your plan starts before you reach your deductible. To view your pre-deductible benefits go to your account online (opens in new tab) and click your Schedule of Benefits (opens in new tab).

Learn about what $0 preventive care and benefits come with your plan.

Your Oscar plan comes with $0 preventive care and benefits, so you and your family can stay healthy without paying a dime out-of-pocket.

Some examples of benefits that are covered-in-full (opens in new tab) by Oscar include your annual physical, some kinds of primary care based on your health history, your annual well-woman (OB-GYN) exam, an annual flu shot, and many immunizations.

To see what $0 pre-deductible benefits you get with your plan and which medications may be $0 log into your account online (opens in new tab).

Whether you rarely see a doctor or you’re managing a chronic condition, you can take advantage of these benefits.

Learn more about Preventive Care 101 (opens in new tab).

Learn about Virtual Urgent Care and Virtual Primary Care.

Virtual visits with providers through Oscar Care (opens in new tab) (Virtual Urgent Care and Virtual Primary Care*) are $0 for all members except those on Secure/Catastrophic & HSA plans.

What is Virtual Urgent Care?

Virtual Urgent Care is great for non-emergencies and when you need care fast. It's great for most last minute prescription refills and for acute issues like pink-eye, skin issues, minor sprains and bruises, flu, sore throat, etc. To book an appointment for Virtual Urgent Care you’ll need to create an account online (opens in new tab) if you haven’t already and fill out your Health Profile.

Learn more about Virtual Urgent Care here (opens in new tab).

What is Virtual Primary Care?

Virtual Primary Care is $0 and only available in certain markets and is great for annual wellness visits, regular chronic care management, preventive care management and for forming a long term relationship with a provider who can help you manage your health long term. Appointments are available via video chat and phone calls. Virtual visits should be booked ahead of time through your account online (opens in new tab) or in the app (opens in new tab).

Learn more about Virtual Primary Care here (opens in new tab).

*Virtual Primary Care is available in 2022 to Oscar members on Bronze, Silver, and Gold individual & family plans in all of Texas, Miami, FL, Fort Lauderdale, FL, Palm Beach, FL, and Denver, CO. Virtual Primary Care is also available to Oscar members enrolled in non-standard Silver, Gold, and Platinum plans in New York, and to Cigna + Oscar members in Georgia and Tennessee on select Bronze and Silver plans.

Copayments (opens in new tab) (or copays) are fixed dollar amounts (e.g. $20) you’re responsible for paying for a covered appointment, service, durable medical equipment, or prescription. Your copay amount will vary depending on the type of service or item you receive. Your insurance plan’s Schedule of Benefits (opens in new tab) outlines what your copays for each type of care. Copayments often come into effect after you’ve met your deductible (opens in new tab), and apply toward your out-of-pocket max (opens in new tab). Some plans also include copayments pre-deductible as well. In most instances, you'll be required to pay your copayment up front when you go in for an appointment or your doctor orders a drug or piece of equipment.

A subsidy (opens in new tab) is a form of monetary support from the exchange that applies to your premium every month. It’s important to keep the marketplace updated if there are any changes to your income to avoid unexpected changes to your subsidy. To update the marketplace make sure you upload all subsidy-related documents to your profile on the exchange website. If you need help you can contact the exchange directly or call your Care Team at 1-855-672-2755.

Click here (opens in new tab) to learn more about estimating your income to get a health insurance subsidy.

Here are some ways you can save money on your meds:

• Get your prescriptions (opens in new tab) delivered to your door. If you’re in one of our service areas (opens in new tab), you can get meds delivered right to your door with Capsule. Live outside those areas? Our preferred pharmacy partner, CVS, offers mail-order services to help you save time and money. Learn more and sign up (opens in new tab).
• Save money with $3 prescriptions (opens in new tab). We talked to doctors and analyzed member data to find ways to reduce drug costs to $3 or less. Check out our $3 meds list (opens in new tab).*
• Switch to a generic formula (if your doctor approves). Generic drugs are usually identical to brand-name drugs, and they cost less! If you’re taking a brand med, check with your doctor to see if you can switch.
• Choose a plan with prescription copays you can afford.

Be sure to understand how your plan’s prescription drug coverage works. At Oscar, some plans have copays (opens in new tab) for prescriptions, even if you haven't met your deductible. You'll also want to search your meds in your Oscar homepage search bar (opens in new tab) to make sure we cover them.

• Ask your doctor about other resources. Some drug manufacturers offer coupons, samples, or rebates that can help with the cost of your meds. Because doctor's offices deal directly with drug reps, they’re often the first to have access to these kinds of resources.

Have questions? Reach out to your Care Team at (855) 672-2755 or message them through your account online or Oscar app.

*$3 drug list only available for non-standard plans. A non-standard plan has 6T. Tier 1a indicates medication that are $3

If you have prescriptions to refill, get in touch with your in-network provider and make sure they have your in-network pharmacy info.

If you have refills left on your prescription, contact your pharmacy to pick it up.

You can also fill most meds virtually through Oscar Primary Care (opens in new tab)* or Oscar Virtual Urgent Care (opens in new tab).** Just submit a Prescription Renewal request right from your Oscar account and a provider will get in touch.

*: Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

**:Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

If you’re eligible to make the switch, we’ll send a secure message to your Oscar account.* Once you hear from us, call your pharmacy to make the switch. Then, log into your Oscar account, go to your messages, and confirm next steps. That’s it!

*Members with qualifying prescriptions will be notified of their eligibility by secure message in their Oscar App. Benefits and rewards can vary by Plan and state, and certain restrictions apply. NJ members are eligible for a $10 reward.

If your Rx isn’t covered by your plan, your doctor can ask Oscar to request an exception to our coverage rules.

To do so, have them submit a drug prior authorization (opens in new tab):

• Through an electronic PA provider like CoverMyMeds
• By fax at (844) 814-2259 for specialty drugs and non-specialty drugs
• Or by calling (855) 672-2755

Oscar tip! Generally, Oscar will only approve your request for an exception if the alternative drugs included on the plan’s formulary would not be as effective in treating your condition and/or would cause you to have adverse medical effects. Just ask your provider to send us your medical history to expedite the process.

If you live in one of our service areas (opens in new tab), you can get your meds delivered right to your door with Capsule. Learn more (opens in new tab).

If you live outside these areas, no worries! You can use our preferred pharmacy partner, CVS, for delivery. Sign up for CVS mail-order pharmacy here (opens in new tab).

We love rewarding our members for staying on top of their health. Treat yourself to something good!

See the Perks Page (opens in new tab) in your Oscar account for more information.

For more info about HelloMeno eligibility, benefits, and rewards — go to hioscar.com/hellomeno.

With Oscar, you’re supported by a Care Team (opens in new tab). These are care guides and nurses who can help answer your questions and save you money by finding the most affordable, highest quality care in your area. And when you need us most, your Care Team will be there for you in a way that’ll make you forget we're a health insurance company.

If you’re managing a chronic condition, receiving treatment, or have an upcoming procedure, your nurse can also help coordinate your care so you can feel better faster.

You can contact your Care Team from your account online (opens in new tab) or in the Oscar app (opens in new tab), or call them at (855) 672-2755.

With Oscar, you’re supported by a Care Team (opens in new tab). These are care guides and nurses who can help answer your questions and save you money by finding the most affordable, highest quality care in your area. And when you need us most, your Care Team will be there for you in a way that’ll make you forget we're a health insurance company.

If you’re managing a chronic condition, receiving treatment, or have an upcoming procedure, your nurse can also help coordinate your care so you can feel better faster.

You can contact your Care Team from your account online (opens in new tab) or in the Oscar app (opens in new tab), or call them at (855) 672-2720.

A case manager is a dedicated professional, such as a nurse, social worker, or community health worker, who partners with your health insurance plan to ensure you receive the care and support you need. Your case manager can connect you with doctors and services, help you better understand your medical conditions, and link you to valuable community resources. They are dedicated to supporting you in managing your health, answering your questions, and empowering you to make informed decisions.

Your provider will assess your health and any existing conditions, and they’ll recommend a personalized care plan for you, which may include writing prescriptions. Your Oscar Primary Care provider will not write prescriptions for you that were prescribed by another provider or specialist unless they deem them medically necessary based on your specific needs.

If you need a one-time last minute refill for something that was prescribed by a provider outside of Oscar Care, we encourage you to use Oscar Virtual Urgent Care. All Oscar members can use Oscar Virtual Urgent Care regardless of whether they have a primary care provider through Oscar Primary Care or not.

Oscar Primary Care (opens in new tab) isn’t available if you’re outside your home state. If you have an urgent healthcare need while you’re traveling domestically, use our Virtual Urgent Care (opens in new tab).

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In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

A video call is a great way to see your provider face-to-face, but you won't need a device with a camera to use Oscar Primary Care. You can always talk with your provider by phone.

It’s simple to book a phone or video chat session with your Oscar Primary Care (opens in new tab) provider for $0 using the Oscar app (opens in new tab), or via your online account (opens in new tab). First, you’ll need to create an online account (opens in new tab) and fill out your Health Profile by answering a few questions about your health history.

Once you finish creating your online account, tap “Oscar Primary Care” on your account homescreen. Then you can choose a provider and schedule an appointment. To get help with setting up an appointment, just call your Care Team at (855) 672-2755 or send them a message through your online account (opens in new tab).

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*In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit. *On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

You can book a phone or video visit right here, using the Oscar app, or logging into your Oscar account here.

If you haven’t done so already, you’ll need to create an online account and fill out your Health Profile by answering a few questions about your health history. Once that’s completed, tap “Book a Primary Care Visit” on your Oscar account home screen. Then you can choose a provider and schedule an appointment as needed. To get help with setting up an appointment, just call your Care Team or send them a message through your Oscar account.

To help you enjoy the best possible care, we have a few prep tips.

First, choose an area where you won’t be distracted and that is quiet and safe. If you’ve booked a video appointment, you’ll join the video call at your scheduled time. You can join via the Oscar app (opens in new tab) or your online account (opens in new tab).

Make sure you’re prepared and download the app from the App store (opens in new tab) or Google Play store (opens in new tab). If you’ve booked a phone appointment, your provider will call you at the phone number you provided.

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*In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit. *On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

Oscar Primary Care is great if you’re looking to establish long-term care with a primary care provider. They get to know your unique needs and can help you manage your whole health, including chronic care management for issues like high blood pressure, diabetes, and more.

When something urgent comes up, Virtual Urgent Care offers you a care alternative to get care right away for things like pink-eye, skin issues, minor sprains and bruises, flu, sore throat, etc. You can easily request a phone or message consultation from the comfort of your home through our app. However, if you’re having a medical emergency, go to your nearest emergency room or dial 911.

If you have a primary care provider that you’re happy with, there’s no need to rely on Oscar Primary Care (opens in new tab) too. It’s always best and safest to have one primary care provider (opens in new tab) who can oversee your care.

That said, if you have a primary care provider, but you’re looking for a new one, Oscar Primary Care may be a great and convenient option for you. If you want to switch to Oscar Primary Care, we are happy to coordinate with your previous provider to get your medical records.

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In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

Virtual visits by phone or video chat are $0 in select markets.* You can also message your provider between visits for $0.

After an Oscar Primary Care visit, your provider may suggest you get in-person care and will direct you to the right specialist, lab or imaging facility.

Oscar Primary Care is comprehensive care that comes to you by phone or video chat. You’ll usually talk to the same provider every time (and you can skip the waiting room). Best of all, your Oscar Primary Care visits are $0 in select markets.*

Great question! When you book your first virtual visit through Oscar Primary Care (opens in new tab), we’ll send you a vitals kit (opens in new tab) afterwards. It’ll include a blood pressure cuff and instructions on how to use it. We’ll ask you to log your blood pressure in your online account after your visit. Your doctor can then review it before your next visit. Tracking your blood pressure between visits is one of the ways your doctor can help care for you.

For 2023, Oscar Primary Care is available in TX (excluding Secure plans), NY (excluding Standard Silver, Standard Bronze, and Secure plans), FL, Palm Beach, Miami Dade, and Broward (excluding HSA and Secure plans), AZ (excluding HSA and Secure plans), GA (excluding HSA and Secure plans). Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

Oscar Primary Care (opens in new tab) is great for annual wellness visits, chronic disease management, preventive care and for forming a relationship with a provider who can help you manage your health long term. You can easily get an appointment via video chat or by phone. Just book a visit using the Oscar app (opens in new tab) or on your online account (opens in new tab).

Virtual Urgent Care (opens in new tab) is great for non-emergencies and when you need care fast. It's great for most last minute prescription refills and for acute issues like pink-eye, skin issues, minor sprains and bruises, the flu, sore throats, and more. You can get a consultation via the phone or messaging, and you don’t need to book a visit ahead of time.

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*FoIn 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

With Oscar Primary Care (opens in new tab) you can choose a primary care provider who is your long-term partner in your health. You can schedule your annual wellness visit, get support on chronic disease management, and advice on preventive care (opens in new tab). Your provider is there to help you manage your health and stay on top of next steps.

You can make an appointment via video chat, messaging, or on the phone. Book a virtual visit ahead of time using the Oscar app or your online account.

*For 2025, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Standard Silver, Standard Bronze, and Secure plans), FL (excluding HSA and Secure plans), AZ (excluding Secure plans), GA (excluding HSA and Secure plans), OK (excluding Secure plans). Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information

In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA, Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK.

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Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information*

Oscar’s Virtual Urgent Care is available on all Oscar plans. Oscar members can use Virtual Urgent Care in all 50 states, however it is not available in US territories or internationally. Prescriptions, visits and services may be limited per provider discretion.

Oscar Primary Care offerings vary by market and may not be available in your area. Oscar Primary Care offerings are only available for members ages 18 and over.

Your first Oscar Primary Care (opens in new tab) appointment is over video, a phone call, or via online messaging. If your provider suggests you need in-person care, they’ll send you to the right specialist (opens in new tab), lab, or imaging facility.

To learn more about in-person Oscar Primary Care, check out this Oscar Primary Care video (opens in new tab).

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In 2026, Oscar Primary Care is available in TX (excluding non-elite EPO Bronze plans), NY (excluding Bronze Elite and Secure plans), FL (excluding HSA Secure and EPO Bronze Elite plans), AZ, GA (excluding HSA and Secure plans), and OK. Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider’s discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.

*On HMO plans in GA and TX, and on EPO plans in Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here (opens in new tab) (opens in new window) for more detailed information*

Yes, rewards expire at the end of your benefit year.

Once you have enrolled and activated Livongo within the first three months of an active plan, Livongo will share member engagement with Oscar to provide a $50 debit card to spend towards healthy groceries.

For any preventive exam, annual wellness visit, or annual routine physical exam, the claim from your visit will serve as verification of completion and reload the original debit card with an additional $50 to spend towards groceries.

Claims for any two of the following prescribed/ordered services will serve as verification of completion, in order to qualify for subsidized access to ASH Gyms and fitness classes. Prescribed/ordered services by a physician: HbA1c, metabolic, lipid, UA (Urine Albumin), diabetic eye exam.

If you have not received your reward, you can call your Care Team at (855) 672-2755.

No, it does not exclude you from participating in other rewards and incentives programs offered by your plan.

Click here to see a full list of the items, foods and beverages that you can purchase with your healthy foods debit card.

Oswell is only available to members who are logged into their member portal. This helps keep member data private. At Oscar, member data is protected with strong encryption and security controls.

What sets Oswell apart is its personalized approach. It draws from member medical records, interactions with Oscar care guides, and plan benefit details to deliver tailored answers and support specific to the individual.

Oswell combines the best of AI with the best of expert physicians, giving members access to seamless, personalized healthcare information. When you ask Oswell a health or wellness question, he first gathers information and shares some basic guidance. If your question is more complicated, sensitive, or if you just need more help, Oswell connects you directly with our Care Team during our clinical hours (8am to 9pm, 7 days/week).

Oswell is available in English and Spanish.

Oswell provides general health and benefits information only. It is not a doctor and does not provide medical advice, diagnosis, or treatment, and does not create a provider-patient relationship. The chatbot does not provide therapy or behavioral-health treatment.The chatbot’s answers may be inaccurate or incomplete, and are not reviewed by a clinician. Do not rely on it for decisions about your health. Always talk to a qualified clinician about your specific questions. Do not ignore or delay seeking professional medical advice because of something you read here.In an emergency, call 911. For a mental health crisis, call or text 988.Use of Oswell is governed by Oscar’s Terms of Service.

Oswell covers all of your health and wellness questions. These include things like:

• “Can you help me refill my diabetes med? I forgot the name of it.”
• “My doctor said something about high cholesterol. Explain the lab results she gave me and what I should do.”
• “My hip hurts. Is it just my arthritis? Or which doctor can I see asap and how much would it” cost?

Oswell is a wellness AI chatbot built to make healthcare easier, more connected, and more personal. Oswell pulls from medical records, interactions with Oscar care guides, and plan benefit documents to help members understand their medications, explain common test results, check drug interactions, assist with prescriptions refills, review symptoms, provide questions to ask their doctors, and more.

Oswell is rolling out in phases to Oscar insurance members 18+. If you have access to Oswell, you will see it within your Oscar account. We expect to launch Oswell to all Oscar insurance members in the coming months.

There are a few ways to make a payment with us. You can:

• Set up monthly recurring autopay (opens in new tab) in your Oscar account with a saved checking account or debit card. (This is for primary subscribers.)
• Make a one-time payment with a checking account or debit card. Your payment will be processed automatically on the last day of the month.
• Send a check or money order to the mailing address shown on your monthly billing statement.

Need help setting up autopay? Here’s a step-by-step guide (opens in new tab).

First, let’s talk about what a subsidy (opens in new tab) does. It’s a form of financial support from the health insurance exchange that can help you pay your premium every month.

We get information about your subsidy directly from the health insurance marketplace, so we’re not able to update your subsidy directly.

To find more information about your subsidy, it’s best to call:

• Federal Marketplace: (800) 318-2596
• Georgia: (888) 687-1503
• Illinois: (866) 311-1119
• New Jersey: (833) 677-1010
• New York: (855) 355-5777
• Pennsylvania: (844) 844-8040
• Virginia: (888) 687-1501

Health insurance can be costly, so we’re glad you asked. Oscar works hard to keep costs down for our members, but we (and many other health insurance companies) adjust the pricing of our premiums every year. This ensures that we can keep paying for the health care our members need and provide high-quality service to our members.

If you have questions about your premium, don’t hesitate to reach out! Call us at (855) 672-2794 from 9 a.m. - 8 p.m. EST during Open Enrollment.

Lab services are one of the most common surprise bills. But they’re easy to avoid! Whether you’re getting preventative or diagnostic tests (opens in new tab), it’s important to remember that not all laboratories are partners of Oscar. it’s important to remember that not all laboratories are partners of Oscar.

Find your nearest in-network provider (opens in new tab)

If you work with these partners, your preventative (opens in new tab) labs will only be $0 if they’re processed at those locations or at any of our in-network labs in your state. Preventative labs sent out of the network may be expensive and won’t be covered by your Oscar plan, which means you’ll be responsible for the cost.

Oscar tip! The next time you’re scheduled for an appointment, be sure to ask your doctor’s office to send your labs to Quest, Labcorp, and BioReference Labs.

*Quest Diagnostics is the only lab available in New Jersey

*Ohio Tier 1 have all three partners available, in addition to Cleveland Clinic

If you have a family health insurance policy, the family deductible has a big impact on how much you spend on your healthcare during the year. Here’s how the family deductible works, and how it can benefit you.

Most health insurance plans have a deductible (opens in new tab) and an out-of-pocket maximum (opens in new tab), which work together to limit the amount of money you'll spend on health care during the year.

• Family deductible: This is the amount your family must pay out of pocket before your plan offers you additional savings and pays for another portion of the costs. Your family deductible is twice the amount of an individual deductible.
• Family out-of-pocket maximum: This is the greatest amount your family will ever have to pay out of pocket in a given year. Your plan will take care of the rest. The family out-of-pocket maximum is twice the individual maximum.

Some types of healthcare services, treatments, drugs, and medical equipment require a prior authorization (opens in new tab) to be completed before your doctor can continue with your care plan and bill your insurance. A prior authorization may also be called pre-authorization, prior approval, or precertification.

Prior authorizations are usually needed for highly-regulated or complex medical services, care, and medicines.

Oscar tip! Don’t follow through with a particular care or service until you’ve received the prior authorization approval. This will help make sure the service is covered by your plan and help avoid surprising bills.

If you’ve heard of prior authorization, you may be wondering how it works. We’ll break it down.

If your care requires prior authorization, these are the steps you need to take:

1. Talk with your doctor about what care or service is needed.

2. Once you agree on your care plan, your doctor needs to fill out a pre-authorization form (opens in new tab).

3. Oscar then needs to review and approve the request from your doctor.

4. Once insurance approves of the care or service, you and your doctor can schedule an appointment, fill a prescription, or order necessary equipment.

Oscar tip! Just because your doctor fills out the form doesn’t guarantee your health insurance plan to cover the cost. So hang tight for necessary approvals to avoid surprise bills.

Your primary care doctor (opens in new tab) (PCP) is your main doctor who manages your health. A PCP can give you recommendations on where to get more specialized care, like a cardiologist for heart issues.

Some plans require that you get a referral (opens in new tab) before you see a more specialized doctor. Here’s how it works for different types of health insurance plans:

• HMO plan (opens in new tab)* (Health Maintenance Organization): Your coverage is limited to a network of providers chosen by your insurance carrier. If you’re in need of a specialist, you will most likely need a referral.
• EPO plan (opens in new tab) (Exclusive Provider Organization): You don’t need a referral to see a specialist (opens in new tab).
• PPO plan (opens in new tab) (Preferred Provider Organization): You don’t need a referral to see a specialist.
• POS plan (opens in new tab) (Point of Service): This plan is a hybrid of an HMO and PPO plan. You’ll need to get a referral from your primary care doctor.

Even though Oscar EPO plans do not require a referral, some specialists may ask for referrals anyway. If this happens, you can talk to your primary care doctor about getting a referral.

*All Oscar plans function as an EPO except Illinois. Illinois plans are true HMOs. This means they require members to select a primary care doctor, and that referrals from the primary care doctor are required to see a specialist.

Well, it depends on your dependent’s age.

If they’re over 18, they’ll need to create an Oscar profile (opens in new tab) using their email address.

If they’re under 18, the parents or legal guardians can create an account for them! Here’s how:

1. Create an account (opens in new tab) using a valid email address (that’s not already in use by another online account).
2. Follow the prompts:

• Add your communication preferences
• Include the dependents last name, DOB, SSN or Oscar ID
• Add your info too (Last name, DOB, SSN or Oscar ID)

1. Then, you’ll just need to tell us how you’re connected to the member. If you’re a parent, you’ll receive immediate access to their account. If you’re a legal guardian, just upload any documents that prove your legal guardianship. We’ll email you within five to seven business days to provide access or request more info.

Contact Oscar or your Oscar broker as soon as possible to share the good news and add your baby to your coverage. This doesn’t happen automatically.

Your policy covers your newborn for the first 31 days.*

You have 60 days from your baby’s birth to formally add them to your policy. If you don’t add your baby within 60 days, claims for care between days 31 and 60 will be denied, and you’ll be responsible for 100% of those costs.

After 60 days, you’ll need to wait until Open Enrollment or another Qualifying Life Event (like moving) to add your baby to a plan. For more information, click here. (opens in new tab)

*Infant coverage dates vary for New York (NY) and New Jersey (NJ). If you live in NY, baby is only automatically covered for the first 48 hours post a vaginal birth, or 96 hours after a c-section birth. In New Jersey, baby is automatically covered for 60 days.

After your baby is born, you have up to 60 days (opens in new tab)to add them to your health insurance plan.

Before you do that, check if your child can get health insurance through CHIP. CHIP is a health insurance program run by the government that provides low-cost health coverage to children and pregnant women in families that earn too much money to qualify for Medicaid.

Each state has its own CHIP program and works with Medicaid. To see if your child can get CHIP, visit the official site here. (opens in new tab)

You can sign your HIPAA authorization (opens in new tab) form right in your Oscar account. It only takes a few minutes.

You can also find it at hioscar.com/forms (opens in new tab) listed as “Authorization Form to Allow Us to Disclose Your Information”. You are able to print it out and email the completed form to help@hioscar.com.

In case you’re wondering, a HIPAA authorization form allows Oscar to disclose your health information (like claims data, dates of service, and care you’ve received) to someone you trust.

You can sign your HIPAA authorization (opens in new tab) form right in your Oscar account. It only takes a few minutes.

You can also find it at hioscar.com/forms (opens in new tab) listed as “Authorization Form to Allow Us to Disclose Your Information”. You are able to print it out and email the completed form to help@hioscar.com.

In case you’re wondering, a HIPAA authorization form allows Oscar to disclose your health information (like claims data, dates of service, and care you’ve received) to someone you trust.

Make sure you're covered when it matters most and pay your bill on time.

To pay your bill:

Set up autopay through your online account (opens in new tab), through the Oscar app (we're available on iPhone and Android), or by calling your Care Team at 1-855-672-2755.

Pay online with your checking account or debit card (sorry, we can’t accept credit cards).

Pay over the phone with your checking or savings account at 1-855-672-2755.

Pay by check or money order using the mailing address on the bill you’ll get in the mail.

If your spouse is on your plan, they are also able to make payments on behalf of the family, but only the policy holder will be able to change autopay settings and change the saved payment method.

Check out this video (opens in new tab) which walks you through how to pay your bill online. If you need help don't hesitate to reach out to your Care Team at 1-855-672-2755.

Remember, you won't receive your Welcome Kit in the mail with your physical insurance card until you make your first premium payment

Where would I be able to find all the prescriptions that are covered by Oscar?

Oscar's formulary is a list of all the prescriptions that are covered by Oscar. It can be found by navigating to the "Member Resources" tab on hioscar.com and clicking "Member Forms (opens in new tab)." Enter your state and plan year and you'll see it listed under the "Drug & Formulary Information" section.

I've heard that some of the prescriptions cost only $3. Which prescriptions would qualify? The list of $3 prescriptions can be found by navigating to "Member Resources" and clicking "$3 Prescriptions (opens in new tab)" on hioscar.com.

Where can I get a cost-estimate for my prescription?

To get a cost-estimate for your prescription, navigate to your Oscar web profile or mobile app and search the prescription in the search bar. On the following page, select the appropriate drug variation and the cost will be reflected based on three different circumstances: before you have met your deductible, after you have met your deductible, and after maximum out-of-pocket has been met.

Where would I find my prescription order?

To find your prescription order, navigate to the "Care" tab on your Oscar web profile or mobile app and click on "Medications." All prescription orders will be reflected there including the pharmacy it was sent to and the number of refills available.

We make meds affordable and seamless.

You can get many commonly prescribed drugs for just $3 (opens in new tab), a prescription or free refill (opens in new tab) in our app, and get it delivered (opens in new tab) to your home. Taking the right meds at the right dosage is a critical part of staying healthy- and it should be free of hassle and worries.

1. Get your prescriptions delivered to your door.

If you’re in New York, Miami, Los Angeles, Houston or Austin, you can get meds delivered right to your door with Capsule. Live outside those areas? Our preferred pharmacy partner, CVS, can provide mail order services. Mail-order saves you money and time. Click here (opens in new tab) to learn more and get set up.

2. Save money with $3 prescriptions.

$3 Prescriptions. Yes, really.

We talked to doctors and analyzed member data to find a way to reduce drug costs to $3 or less for as many as 88 common conditions. This is a gigantic step we’re taking toward bringing costs down for everyone. Click here (opens in new tab) to learn more and use the list.

3. Switch to a generic formula if your doctor agrees it will work for you.

In most cases, generic drugs are identical to brand-name, so they’ll work exactly the same way in your body. You may already be taking the generic version of your drug, but if you’re not, it’s possible based on your health information that you could switch and lower your costs substantially.

4. Choose a plan with prescription copays you can afford.

Be sure to understand how your plan’s prescription drug coverage works. At Oscar, for instance, some plans have copays (opens in new tab) for prescriptions even if you haven't met your deductible (opens in new tab) yet. You'll also want to make sure we cover your medication. Search for the names of any prescriptions you take to be sure they're covered and to note the drug tier. This can impact how much you pay. Need help choosing the right plan to keep your prescription costs down? Speak to one of our enrollment guides at 1-855-672-2788.

5. Ask your doctor about other resources.

Some drug manufacturers offer coupons, samples, or rebates that can help you get the medicine you need. Because doctor's offices deal directly with drug reps, they’re often the first to hear of or have access to resources that can help.

We know managing your prescriptions can be frustrating, but we're here to help.

If you have questions or need help please don’t hesitate to reach out to your Care Team at 1-855-672-2755 or message them through your account online (opens in new tab) or in the Oscar app (opens in new tab).

You can find which drugs are covered by Oscar in Oscar’s drug formulary here (opens in new tab). If you have questions or need help, call your Care Team at 1-855-672-2755 or message them through your account online (opens in new tab) or in the Oscar app (opens in new tab).

Prescriptions without leaving your home — or even your couch.

Getting your meds should be hassle and worry free. Our mission is to make health care more accessible and affordable, and there’s never been a better time to simplify things for our members.

Here’s how to get your refills. You can do this with a few simple taps in our app.

Step 1: Tap "Talk to a doctor" in the Oscar app and select "Prescription Renewal" to answer a few questions about your prescription.

Step 2: A provider will get back to you and can help you get a new prescription for most things anytime.

That's it. You’ll stay healthy and safe while saving time, money, and the hassle of the waiting room.

Log in or create an Oscar account (opens in new tab) to get started.

If you have questions or need help, call your Care Team at 1-855-672-2755 or message them through your online account (opens in new tab).

What are preventive services?

Preventive services include certain services that are intended to prevent health problems. Services include certain types of immunizations, lab work, and screenings, among other services. You can see what would be deemed as a preventive service and more information by navigating to https://www.hioscar.com/benefits/preventive/.

What would be the cost share for preventive services?

If you receive preventive care from an in-network facility or provider, your care will be covered in full.

Would my annual physical be considered preventive service?

Yes, all members are eligible for one annual physical per calendar year at no cost to you.

Does Oscar have a preferred lab facility?

Oscar's preferred partners are Quest Diagnostics, Labcorp, and BioReference Labs. You'll also be able to see the results of your labs on our mobile app when they're ready.

Oscar will cover serological (antibody) tests that are ordered by a physician or authorized health care professional when ordered in an acute/emergent facility setting and are medically necessary for diagnosis or treatment of COVID-19 or multisystem inflammatory syndrome (MIS).

Maybe you already paid for a COVID-19 vaccination or booster shot with an in-network location. If this is the case, you can get reimbursed. Just submit a Member Claim Form to us. To find the form:

1. Go to the "Member Resources" tab on hioscar.com (opens in new tab) and click "Member Forms."
2. Enter your state and plan year.
3. Download the Member Claim Form.

The public health emergency officially ended in May 2023. With the ending of the public health emergency, health plans will go back to our standard benefits starting May 12th, 2023. Learn more by clicking here to visit our COVID-19 Resource Center (opens in new tab).

Treatment for COVID-19 is still covered under your health plan benefits. You’ll just have to pay your plan's normal cost-sharing (opens in new tab) rate, which may include payments up until your deductible is met, or coinsurance or copays*.

*If you have coverage in the state of California out-of-network COVID-19 treatment will be covered with no cost-sharing until 11/11/23. After that date, applicable cost-sharing will apply for out-of-network treatment.

Testing for COVID-19 is still covered under your health plan benefits, just like any other covered health condition or test. Just make sure you go to an in-network lab*. Your normal member cost share will apply.

*If you have coverage in the state of California out-of-network COVID-19 lab tests will be covered with no cost-sharing until 11/11/23. After that date, applicable cost-sharing will apply for out-of-network lab tests.

Preventative care (opens in new tab) is any care that helps prevent illness or disease, keeping your body and mind healthy.

Check out what’s considered preventive care (and covered by your plan) in your Coverage and Benefits Preventive care overview (opens in new tab).

Understanding the difference between preventative and diagnostic services is important. Let's dive in.

• Preventative care is provided when you're symptom-free and have no reason to believe you might be unhealthy. It’s primary objective is to help prevent or detect health issues before they happen, and it’s usually part of your yearly physical or checkup.
• Diagnostic care is the type of care you may receive when you have symptoms or risk factors, and your doctor wants to diagnose them.

If you have certain symptoms or a particular health history, a test that might otherwise be preventive may now be considered diagnostic. When that test is part of diagnosing a condition, it’s covered differently under your plan. It won’t be considered preventative care. This means you may need to pay all or part of the bill.

Here’s a quick example. Let’s say you’re at your yearly checkup, and your doctor recommends a mammogram because they think you might need to be screened, even though you don’t have any symptoms. That service would typically be considered preventative care and would be covered-in-full (opens in new tab). If, however, you or your doctor has noticed a symptom, like a lump, and recommends a mammogram to check it out, then the service is diagnostic (opens in new tab).

There are a couple easy ways to get tested for COVID-19.

Use an over-the-counter test:

• You can get a reliable over-the-counter COVID rapid test at a variety of retailers (like CVS). These do not require a deep nasal swab like the PCR testing early in the pandemic did and are generally easy to use.

Visit a healthcare professional:

• Lab testing for COVID-19 is still covered under your health plan benefits.This includes COVID-19 PCR or Rapid Antigen tests.
• Your standard lab deductible and cost-share may apply, but just know that you’re covered for in-network labs. If you go out-of-network for testing, though, you now have to pay up to 100% of the cost. So keep that in mind!
• You can log into your member account (opens in new tab) to view your specific lab benefit coverage details or find an in-network lab.

Don’t worry! Having a primary care provider (opens in new tab) name or provider group name on your ID card isn’t required for booking an appointment or receiving care from your physician.

Don’t worry, we'll let you know if your provider leaves the network. If this happens, you’ll have 30 days from the day the provider leaves to choose a new PCP. If you don’t choose a new PCP (opens in new tab), we'll assign one for you.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

No, you can see any PCP (preferably in-network). Your Oscar plan allows you to see any providers without a referral, but we encourage you to see providers that are in-network, so that your care is covered by your plan.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Yes, you can change your PCP as many times as you'd like via your online account here (opens in new tab) or by contacting your Care Team at (855) 672-2755.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Yes, although having a PCP name or provider group name on the ID card is not required for your physician to render care. If you would like to have your ID card replaced, please contact your Care Team at (855) 672-2755.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Your PCP assignment may be updated based on claims data. This change is automated and is made to reflect your PCP visit history.

Regardless of your assignment or designation listed on your ID card, you always have the freedom to see any other primary care provider for care. We do however encourage you to see a provider that is in-network so that your care is covered by your plan.

Your PCP assignment may be updated based on claims data. This change is automated and is made to reflect your PCP visit history.

Regardless of your assignment or provider group designation listed on your ID card, you always have the freedom to see any other primary care provider for care. We do however encourage you to see a provider that is in-network so that your care is covered by your plan.

If a PCP is not selected within 30 days, we'll auto-assign you a PCP based on your encounter and claims data. If encounter data is not available, we'll auto-assign your PCP based on your demographics and geography.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Once you are auto-assigned a PCP, then you can start to see them. However, regardless of your assignment or designation listed on your ID card, you also have the freedom to see any other in-network primary care provider for care.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

We'll notify you if your provider leaves the network and you will have 30 days from the day the provider leaves the network to select a new PCP. If you do not select a new PCP, we'll auto-assign one.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Once you select a PCP you'll get an email confirmation. Your digital ID card in your online account will be updated immediately to reflect your PCP, or your provider group if you live in South Florida, and you can expect a second, physical ID card in the mail.

You can begin seeing this PCP as soon as you're ready. Remember: seeing a PCP is not dependent on selecting one. You have the freedom to choose to see any other in network primary care provider for care.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

There are different types of PCPs which can vary by state. Types of PCPs may include: family practice & internal medicine physicians, obstetricians and gynecologists, nurse practitioners and physicians assistants and pediatricians to name a few.

To find a PCP that is in network through your online account, click here (opens in new tab) or call the Care Team at (855) 672-2755.

*This information is applicable for Individual and Family Plan members in the following areas: AR, AZ, CA, FL (Miami-Dade, Broward, and Palm Beach counties), IL, and OH. Members in AR will not receive a digital ID or physical ID card with their primary care provider's name on it.

Some types of services, treatments, drugs, or medical equipment require a prior authorization (opens in new tab) before your doctor can move forward with your care.

Prior authorizations (sometimes called pre-authorizations, prior approvals, or pre-certifications) give you the green light that your insurance plan can cover a specific type of care. They’re generally needed for highly-regulated or complex services, care, and medications.

Here’s how prior authorizations work:

• Your doctor will submit an authorization request.
• We’ll review the request for approval.
• If the request is approved, you and your doctor can move on with your care.

You can see a list of your care authorization requests here (opens in new tab).

Something to keep in mind: Not all requests are approved. So, make sure to hold off on any care until you get approval. (That way you can avoid getting a surprise bill).

You (or your doctor) might be asked to fill out a prior authorization (opens in new tab) form for certain drugs. This means that you need advanced approval from Oscar before you get your prescription filled (opens in new tab). (We do our best, but sometimes certain drugs aren't covered.)

Check out Oscar’s drug formulary (opens in new tab), also known as the preferred drug list, to see all the medications Oscar covers and any that require prior authorizations (opens in new tab). You’ll also see a breakdown for certain maximum doses and quantities that can be prescribed and covered.

If you’re an Oscar member now, you may be wondering how you should handle Open Enrollment. Here’s the scoop:

If you enrolled through HealthCare.gov or a state marketplace like NY State of Health, Covered CA, Get Covered NJ, or Pennie:

• You’ll be automatically renewed into a plan that’s most similar to your current plan, as long as you remain eligible. You should receive a notice from your marketplace if you need to do anything else to renew. If you’re happy with your current plan, then all you have to do is to pay your bill by January 1.

If you enrolled in a plan through Oscar’s site:

• You’ll be automatically renewed into a plan that’s most similar to your current plan — and we’ll notify you by mail if you need to do anything else to renew. If you’re happy with your current plan, then all you have to do is to pay your bill by January 1.

Some things to think about to make sure you renew into a plan that meets your needs next year:

• Have your financial needs changed? If you receive financial assistance in the form of a subsidy to pay for your insurance, and you’ve experienced a change in your income or household size, update your health insurance application to get the right amount of financial assistance each year.

If you didn’t qualify for financial assistance this year, but you’re experiencing a change that impacts your budget, estimate your household income for the upcoming year to see if you’ll qualify for subsidies (opens in new tab) or Medicaid (opens in new tab).

• Have your medical needs changed? Check that the providers that you need (such as a psychologist, pediatrician, or someone who is treating you now) are in-network next year. Also, look up any medications you take to make sure they’re covered too. You can search the doctors, hospitals, and drugs covered by Oscar plans here (opens in new tab).
• Have questions? Call (855) 672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

If you like your health insurance plan and want to renew it, great!. Just remember to renew your plan during Open Enrollment (opens in new tab). Fortunately, most insurers make it easy. All you have to do to “renew” your plan is keep paying your bill.

Have questions? Call (855) 672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

If you’re looking to renew your health insurance, it’s easy. Here’s what you should do:

• If you work with an insurance broker (opens in new tab), your broker can help you renew your Oscar plan during Open Enrollment.
• If you don’t work with a broker, call us at (855) 672-2794 from 9 a.m. - 8 p.m. EST during Open Enrollment. One of our licensed Enrollment Guides will be able to assist you — in English or in Spanish!

If you enrolled through Healthcare.gov or directly on Oscar’s site:

Once Open Enrollment starts on November 1, you can compare plans by logging into your online account (opens in new tab). You’ll also receive information in the mail with the details on your renewal plan before the start of Open Enrollment.

If you enrolled through your state Marketplace like NY State of Health, Covered CA, Get Covered NJ, Connect for Health Colorado, or Pennie:

Once Open Enrollment starts on November 1, you can compare plans by logging into your online account in most states*. If you have questions about your renewal, contact your broker or call us 1-855-672-2794. You’ll also receive information in the mail with the details on your renewal plan before the start of Open Enrollment.

*Oscar relies on your state’s Marketplace to send us your renewal plan information. If Oscar has not received this information, we will not be able to show you your plan comparison in your online account.

Don't have an online account? It's easy to create one on our site (opens in new tab).

Why does my premium amount change from one year to the next?

Oscar works hard to keep costs down for our members, but we (and many other health insurance companies) adjust the pricing of our premiums every year. This ensures that we can keep paying for the health care our members need and provide high-quality service to our members.

Got questions? Call 1-855-672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

Sure! If you work with an insurance broker (opens in new tab), your broker can help you renew your Oscar plan during Open Enrollment.

If you don’t work with a broker, you can call us at 1-855-672-2794 between 9 a.m. and 8 p.m. EST during Open Enrollment and one of our licensed Enrollment Guides will be able to assist you—in English or in Spanish!

If you want to switch your Oscar plan, here's what you need to do depending on how/where you enrolled:

If you enrolled through HealthCare.gov or directly on Oscar’s site: You can switch to another Oscar plan with our easy-to-use enrollment tool by logging into your online account (opens in new tab) once Open Enrollment starts on November 1. You can also use this tool to compare your Oscar plan options and to check if you may qualify for financial assistance.

If you enrolled through your state Marketplace, like NY State of Health, Get Covered NJ, Georgia Access, Virginia Insurance Marketplace, Get Covered Illinois, or Pennie: You can switch to another Oscar plan once Open Enrollment starts on November 1 in most states*. Switch to a new Oscar plan through your state Marketplace by contacting your broker or calling us at (855) 672-2794.

• * If you enrolled through the NY State of Health marketplace, you need to wait until November 16 to make a plan change for the upcoming year.

Have questions?

• Call (855) 672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

If you enrolled through HealthCare.gov or a state Marketplace like NY State of Health, Covered CA, Get Covered NJ, Connect for Health Colorado, or Pennie:

You’ll be automatically renewed into a plan that’s most similar to your current plan, as long as you remain eligible. You should receive a notice from your Marketplace if action is required to renew. If you’re happy with your current plan, then all you have to do is to pay your bill by January 1.

If you enrolled in a plan through Oscar’s site:

You’ll be automatically renewed into a plan that’s most similar to your current plan—we’ll notify you by mail if any action is required to renew. If you’re happy with your current plan, then all you have to do is to pay your bill by January 1.

There are some things to consider to make sure you’re renewing into a plan that meets your needs next year:

Have your financial needs changed? If you receive financial assistance in the form of a subsidy to pay for your insurance, and you’ve experienced a change in your income or household size, update your health insurance application to get the right amount of financial assistance each year.

If you didn’t qualify for financial assistance this year, but you’re experiencing a change that is impacting your budget, estimate your household income for the upcoming year to see if you’ll qualify for subsidies (opens in new tab) or Medicaid (opens in new tab).

Have your medical needs changed? Check that the providers that you need (such as a psychologist, pediatrician, or someone you’re in the middle of treatment with) are in-network next year. Look up any medications you take to make sure they’re covered too. You can search the doctors, hospitals, and drugs covered by Oscar plans here (opens in new tab).

Got questions? Call 1-855-672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

In the health insurance world, a renewal is when you re-enroll in the same health insurance plan for another year. Health insurance plans typically last for a calendar year, so if you want to continue being covered, it’s important to renew during Open Enrollment (opens in new tab). But don’t worry - in most cases all you have to do to “renew” is to keep paying your bill.

Got questions? Call 1-855-672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

Absolutely. You can turn your healthy habits into real savings by applying earned points directly to your monthly premium.

As long as your Oscar plan stays active, your points stay in your wallet. Use them now or save them for later — your call!

Watch your points add up in real time right inside your Oscar dashboard. When you're ready to redeem them, you can transfer your points to your Oscar Debit Card to spend however you like. Or you can apply them directly towards your monthly premium.

Many points land in your dashboard as soon as your visit, lab, or task claim is processed — typically within a few business days. If the reward is connected to a claim, it could take up to 90 days.

Don’t worry, we'll let you know if your PCP leaves our network. We’ll send you an e-mail 60 days before your provider leaves. If you don’t choose a new PCP within those 60 days, we'll assign one to you.

Think of your primary care provider (PCP) (opens in new tab) as the MVP of your health care team. You'll want to pay them a visit at least once a year to get your $0 yearly physical to check your overall health.

Your PCP will serve as your first line of defense whenever you get sick or injured. They can often treat you on the spot or recommend a specialist who can help. While you don’t need a referral (opens in new tab) to see a specialist with your Oscar plan, going straight to a specialist could mean overpaying for care.

If you are an Oscar member, remember to check and see if Oscar Primary Care (opens in new tab) is available in your market. You can book an appointment in your online account or in the Oscar app.

Going paperless lets stay in touch and get you important info faster. (It’s also nice for the trees.)

Here’s how you set it up:

1. Navigate to the Settings page of your Oscar account (opens in new tab)
2. Scroll down to the ‘Paperless’ section
3. Toggle on the ‘All communications’ button

You did it!

Enroll during Open Enrollment

Open Enrollment (opens in new tab) is the time of year when anyone can sign up for a health insurance plan or switch plans. In most states, it starts November 1 and finishes up December 15. You’ll also renew your plan every year during this time period. You can evaluate if you want to stay on the plan you have or make a change. During other times of the year, you can only sign up if you’ve recently lost coverage from a job or had another kind of "qualifying life event." (opens in new tab)

Where to sign up

If you're interested in Oscar, the easiest way to sign up is right here (opens in new tab). Start by getting a quote, tell us a little about your health to see which plans we recommend (don’t worry, nothing you say there will impact your price), and follow the enrollment prompts. It takes about five minutes if you don’t qualify for financial assistance and a few more (well worth it) minutes if you do.

If you’re qualified for Advance Premium Tax Credits, you’ll finish the enrollment process on the government marketplace website for your state, which might be New York State of Health (opens in new tab), Covered California (opens in new tab), or HealthCare.gov (opens in new tab). You can also apply directly through these marketplaces to see all the plans from all the insurers in your area.

How to sign up

Having the right information at your fingertips during the enrollment process will help things go smoothly once you start your application. Gather the following information for yourself and any family members who are going to be on your health plan:

• Full legal name.
• Date of birth.
• Social Security number.
• Immigration information like visa or green card numbers, if applicable.
• Employment information including the amount each person in your household expects to earn in the upcoming year, employers' names, addresses, and phone numbers. A copy of your most recent tax return is a good place to find a lot of this information.

When estimating your income (opens in new tab), keep in mind that you can update your application during the year if you’re earning more or less than you originally expected. Give your best estimate at the time you apply and check in quarterly if your income is unpredictable.

After you complete your application, you’ll see a confirmation screen that confirms your effective date. This is the date your coverage begins. You don’t owe a payment when you sign up, but you’ll have to pay your first bill in order for your coverage to start on your effective date. If you don’t pay within 10 days of your effective date, your enrollment could be canceled.

You can choose dental or vision insurance separately. You can enroll directly with those insurers or add them on to your application through the marketplace. Keep in mind that you can sign up for dental and vision insurance anytime during the year.

Ready to go? It all starts with getting a free personalized quote (opens in new tab) or give us a call and talk to a licensed plan guide at 855-672-2788.

Rule of thumb: a year. Most health insurance policies run from January 1 to December 31.

If you're interested in Oscar, it’s easy to get a quote and enroll online (opens in new tab). First, tell us a little about your health to see which plans we recommend (don’t worry, nothing you say there will impact your price) and then follow the enrollment prompts. It takes about five minutes if you don’t qualify for financial assistance and a few more (well worth it) minutes if you do.

If you’re qualified for Advance Premium Tax Credits, you’ll finish the enrollment process on the government marketplace website for your state, which might be New York State of Health (opens in new tab), Covered California (opens in new tab), Get Covered NJ (opens in new tab) or HealthCare.gov (opens in new tab). You can also apply directly through these marketplaces to see all the plans from all the insurers in your area.

You will need to renew or enroll in health insurance coverage each year! Here are a few ways to make sure you’re covered:

• If you’re already an Oscar member you can keep an eye out for a plan renewal notification that will be sent to you before Open Enrollment (opens in new tab).
• If you work with an insurance broker (opens in new tab), your broker can help you renew your Oscar plan during Open Enrollment.
• You can also call us at (855) 672-2794 from 9 a.m. - 8 p.m. EST during Open Enrollment. One of our licensed Enrollment Guides will be able to assist you — in English or in Spanish!

If your plan is not meeting your needs, you can switch to another plan if you have a qualifying life event, or during Open Enrollment for the next plan year.

If you’re sure you want to cancel your plan, here’s how:

• If you enrolled through the Marketplace, visit HealthCare.gov (opens in new tab) or your state's exchange website.
• If you enrolled with a broker, contact them directly.
• If you enrolled directly with Oscar, call us at (855) 672-2755.

Before canceling, make sure you’re aware of the following:

• If you cancel your plan, you won’t be able to re-enroll in coverage outside of Open Enrollment for the next plan year, unless you have a qualifying life event.
• There are significant benefits to having coverage — and risks to going without. Medical care without insurance can be costly, so it’s important to be protected against the unexpected.
• Plan coverage can help keep you healthy with free preventive care.

In order to save money on health insurance, it will depend on how much you earn. You may qualify for financial assistance in the form of tax credits immediately applied to your premiums to make your coverage more affordable.

If you qualify, you can apply your tax credits (opens in new tab) to any plan in the marketplace. To qualify for tax credits, you have to report the income you expect to earn as a household (that means your spouse’s paycheck, your kids' jobs, etc.).

If you’re married, you have to file your taxes jointly to qualify for assistance. If you’re married but filing separately, you won’t be able to claim tax credits. To claim your credits, you have to enroll through the marketplace.

If you want to switch your Oscar plan, here's what you need to do depending on how/where you enrolled:

If you enrolled through HealthCare.gov or directly on Oscar’s site: You can switch to another Oscar plan with our easy-to-use enrollment tool by logging into your online account (opens in new tab) once Open Enrollment starts on November 1. You can also use this tool to compare your Oscar plan options and to check if you may qualify for financial assistance.

If you enrolled through your state Marketplace, like NY State of Health, Get Covered NJ, Georgia Access, Virginia Insurance Marketplace, Get Covered Illinois, or Pennie: You can switch to another Oscar plan once Open Enrollment starts on November 1 in most states*. Switch to a new Oscar plan through your state Marketplace by contacting your broker or calling us at (855) 672-2794.

• * If you enrolled through the NY State of Health marketplace, you need to wait until November 16 to make a plan change for the upcoming year.

Have questions?

• Call (855) 672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

If you want to switch your Oscar plan, here's what you need to do depending on how/where you enrolled:

If you enrolled through HealthCare.gov or directly on Oscar’s site: You can switch to another Oscar plan with our easy-to-use enrollment tool by logging into your online account (opens in new tab) once Open Enrollment starts on November 1. You can also use this tool to compare your Oscar plan options and to check if you may qualify for financial assistance.

If you enrolled through your state Marketplace, like NY State of Health, Get Covered NJ, Georgia Access, Virginia Insurance Marketplace, Get Covered Illinois, or Pennie: You can switch to another Oscar plan once Open Enrollment starts on November 1 in most states*. Switch to a new Oscar plan through your state Marketplace by contacting your broker or calling us at (855) 672-2794.

• * If you enrolled through the NY State of Health marketplace, you need to wait until November 16 to make a plan change for the upcoming year.

Have questions?

• Call (855) 672-2794 to speak to an Enrollment Guide during Open Enrollment. As an Oscar member, you can also call or message your Care Team through your Oscar account online or in the Oscar app.

Medicaid Redetermination is the process in which individuals & families reapply to keep their Medicaid coverage for themselves and beneficiaries, or transition to another type of coverage, including ACA, if they’re no longer eligible for Medicaid.

Wondering what makes Oscar different? With Oscar, you can expect:

• An entire team available to you: Oscar Care (opens in new tab) gives you personalized virtual care from the comfort of your home, at work, or on-the-go.
• $3 prescriptions: We talked to doctors and analyzed member data to find ways to reduce drug costs to $3 or less. Check out our $3 meds list.*
• An easy way to find a doctor: Use the search tool (opens in new tab) to get access to top-rated hospitals and doctors in your neighborhood

*$3 drug list only available for non-standard plans. A non-standard plan has 6T. Tier 1a indicates medication that are $3

Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Before enrolling in health insurance there are a few things you should do:

1. Figure out where to apply. If you’re interested in getting insurance through your state, check out the federal marketplace, HealthCare.gov (opens in new tab).

2. Estimate your household income. You’ll need an estimate of your total household income before tax for the upcoming year.

3. Make sure an individual plan is right for you. You may not be able to get a plan through HealthCare.gov (opens in new tab) if you:

• Get insurance through your job. If your employer (or your spouse’s employer) offers health insurance, you can’t buy insurance through the healthcare exchange unless their plans are deemed “unaffordable.” For more information regarding employer-sponsored coverage and the exchange you can review the information provided on HealthCare.gov.
• Qualify for Medicaid or CHIP. Medicaid (opens in new tab) and CHIP (opens in new tab) are more affordable options for low-income people. You can find out if you qualify for Medicaid in your state (or qualify for subsidies (opens in new tab) on a Marketplace plan) at healthcare.gov/lower-costs (opens in new tab).

4. Figure out who needs coverage. Maybe you’re the only person who needs an individual health insurance plan because you’re not married or your spouse’s insurance doesn’t cover family members. Or maybe you, your spouse, and your kids all need a family plan. Whatever the case, you’ll want to be sure everyone in your household, including your dependents (opens in new tab), is covered.

5. Note everyone’s social security number and dates of birth. You’ll need both for everyone who will be on your plan.

6. Gather immigration paperwork, if applicable. If anyone in your family is not a citizen, but needs insurance, see HealthCare.gov’s full listing of immigration document types (opens in new tab).

7. Jot down everyone’s employer information. You’ll need the employer business names, addresses, and phone numbers for everyone in your household who files a tax return.

8. Grab your tax return from last year. You’ll use this to input your tax information. It also helps you to determine your modified adjusted gross income (MAGI) (opens in new tab), which is used to figure out if you qualify for tax credits or any other savings with a exchange plan.

9. Pick your plan. Do your research to figure out what kind of plan is best for you and your family.

For more information about Oscar's plans available in your area, please visit https://www.hioscar.com/individuals (opens in new tab).

If you're looking to sign up for health insurance, there are multiple avenues available:

• National Health Insurance Marketplace: To enroll in an ACA plan, visit healthcare.gov (opens in new tab), the national marketplace website, where you can explore a wide range of health insurance plans offered by different insurers.
• State-based Health Insurance Exchanges: Depending on your state, you may have a state-based health insurance exchange (opens in new tab) that you'll use to apply and enroll in coverage.
• Private Insurance Companies: If you’d like to sign up for a health insurance plan directly through a private health insurer such as Oscar, you can do so on our website at hioscar.com/individuals (opens in new tab), or contact the insurer directly.
• Health Insurance Broker: Health insurance brokers are licensed professionals who are experts in health insurance. They can guide you through the enrollment process on the exchange, or through an insurer directly.
• Employer-sponsored Health Insurance: If you're employed, check if your employer offers health insurance coverage. Speak with your Human Resources department or benefits coordinator to get the necessary information.

If you enrolled in an Oscar plan through the health insurance marketplace (also known as the exchange), the exchange will send your 1095-A tax form by paper mail by mid-February. Please note that Oscar does not have your tax form if you enrolled through the exchange, only the exchange does.

Contact the exchange directly if delivery is delayed or if the information on your tax form is incorrect:

• Federal Marketplace: Call (800) 318-2596 or visit healthcare.gov (opens in new tab)
• Georgia: Call (888) 687-1503 or visit georgiaaccess.gov (opens in new tab)
• New Jersey: Call (833) 677-1010 or visit nj.gov/getcoverednj (opens in new tab)
• New York: Call (855) 355-5777 or visit nystateofhealth.ny.gov (opens in new tab)
• Pennsylvania: Call (844) 844-8040 or visit pennie.com (opens in new tab)
• Virginia: Call (888) 687-1501 or visit marketplace.virginia.gov (opens in new tab)

If you enrolled in an Oscar plan directly with Oscar, log in to your account, go to Documents & Forms (opens in new tab) and scroll down to the ‘Tax Forms’ section. You should see your 1095-B tax form by mid-February. Please note that only the plan subscriber will see the tax form in their account.

Great question! If you’re traveling in the U.S, in-person urgent or emergent care services are fully covered (as long the visit is considered medically necessary (opens in new tab)).

Check our more details about travel coverage on the Benefits page in your Oscar account (opens in new tab). And this FAQ for international travel info (opens in new tab).

If you’re traveling internationally, you’ll have coverage for life and limb emergencies only, rendered in emergency settings.

Just know that you’ll most likely have to pay out of pocket and then submit a reimbursement form (opens in new tab). You’ll then need to provide some documentation that shows:

• The dates of service
• The amount paid out of pocket
• Itemized bills or receipts for the services provided
• The diagnosis or nature of illness
• The level of medical care (i.e. Did the injury warrant a visit to the ER or urgent care?)

Oscar pro tip: Make things easier for yourself and collect all the needed documents when you receive service.

When you book your first virtual visit through Virtual Primary Care (opens in new tab), you’ll be sent a Vitals Kit (opens in new tab) which includes a blood pressure cuff and thermometer along with instructions on how to use the devices. Tracking your blood pressure and temperature during and between appointments is one of the main ways your provider can determine if you are at risk of any conditions.

Learn more here (opens in new tab).

Not at all. You can join visits using your smartphone, tablet, or computer via the Oscar app or online web account. All you need is a phone line or internet connection.

Not at all. Oscar Virtual Care is available 24/7, and you can connect with a clinician in as little as 15 minutes.

Depending on your plan, you may be eligible for $0 follow up services when they’re prescribed or ordered by your provider through Oscar Care (opens in new tab) (either Oscar Virtual Urgent Care or Oscar Virtual Primary Care where available).

Virtual Urgent Care

When prescribed by a provider through Virtual Primary Care (opens in new tab), the following services are $0**:

• $0 drugs (Tiers 1A and 1B)
• $0 labs
• $0 initial specialist visits
• $0 durable medical equipment (DME)
• $0 diagnostic imaging
• $0 vitals monitoring kits

$0 follow up services are not available in California or on any HSA-compatible or Secure plans in any state.

Learn more about Virtual Primary Care here (opens in new tab).

*Oscar's Virtual Primary Care offerings are only available for members ages 18 and over. Oscar’s Virtual Primary Care offerings vary by market and may not be available in your service area. Visits and services may be limited per provider discretion.

**$0 prescriptions, labs, and imaging vary by market and may not be available in your service area. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 follow-up services. Prescriptions, visits and services may be limited per provider discretion.

You can book a phone or video chat session through Oscar Virtual Primary Care for $0 using the Oscar app (opens in new tab), or your account (opens in new tab). If you haven’t done so already, you’ll need to create an account (opens in new tab) and fill out your Health Profile by answering a few questions about your health history.

Once that’s completed, tap “Virtual Primary Care” on your account homescreen. Then you can choose a provider and schedule an appointment as needed. To get help with setting up an appointment, just call your Care Team at 1-855-672-2755 or send them a message through your account.

Virtual Primary Care is available in 2022 to Oscar members on Bronze, Silver, and Gold individual & family plans in all of Texas, Miami, FL, Fort Lauderdale, FL, Palm Beach, FL, and Denver, CO. Virtual Primary Care is also available to Oscar members enrolled in non-standard Silver, Gold, and Platinum plans in New York, and to Cigna + Oscar members in Georgia and Tennessee on select Bronze and Silver plans.

For members with Secure/Catastrophic plans:

Unfortunately we’re no longer able to offer Virtual Primary Care (opens in new tab) visits to members on Secure/Catastrophic plans. Members will still have access to Virtual Urgent Care (opens in new tab), but it will no longer be $0*. You can search here (opens in new tab) to find another primary care provider near you, and your Virtual Primary Care team will assist to make sure that your transition to another provider is a seamless one. If you'd like to continue to use Virtual Primary Care, we recommend checking out Oscar's other plans available in your area (opens in new tab).

For members with Bronze plans:

Virtual Primary Care (opens in new tab) visits will continue to be $0, but the other $0 benefits you might’ve enjoyed last year will no longer be available in 2022, including Tier 1 drugs, labs, imaging, or durable medical equipment. You’ll no longer be eligible for a $0 office visit for your first visit with a specialist or $0 behavioral health visits. You’ll pay for those services according to your plan benefits, so make sure to take a look at your renewing plan documents to better understand your costs.

If you'd like, you can renew into a Silver, Gold, or Platinum (where available) plan to continue to get $0 Tier 1 drugs and labs in 2022. We recommend checking out Oscar's other plans available in your area (opens in new tab).

For members with Silver, Gold, or Platinum plans:

Virtual Primary Care (opens in new tab) visits, Tier 1 drugs, and labs will continue to be $0, but you’ll no longer receive $0 imaging or durable medical equipment. You’ll no longer be eligible for a $0 office visit for your first visit with a specialist or $0 behavioral health visits. You’ll no longer be eligible for a $0 office visit for your first visit with a specialist or $0 behavioral health visits. You’ll pay for those services according to your plan benefits, so make sure to take a look at your renewing plan documents to better understand your costs.

Note: Virtual Primary Care (opens in new tab) plans are only available to members 18+.

• Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Yes! Oscar Virtual Care is included with your plan membership at a $0 copay. There are no hidden fees or extra costs for virtual visits.

Your provider will order tests directly to an in-network lab or imaging center near you. You just show up for your test, and results sync right back to your profile.

Virtual visits with providers through Oscar Care (opens in new tab) (Virtual Urgent Care and Virtual Primary Care) are always $0. Then, depending on your plan, you may be able to access other $0 follow up services.

Virtual Urgent Care

Tier 1 meds, when prescribed by a provider through Oscar Virtual Urgent Care will be $0. Be sure to show the pharmacist your Oscar Care Rx Card to reduce the price to $0. Note: $0 Tier 1 meds are not available through CVS Caremark Mail Order delivery. Learn more about Virtual Urgent Care here (opens in new tab).

Virtual Primary Care*

When prescribed by a provider through Virtual Primary Care, the following services are $0**:

• $0 drugs (Tiers 1A and 1B)
• $0 labs
• $0 initial specialist visits
• $0 durable medical equipment (DME)
• $0 diagnostic imaging
• $0 vitals monitoring kits

$0 follow up services are not available in California or on any HSA-compatible or Secure plans in any state.

*Oscar's Virtual Primary Care offerings are only available for members ages 18 and over. Oscar’s Virtual Primary Care offerings vary by market and may not be available in your service area. Visits and services may be limited per provider discretion.

**$0 prescriptions, labs, and imaging vary by market and may not be available in your service area. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 follow-up services. Prescriptions, visits and services may be limited per provider discretion.

Oscar Care (opens in new tab) gives you a unique virtual care experience from the comfort of your home, at work, or on-the-go. With every Oscar plan, members get access to Oscar Care - an integrated approach to health care. Oscar Care includes Virtual Urgent Care (opens in new tab) and, in some markets, $0 Virtual Primary Care (opens in new tab) visits.

Oscar's Virtual Primary Care offerings vary by market and may not be available in your area. Oscar's Virtual Primary Care offerings are only available for members ages 18 and over. Learn more here (opens in new tab).

Virtual Urgent Care (opens in new tab) is great for non-emergencies and when you need care fast. It's great for most last minute prescription refills and for acute issues like pink-eye, skin issues, minor sprains and bruises, flu, sore throat, etc. when you can't get an appointment with your doctor. Consultations are available via phone and messaging and don't need to be booked ahead of time. To request a consultation for Virtual Urgent Care you’ll need to create an account (opens in new tab) if you haven’t already and fill out your Health Profile. In your account (opens in new tab) or the app (opens in new tab) click “Care” and then "Virtual Urgent Care” (opens in new tab).

Virtual Primary Care (opens in new tab) is only available in certain markets and is great for annual wellness visits, regular chronic care management, preventive care management and for forming a long term relationship with a provider who can help you manage your health long term. Appointments are available via video chat and phone calls. Providers through Virtual Primary Care are here for you to help you stay on top of your health. Virtual visits should be booked ahead of time through your account (opens in new tab) in the Oscar app (opens in new tab) or at hioscar.com/member (opens in new tab).

Learn more at hioscar.com/virtual-primary-care.

Virtual Primary Care is available in 2022 to Oscar members on Bronze, Silver, and Gold individual & family plans in all of Texas, Miami, FL, Fort Lauderdale, FL, Palm Beach, FL, and Denver, CO. Virtual Primary Care is also available to Oscar members enrolled in non-standard Silver, Gold, and Platinum plans in New York, and to Cigna + Oscar members in Georgia and Tennessee on select Bronze and Silver plans.

Yes! We can send visit summaries, prescriptions, and lab results directly to your local doctor so your care stays completely connected.

It’s easy! Plus, you don’t need to book your consultation ahead of time.

• First, create an account (opens in new tab) if you haven’t already and fill out your Health Profile.
• In your online account (opens in new tab) or the Oscar app (opens in new tab) click “Care” and then “Virtual Urgent Care (opens in new tab)”.
• Fill out some key information and get a call or message back in as little as 15 minutes.

You can also call your care team directly at (855) 672-2755 and speak to someone who can help you schedule a visit directly.

Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Completing your health profile unlocks access to Virtual Urgent Care (opens in new tab). Once you fill out your health profile you’ll be able to request a call with a doctor or provider for $0 24/7.* It’s great for common health issues like rashes, UTIs, and cold symptoms. They can help diagnose and prescribe you medication when necessary. Click here to log into your account (opens in new tab) and complete your health profile.

*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits, and services may be limited per provider discretion.

You may be wondering when you should use Virtual Urgent Care (opens in new tab). This service is great for non-emergencies and when you need care fast. It's also great for most last minute prescription refills and for acute issues like pink-eye, skin issues, minor sprains and bruises, flu, sore throat, and more. Or you can try using it when you can't get an appointment with your doctor.

You can easily get a consultation on the phone or via online messaging. And, it doesn’t need to be booked ahead of time. To book an appointment for Virtual Urgent Care you’ll need to create an account (opens in new tab) if you haven’t already and fill out your Health Profile. In your online account (opens in new tab) or the Oscar app (opens in new tab) click “Care” and then “Virtual Urgent Care (opens in new tab)”.

Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.

Great news! All Oscar Members can use Virtual Urgent Care (opens in new tab). The service is available at no extra cost ($0), except for those members with HSA-compatible high-deductible health plans or Secure plans. If you have an HSA-compatible high-deductible health plan or Secure plan, you’ll have to pay a portion of the cost (called cost sharing). Also, Oscar’s Virtual Urgent Care offerings aren’t available in U.S. territories or internationally.

If you need to see a provider and still don’t have your ID card, no problem. You can view your virtual ID card at any time within the home page of your online member account under 'Quick Links'.

To change or update the personal information on your ID card (like your name or address) follow these steps:

• If you bought a plan through an exchange: Just contact them and let them know what’s changed. You’ll find the number of all state-based exchanges on healthcare.gov or on the state's health insurance exchange website.
• If you bought a plan directly through Oscar: And you’re the primary account holder or responsible party, just send us a secure message or contact your Care Team directly.

One thing to note: Your new address needs to be within Oscar’s existing service area to keep your coverage going.

To change or update the personal information on your ID card (like your name or address) follow these steps:

• If you bought a plan through a state-based exchange: Just contact them and let them know what’s changed. You’ll find the number of all state-based exchanges on healthcare.gov or on the state's health insurance exchange website.
• If you bought a plan directly through Oscar: And you’re the primary account holder or responsible party, just send us a secure message or contact your Care Team directly.

One thing to note: Your new address needs to be within Oscar’s existing service area to keep your coverage going.

Oscar doesn’t have group numbers for our members on the Individual and Family Plans, so don’t worry that it’s not on your ID card. If someone requested your Group ID, just let them know you don’t have one.

You should receive your welcome kit and ID card within 10 business days after plan enrollment.