Oscar - Simple Silver - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits

Texas, 2017

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $7,150

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $7,150
Deductible (Family) $14,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging No charge after deductible

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $4,500
Deductible (Family) $9,000
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $2,000
Deductible (Family) $4,000
Out of Pocket Maximum (Individual) $2,000
Out of Pocket Maximum (Family) $4,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Texas

Plan Market Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits Deductible $3,000 Coinsurance Not applicable Out of Pocket $3,000
Plan Market Gold Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Simple Secure Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Market Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $7,150
Deductible (Family) $14,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging No charge after deductible

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $4,500
Deductible (Family) $9,000
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $2,000
Deductible (Family) $4,000
Out of Pocket Maximum (Individual) $2,000
Out of Pocket Maximum (Family) $4,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Texas

Plan Market Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Simple Gold - Free Telemedicine, Free Generic Drugs, $10 Primary Care Visits Deductible $3,000 Coinsurance Not applicable Out of Pocket $3,000
Plan Market Gold Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Simple Secure Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Simple Bronze - Free Telemedicine, $5 Generic Drugs, Step Tracking Rewards Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Market Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150