Oscar Health Insurance Review 2024 (2024)

Oscar Health began in 2012 and now is the third-largest for-profit national insurer in the U.S. individual market.

Oscar Health provides coverage in three types of health insurance markets—individual and family, group and Medicare Advantage.

Oscar Health says it approaches the notion of a provider network in a different way compared to other health insurers. The health insurer says that in several cities, including New York, San Francisco and San Antonio, its networks are “curated,” providing “a suite of care options like a broad network, while driving the cost savings, clinical integrations and quality outcomes of a narrow network.”

Oscar’s ACA marketplace plans are available in:

• Arizona
• Florida
• Georgia
• Illinois
• Iowa
• Kansas
• Missouri
• North Carolina
• Ohio
• Oklahoma
• Tennessee
• Texas
• Virginia

Oscar Health offers three types of insurance plans on the health insurance marketplace:

• HMO plans: A health maintenance organization (HMO) plan generally has lower premiums than other health plans. But HMOs also usually restrict you to only see in-network providers who either work directly for or contract with the HMO. You have to typically pay for out-of-network care with no help from the health plan. HMOs also usually require referrals from your primary care doctor to see a specialist. An HMO often has lower premiums than those of other types of health insurance.
• EPO plans: An exclusive provider organization (EPO) plan requires you to stay within the plan’s network, if you want the insurance to cover your services. You don’t need a referral from your primary care doctor to see a specialist, though. Premiums are usually similar to HMOs, but lower than a PPO.
• PPO plans: A preferred provider organization (PPO) health care plan lets you see any providers and doesn’t require you to get a referral from your primary care provider before seeing a specialist. Out-of-network care usually costs more than if you get care in-network. PPO health insurance premiums may be higher than those of other insurance plans.

ACA plans are divided by metal tier (bronze, silver, gold or platinum). A metal tier depends on a plan’s premiums and out-of-pocket costs. Bronze plans have the lowest premiums but highest out-of-pocket costs and deductibles. Platinum plans have the highest deductibles and lowest out-of-pocket costs. Oscar Health offers bronze, silver and gold plans.

If you’re looking to pay the least for coverage, bronze and silver plans are your best bet but remember that those cost more when you need care. If you would prefer paying more upfront with the understanding that you won’t have to pay as much when you seek care, a gold or platinum plan is likely best for you.

Oscar Health offers two services at no extra cost to policyholders:

• Virtual urgent care
• Virtual primary care

Those services also offer prescriptions, including some at no cost to members. Other prescriptions are available to Oscar Health policyholders for as low as $3.

Breathe Easy Plan

For those with chronic obstructive pulmonary disease or asthma, Oscar offers a Breathe Easy plan. If you enroll in the plan, you get the following benefits at no additional cost: pulmonologist and PCP visits, pulmonary rehabilitation, oxygen services, Tier 1 preferred generics, nicotine replacement and behavioral health services.

Enhanced Diabetes Care Plan

Those enrolled in the Enhanced Diabetes Care plan can get the following benefits: $0 primary care physician visits, diabetic foot and retinal eye exams, labs, wellness programs, unlimited testing supplies and health coaching.

Mobile App Sync

The Oscar app syncs with both Google Fit and Apple Health. You can earn $1 daily if you hit your step markets with a maximum of $75 per year, depending on where you live.

An Oscar health insurance plan costs $407 monthly on average for a 30-year-old with an ACA marketplace plan. An ACA plan’s cost typically increases with age, which makes it different from group health insurance through an employer.

Average Oscar Health Insurance Costs by Age

ACA marketplaces plans are divided based on costs. There are four metal tiers: bronze, silver, gold and platinum. Bronze and silver plans have the lowest premiums but the most out-of-pocket costs when you need healthcare. Platinum and gold have higher premiums but fewer out-of-pocket costs, which means less money when you need care.

Bronze and silver plans are the most common type of plan, while platinum plans are fairly rare.

Average Oscar Health Insurance Costs by Metal Plan

Oscar Health’s average monthly premiums are better than many competitors and could be a good bet if you are looking for affordable health insurance.

Average Monthly Costs for ACA Marketplace Plan by Company

HMOs: Average Monthly Health Insurance Costs

EPOs: Average Monthly Health Insurance Costs

Complaints filed with state insurance departments against Oscar Health for individual health insurance are about 1.5 times higher than the industry average, but lower than some competitors. Complaint ratios reflect the number of complaints relative to an insurer’s size of business.

Another rating for Oscar is from the National Committee for Quality Assurance. NCQA gave the company 2.5 stars out of five for a New York-based health plan, the only Oscar plan with an NCQA rating.

Oscar received its highest marks (2.5 out of 5) for treatment but only 1.5 for prevention and 1 for how health plan members rated the plan’s services.

We used the following data to determine the best health insurance companies.

• Complaints made to state insurance departments (30% of score): We used complaint data from the National Association of Insurance Commissioners.
• Plan ratings from the National Committee for Quality Assurance (30% of score): The National Committee for Quality Assurance is an independent, nonprofit organization that accredits health plans and produces ratings based on specific metrics.
• Average silver plan deductible (20% of score): The deductible is how much you have to pay for healthcare services in a year before the health plan begins picking up a portion of the costs.
• Breadth of health plans (10% of score): Health insurance companies may offer up to four types of plan benefit designs (PPO, HMO, EPO and POS).
• Metal tier offerings (10% of score): We gave points to companies offering more metal tiers. The ACA marketplace has four metal tier levels.