Making sense of health insurance
So, what’s the ACA?
Understand the costs associated with a plan
The cost of your health insurance depends on your monthly premium, deductible, and out-of-pocket max. It’s important to know these costs upfront because they vary across plans and will impact what you owe.
The fixed monthly fee you’ll pay for your health insurance plan.
A fixed dollar amount you’re responsible for paying for a covered service.
How much you owe for a covered service after your plan pays their share.
The amount spent on certain covered services before your plan starts paying for care.
The maximum amount you’ll pay for covered health care services during the plan year.
Choosing a health plan tier
The Marketplace categorizes plans into metal tiers: Bronze, Silver, Gold, and Platinum. You will receive the same quality of care and the same benefits for all tiers. The difference between them is the monthly premium and the amount you’ll pay for care.
Selecting a plan type
Within each metal tier, Oscar offers 3 plan types, or suites: Simple, Classic, and Elite. The difference between them is the breakout of coinsurance and copays.
The differences between HMO, EPO, and PPO plans
HMO, PPO and EPO are abbreviations for health insurance plans. Plans vary by what doctors you can see and how much you’ll pay for healthcare services.
EPO (Exclusive Provider Organization)
Full access to the network. No referrals required. Limited out-of-network benefits.
HMO (Health Maintenance Organization)
Full access to the network. No out-of-network benefits.
PPO (Preferred Provider Organization)
Full access to the network. Out-of-network benefits. No referrals required.
Ways to save on health insuranceHealth insurance can be expensive. But going without it can be more expensive in the long run. Here are some ways to save:
- Premium tax credits
- Cost sharing reductions
- Cost-sharing reductions (CSRs) are another type of financial assistance, or subsidy, available to Marketplace enrollees. CSRs help lower the amount you pay for copays, coinsurance, and deductibles. You qualify for the cost-sharing reduction if your estimated annual household income falls within certain guidelines of the Federal Poverty Level. Unlike the premium tax credit, which can be applied toward any metal level of coverage, cost sharing reductions are only offered through Silver plans.
- Use in-network providers
- Once you enroll in a plan, ensure that you receive care from providers that are in-network. Providers in our network have already agreed to our negotiated rates. Even if you have a deductible 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 maximum. You can find in-network care at hioscar.com/care-options.
- Know where to go for care
- If you have a minor health issue, visit your in-network primary care provider. You can talk to a healthcare provider anytime using Virtual Urgent Care. They can provide immediate care for urgent problems like pink-eye, skin issues, minor sprains, bruises, flu, or a sore throat. Only visit the emergency room if you have a life-threatening emergency. You can find in-network care at hioscar.com/care-options.
- Use your covered preventive care services
- All Oscar plans cover preventive care at no cost to you when you visit an in-network doctor. Preventive care includes annual checkups, screenings, vaccines, and more. That’s a great way to stay on top of your health and save at the same time. Find out more about the essential health benefits covered by Oscar, which includes preventive care and more. Find an in-network provider at hioscar.com/care-options.
How & when to enroll in a health plan
- Visit hioscar.com/individuals
- Call your broker
- Go to healthcare.gov or your state’s health insurance marketplace
Enrollment timelinesEvery year, you can buy health insurance, switch plans, or renew your plan through the Marketplace during the Open Enrollment Period. This period typically lasts from November 1 to January 15, depending on where you live. After the Open Enrollment Period ends, the Special Enrollment Period begins. You qualify for a Special Enrollment Period if you experience a qualifying life event, such as losing health coverage, moving, getting married, or having a baby. Depending on your Special Enrollment Period type, you will have 60 days from the event to choose new coverage. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time.
Oscar members enjoy access to affordable, convenient care
Here's what you'll love as an Oscar member:
Savings with $3 meds
Many commonly prescribed prescription drugs are as little as $3.3 Get a prescription or refill through the Oscar app, and get it delivered right to your door.
$0 preventive care
Your plan fully covers preventive care. That means your annual checkup, vaccines, or screenings (like blood pressure or cholesterol) are all $0.