Making sense of health insurance

Learn what you need to know to find an individual and family plan that’s right for you. We’ll break down the Affordable Care Act (ACA), how the plans work, and your best options with Oscar.
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So, what’s the ACA?

The Affordable Care Act (ACA), also known as Obamacare, helps all Americans have access to affordable health insurance coverage. We’re all about that.Understanding what ACA health plan is right for you can be overwhelming and confusing. We're here to help make it a little easier.

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.

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The fixed monthly fee you’ll pay for your health insurance plan.

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A fixed dollar amount you’re responsible for paying for a covered service.

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How much you owe for a covered service after your plan pays their share.

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The amount spent on certain covered services before your plan starts paying for care.

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Out-of-pocket maximum

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.

image of bronze, silver, gold, and platinum health plan metal tiers with details of each

*Oscar's Platinum plans are only available in New York state.

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.

Three boxes illustrating Oscar's three types of plans - Simple, Classic, Elite

*Bronze Elite plans feature $0 medical deductibles but may have a separate Rx deductible.

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.

Image of hand holding Oscar insurance card that reads "EPO"

EPO (Exclusive Provider Organization)

Full access to the network. No referrals required. Limited out-of-network benefits.

Image of hand holding Oscar insurance card that reads "HMO"

HMO (Health Maintenance Organization)

Full access to the network. No out-of-network benefits.

Image of hand holding Oscar insurance card that reads "PPO"

PPO (Preferred Provider Organization)

Full access to the network. Out-of-network benefits. No referrals required.

Ways to save on health insurance

Health 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 (PTCs) are a type of financial assistance, or subsidy, available to Marketplace enrollees. PTCs help reduce the monthly cost (or premium) of your health insurance plan. You qualify for a premium tax credit if your estimated annual household income falls within certain income levels for your household size. The lower income, the larger the credit. You can apply premium tax credits toward any metal level of coverage.
    • 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. 
    • 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
    • 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
    • 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

How & when to enroll in a health plan

Enrollment options

Enrollment timelines

Every 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.
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Oscar members enjoy access to affordable, convenient care

Here's what you'll love as an Oscar member:

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Great providers near you

Find doctors, hospitals, and pharmacies near you that accept our plans. See providers that understand your language, race, ethnicity, and health history.

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A supportive Care Team

Your Care Team will help you find virtual or local providers, give cost estimates for care, and offer support whenever you need it.

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Virtual care anywhere

Enjoy virtual care from the comfort of your home, at work, or on-the-go. All Oscar plans include Oscar Care, which has $0 Virtual Urgent Care1 and, in some places, $0 Oscar Primary Care.2

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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

$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.

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An app at your fingertips

Get care, refill prescriptions, message your Care Team, and look up benefits — all on-the-go with the Oscar app.

Oscar Medical coverage is underwritten by Oscar Insurance Company located in New York, New York. Plans sold in New York are underwritten by Oscar Insurance Corporation located in New York, New York. Plans sold in Florida are underwritten by Oscar Insurance Company of Florida. Plans sold in New Jersey are underwritten by Oscar Garden State Insurance Corporation. Administrative Services for all plans provided by Oscar Management Corporation. Plans sold in Texas use policy form numbers OSC-TX-IVL-EOC-2024/OSC-TX-IVL-EOC-2024-HIX and associated COC forms OHIN-133765733/OHIN-133765677/OHIN-133656589/OHIN-133656586. Plans sold in Virginia use policy form number OSC-VA-IVL-EOC-2024-HIX/OSC-VA-IVL-EOC-2024 with associated COC form number OHIN-133619594/OHIN-133619595. HMO products are offered by Oscar Insurance Corporation and Oscar Buckeye State Insurance Corporation in Ohio, Oscar Health Plan, Inc. in Arizona and Illinois, Oscar Health Plan of Pennsylvania, Inc in Pennsylvania, Oscar Health Plan of Georgia in Georgia, Oscar Health Plan of North Carolina, Inc. in North Carolina, Oscar Managed Care of South Florida, Inc. in Florida, and Oscar Health Plan of New York, Inc. in New York.All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs, and complete details of coverage, contact a licensed agent or Oscar sales representative.
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.
For 2024, Oscar Primary Care is available in TX (excluding HSA, Secure, and non-elite Bronze plans), NY (excluding Standard Silver, Standard Bronze, and Secure plans), South FL (Palm Beach, Miami-Dade, and Broward, excluding HSA and Secure plans), Northern/Central FL (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. In Northern and Central FL markets there may be a cost share associated with your visit. Please view plan details here for more detailed information.
$3 Prescriptions include up to 30-day supply of medication and are not available in NY, NJ, or for Catastrophic plans, small group plans, or Medicare plans.