Oscar Health Insurance Review: Great Member Benefits, but Limited Availability

Oscar Health Insurance Review: Great Member Benefits, but Limited Availability

Policies available in a limited number of counties and have slightly higher prices compared to competitors.

Good for

  • Member benefits (Oscar app and Doctor On-Call)
  • Customer service through its concierge team
  • Hospital and provider networks

Bad for

  • Limited availability
  • HMO or PPO plans
  • Vision, dental and short-term insurance
  • Cheap rates

Editor's Rating

4.5/5.0

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Oscar Health Insurance is a startup that provides individual and business health insurance policies. The company's plans are more expensive when compared to competitor policies and are limited to a small number or states and counties. However, Oscar excels at its customer service, and its member benefits are recognized as some of the best in the health insurance industry. Overall, the company is a good choice if it is available in your area and you want personalized healthcare coverage.

Oscar Health Insurance: Our Thoughts

Oscar Insurance offers individual and business health insurance plans through its website and on state marketplaces. It has an Exclusive Provider Organization (EPO) network, meaning that coverage from any provider in the network will be free or eligible for co-insurance from the company. However, if you go outside the provider network, you would have to pay extra or full price for services. The deadline to purchase health insurance through Oscar would be during the last day of the Obamacare open enrollment period. But you can also acquire coverage outside of this period if you have a qualifying life event. As with other insurers, health insurance through Oscar can be purchased with a credit card.

Oscar provides an easy search function for finding EPO providers. While visiting the website, interactive maps, reviews and ratings will pop up when you search for the type of coverage or prescription drugs you need. Then you can interact directly with the provider and plan a visit. Say you are looking for acupuncture options in New York City — you would go online to the Oscar website, enter your ZIP code, and select the service you need to be provided from a list of qualified in-network acupuncture providers in your area.

Oscar offers health plans to a limited number of states and counties:

StateAreas of Availability
ArizonaPhoenix
California
  • San Francisco
  • Los Angeles
  • Orange County
FloridaOrlando
New JerseyStatewide
New YorkStatewide
Ohio
  • Cleveland
  • Columbus
Texas
  • Austin
  • San Antonio
  • El Paso
Tennessee
  • Nashville
  • Memphis

Since Oscar is still a startup, these are the only states in which its currently available. Oscar plans on expanding its medical insurance coverage in the future to access more parts of the country.

Oscar Health Insurance Plan Options & Costs

There are three levels of plans for individual health insurance that Oscar sells: Simple, Saver and Classic health policies. The main differences between policy levels are the out-of-pocket expenses and deductibles. Furthermore, the categories also differ in the size of co-pays and co-insurance for specific health services. This can include prescription drugs and specialty providers like dermatologists or therapists.

Although the plans have differences, they all are Affordable Care Act (ACA) qualified health policies and thus cover the essential benefits. Under the legislation, this includes free preventative care, an annual physical, pregnancy services and certain forms of birth control.

Oscar plans do cover preventive lab testing, but it must be processed by Quest Diagnostics or another in-network laboratory to be covered. If you own or purchase an Oscar policy, make sure to ask your doctor to send any lab work to a preferred provider.

If you are looking to cancel your Oscar health policy you can do so either directly through Oscar or via your state health insurance marketplace. Sample policies below are based on plans offered in New York City. Deductibles and monthly premiums for these plans will vary depending on your county.

Simple Health Policies

The Simple category of health policies are the most affordable plans that Oscar offers. These insurance plans cover 100% of any healthcare costs once you have reached the out-of-pocket maximums. Simple plans come in four different metal tiers: Secure, Bronze, Silver and Gold, with each having a deductible and out-of-pocket maximum being the same. This means that as you pay for medical services, you would reach the deductible and out-of-pocket maximums at the same time.

Metal tierDeductibleOut-of-pocket maximumsMonthly cost for a 30-year-old
Secure$7,900$7,900$162.09
Bronze$7,900$7,900$459.55
Silver$7,350$7,350$647.57
Gold$5,000$5,000$797.20
Sample policies are for plans in New York, New York.

The Simple category is best if you are in excellent health and will not require many medical services, as these policies have higher cost-sharing, yet cheap monthly premiums.

Oscar's Simple Secure plan is a Catastrophic health insurance policy which has the cheapest premium but highest deductible. This plan is only available if you are under 30 years old or have received a hardship exemption.

Saver Health Policies

The Saver category policies have different levels for the deductibles and out-of-pocket maximums when compared to health plans in the Simple category. Once you reach the deductible for a Saver health insurance policy, you would begin co-insurance and split any medical costs with Oscar. And once the out-of-pocket maximum is met, any in-network health costs would be fully covered by Oscar. Oscar Health Insurance offers Saver plans in Bronze, Silver and Gold metal tiers.

Metal tierDeductibleOut-of-pocket maximumsMonthly cost for a 30-year-old
Bronze$6,650$6,650$451.70
Silver$2,500$5,500$590.44
Gold$1,500$4,500$744.49
Sample policies are for plans in New York, New York.

As you can see, the higher metal tiers like Gold will have a lower deductible and out-of-pocket maximum, but you will be required to pay a larger monthly premium for this level of coverage. Furthermore, Silver and Gold Saver plans will be eligible for 30% and 20% co-insurance, respectively, once the deductible for the policy has been met. The Saver category is best if you need more comprehensive medical insurance coverage, but cannot afford to buy the Classic category plans.

Classic Health Policies

The most expensive policies offered by Oscar are in its Classic category. The primary difference between Classic and Saver or Simple policies is that Classic plans have lower deductibles, meaning you will gain quicker access to co-pays and co-insurance.

Metal tierDeductibleOut-of-pocket maximumsMonthly cost for a 30-year-old
Bronze$4,000$7,600$478.58
Silver$1,700$7,500$650.31
Gold$600$4,000$816.91
Platinum$0$2,000$1,019.39
Sample policies are for plans in New York, New York.

As you can see, Classic plans have smaller out of pocket expenses compared to other Oscar policy categories, but have the highest monthly premiums. Additionally, Silver, Gold and Platinum Classic policies have before-deductible co-pays for some services like generic and preferred drugs. For example, the Classic Silver tier will have a $10 co-pay for generic drugs before the deductible is met, whereas you would pay the full price with the Saver Silver policy. So if you require a monthly drug prescription, a Classic tier plan would be a great policy to consider.

Classic plan pricing through Oscar is slightly more expensive when compared to competitive plans from other health insurance providers. Below is a graph that shows Classic Silver policies from Oscar against its main competitors. For an individual adult, for instance, Oscar's plan is 11% more expensive — or $63 per month — than the cheapest plan offered through HealthFirst.

Oscar vs Competitors

Business Health Insurance

Oscar offers small business group health insurance that is fully customizable depending on your number of employees. This is a newer service for Oscar and is only available in five areas:

  • New York
  • New Jersey
  • Nashville
  • Los Angeles
  • Orange County.

For employers, you have the ability with Oscar to manage your company's health benefits through its online tool. Here you can make easy payments and quickly add or edit employees if they are hired or leave your company. Your employees would have identical member resources as individual health plan policyowners.

Member Resources and Unique Features

Oscar has many standard health resources, but also offers some unique policyholder benefits when compared to other health insurance providers. All of these resources can be accessed through the Oscar smartphone app or online website.

Once you have purchased an Oscar health plan, you will receive a welcome kit that includes your plan ID cards, a summary of the policy benefits, and a look at other free perks and benefits. This includes a gym membership reimbursement of $400 per year and up to $200 per covered spouse.

In the app and website, you can monitor your progress toward the deductible and view relevant health topics like managing your mental health through their blog. Additionally, you can track your steps and get rewarded with up to $100 in Amazon gift cards per year if you reach your step goal.

Oscar Concierge Team

Oscar assigns you a concierge team that can assist you with your health insurance. This is a group of professionals including healthcare guides and nurses who can provide you on-demand help regarding your health. Services offered by the concierge team include solving billing issues, finding the best urgent care clinic or emergency room, checking the availability of doctors, and answering any policy questions you may have.

Additionally, the concierge team never changes, so you get the same Oscar employees every time. This allows the employees and health professionals to get to know you and your specific health insurance policy. The concierge service can also be accessed through the Oscar app where you would video conference with the care professionals.

Doctor On-Call

A doctor on-call service is also available to Oscar members. This is known as telemedicine and lets you have a face-to-face conversation with an in-network doctor who works with Oscar. In this service, you would be able to request a call from the Oscar app at any time during the day and include a picture of your symptoms. Then you would chat with a doctor to explain your health history and current discomfort. Finally, the doctor would give you a diagnosis and even send a prescription to a pharmacy for you to pick up.

Both the concierge and Doctor On-Call services are best if you want personalized customer service. Furthermore, you want an on-demand health evaluation or help instead of having to make an appointment and visit a health provider. So, for instance, if you were having back pain and could not go to a doctor, you could contact the doctor on-call through the Oscar app who would diagnose the issue. Then, if the issue was severe, he or she could recommend and make you an appointment with a chiropractor.

Customer Reviews and Complaints

If you are looking for a reliable company that has outstanding customer perks and services, then Oscar Health Insurance is a great choice for coverage. Customer reviews for Oscar are positive overall, with many customers stating the best parts are the online app and Doctor On-Call service. However, some policyholders have complained about the thin network of coverage and the inability to find a provider quickly. For this reason, if you have a preferred doctor, you should confirm with Oscar that you will be able to receive care from that provider before purchasing a policy. Other policyholders have had issues with the lack of states that Oscar operates in along with the no dental and vision insurance.

Oscar has also been rated well by some of the largest ranking companies and has an A- from the Better Business Bureau (BBB). Furthermore, it has an NAIC complaint ratio of 0.12, which indicates that it receives fewer complaints than the median company when taking into account its size.

Oscar has a corporate office in New York City and was founded in 2012 by Mario Schlosser and Josh Kushner.

Comments and Questions

Editorial Note: The editorial content on this page is not provided or commissioned by any financial institution. Any opinions, analyses, reviews, statements or recommendations expressed in this article are those of the author’s alone, and may not have been reviewed, approved or otherwise endorsed by any of these entities prior to publication.