Oscar is a newer name among health insurance providers, but it has grown from its initial startup since its founding in 2012. The company values simplicity and communication, so it seeks to simplify policies in order to better cover the needs of its clients.
With Oscar, customers can find plans with health savings accounts (HSAs) and traditional health insurance plans for individuals and families. Oscar also offers Medicare. Oscar does not offer dental or vision coverage.
Oscar Health Insurance was created to give customers a new, simple way to get health insurance and affordable care. Its plans include perks for things like reaching a fitness goal.
Oscar puts a strong emphasis on technology to cater to customers’ needs and add convenience to health care.
Open Enrollment for 2020 health care plans runs November 1, 2019-December 15, 2019. If you missed the open enrollment period, check to see if you qualify for a special enrollment period.
Oscar tries to ensure that all clients find an easy health care plan to suit their individual needs. Oscar offers both on and off exchange individual plans in all states in which it operates, plus small business plans in New York, New Jersey, and Tennessee. Under the Affordable Care Act on- and off-exchange plans must cover essential health benefits, like primary care, hospital stays, and mental health services. (The health insurance exchange is a government-created marketplace, also called the health insurance marketplace.)
Oscar's coverage options include: Health Savings Account (HSA)-compatible plans and self-funded options. From the company's website, t's unclear what kinds of networks Oscar's plan options include. It's common for health insurers to offer plans with in- or out-of-network coverage. For example, Health Maintenance Organization (HMO) plans only cover in-network care, except in emergencies. Preferred Provider Organization (PPO) plans cover in-network care and out-of-network care. Even though a PPO plan offers more flexibility with providers than an HMO plan, your out-of-pocket costs will typically be higher if you see an out-of-network provider than for seeing an in-network provider with a PPO network plan.
Oscar also offers Medicare Advantage plans. It does not offer Medicaid services.
Oscar offers three plan options:
These plans are also organized using the metal tier system created by the Affordable Care Act. Depending on your area, each Oscar insurance product can be a bronze, silver, gold, or platinum plan. Bronze plans put the most cost-sharing on policyholders, while platinum plans put the least. Bronze plans also have lower deductibles. Platinum plans typically have much higher deductibles.
All Oscar Plans have free Doctor on Call telemedicine services, rewards for steps tracking, an Oscar Concierge team, and pre-deductible preventive care benefits to keep out-of-pocket costs to a minimum for both specialty and brand-name drugs.
Oscar Classic plans generally match the policy and structures of most of the plans on the individual insurance market.
However, Oscar Simple plans are easier to understand, because clients only have one dollar amount to remember: all covered services are free after clients hit their deductible. This is because the deductible is set at the same level as the maximum out-of-pocket amount. (Note: Care that happens before the deductible is met requires a copay, coinsurance, or full payment by consumers.)
Oscar Saver plans are HSA-compatible plans with low monthly premiums and a higher deductible. Members use the money in their HSA to pay for health care throughout the year.
Oscar Backup plans are a low premium, high deductible option designed for healthier people who was to save on upfront medical expenses.
Before becoming a member, potential clients can receive free quotes of premiums from Oscar's website or by phone. With this tool, a customer can answer a few general questions about themself (zip code, age, how many people they want to cover) as well as about their expected medical needs in the next year. Through this brief process, Oscar can direct clients to the most cost-efficient health plan with the person's health in mind.
Individuals are then able to see all of Oscar insurance plans, costs (deductibles, copays, out-of-pocket maximums, and health insurance premiums, including government subsidies if you qualify), benefits, and recommended options to help decrease out-of-pocket costs.
After clients pay the first premium, Oscar sends a welcome kit, which includes the client's ID card(s), an in-depth look at the free perks and benefits, as well as the individual's Schedule of Benefits and Coverage. This welcome kit also has a "Health Care Cheat Sheet" to help break down all the details of the chosen insurance coverage within the individuals' plan.
Lastly, Oscar offers a web account and mobile app to its customers. The online account and health insurance app allow users to search for health professionals covered by Oscar's plans, book appointments with healthcare providers, and view detailed doctor credential information and reviews to find the one(s) best suited to handle their specific needs. The Oscar app makes the features of the member portal more convenient to access on the go.
Members can call or message their Concierge team by simply clicking a button within the app. This app also provides members with a "Health Timeline", which contains their personal medical information and history such as appointments, prescriptions, lab results, and billing information.
Oscar has unique features that many other competing health insurance companies do not. One of these is the fast registration process. Because the company emphasizes simplicity, Oscar has taken many steps to remove the complication of choosing a health insurance plan and registering. It also seeks simplicity by providing efficient customer service, clarifying information on health insurance policy and potential medical expenses, and more.
Each member is also assigned to a Concierge team and a nurse, which allows customers to receive specialized service. This team can assist with finding doctors, booking appointments, coordinating care for complex or chronic medical issues, providing clinical guidance, and resolving billing or reimbursement issues.
Furthermore, instead of casting a wide net and contracting with every health care provider, Oscar has developed a curated network of medical groups and doctors in each of its service areas to ensure tighter integration and higher quality health insurance policy for members. Additionally, they use data science and complex modeling to assess network coverage, provider quality, and service volume to improve their offerings.
Oscar also provides rewards to customers who reach their step goals. Customers track their steps using the health apps that come with iPhones and Androids. When they reach their daily step goals, they can receive up to $240 per year.
Oscar provides excellent customer support. They provide phone support from 8 a.m.-8 p.m. Monday-Friday local time in each of its markets, and 9 a.m.-5 p.m. on weekends. When clients call or secure message Oscar, you are connected to a Concierge team. This unique model provides customers with additional support. Each Concierge team consists of a care guide and a registered nurse.
In addition, due to the nurse's experience on the team, they can also handle clinical questions, including assessing a member's needs and connecting them with the proper type of doctor to address their needs. Concierge teams proactively reach out to members if they visit the ER or hospital unexpectedly to make sure they are okay and that they have done all the follow-ups the doctors requested. Because they're familiar with you and use Oscar's powerful backend systems to see your history instantaneously, there is never a need to be passed off to another department.
Oscar also provides what they call Doctor on Call, a telemedicine service that lets members talk to a doctor 24/7 for free over the phone. This service is especially convenient for getting medical advice when you don't want to take a trip to the doctor's office.
Oscar health insurance plans are only available to customers in some parts of the United States, including New York, New Jersey, California, Texas, Ohio, Michigan, Florida, Arizona, and Tennessee. Small businesses may also be eligible for Oscar coverage in California, Tennessee, New Jersey, and New York. To check availability, input your zip code on Oscar's website to see the plans available to you.
Oscar health plans don't include dental or vision coverage, except for children under the age of 18. Many competing insurance providers do include dental and vision options.
Oscar doesn't work with customers on Medicaid. Depending on your plan, you may get health care, prescriptions, and medical supplies from providers who take Oscar plans. This might mean you don't need a referral for a specialist, but it may also mean that you have no out-of-network benefits, except for emergency situations or if you sign up for out-of-area coverage as a small group customer. Be sure to understand how your health coverage works when looking for health care providers.
Oscar insurance customers should also make sure they understand the terms of their health care plan. They should understand under what circumstances they need prior authorization and what kind of coverage is available for pre-existing conditions.
Debbie Christine Tjong
This is the worst health insurance company I've had to deal with. My doctor left the network in the middle of the year, but I had to have follow up appointment with him. I applied for a Continuation of Services and was approved on June 20th 2016. Upon receiving this information by phone (both my provider and I), we proceed to schedule an appointment for July 5th. Shortly after, we received a letter saying that the Continuation of Services expires on June 30th 2016. What were we suppose to do with such a short amount of time? My provider and I both called it to ask about this because it seemed like a mistake, and they said that they would issue another letter to extend the dates to cover the appointment on July 5th since that was made AFTER we received the approval. THAT NEVER HAPPENED. It also mysteriously disappeared from the notes they had on file. After the July 5th appointment, my doctor told me I have to have surgery on my throat and we again tried to extend continuation of services. this time it was denied. My only solution now is to wait till next year when I switch insurance. I can't work, because I cannot use my voice and I need surgery to be able to use it. Now I'm stuck with a bill of $1783 for the doctor's appointment made on July 5th because Oscar would not cover it, stating that the Continuation of services only last 3 months from when the doctor's left the network. That is ridiculous.I applied for the continuation of service beginning of June, and did not get approval till late june, and it expires end of June??! That does not make any sense. It seems that Oscar is just trying to wiggle their way out of paying for bills. My provider only made the appointment for me because we got the call that the continuation of services was approved. I'm at a loss of what to do now because I cannot receive health care i need, and I'm stuck with this bill. DO NOT GO WITH OSCAR. When it really counts, they do not help. I've spoke today with Margery from member's services who, aside from reading back the notes on file to me, could not help me, could not direct me to Jennifer, with whom I've spoken with before, could not transfer me to a supervisor, and seemed offended when I tried to ask her for her name. No empathy, no help at all. I feel bad for everyone who's sick and needs healthcare and have to deal with people and a company that don't care about the health of their members first.
Customer service only exists when they want to bill you -- when it comes time to pay, they DISAPPEAR. Where is Elizabeth Warren for this one???
Cristina Grever McAllen
Absolute worst insurance company! If youi live in Texas and considering Oscar, DON'T!!!! I have never felt the need to write a review about anything until now. Too much to complain about. Bottom line…cheap monthly premiums = bad health insurance. There is a reason why very few health care providers in San Antonio, Tx are not contracted with Oscar and refuse to accept their services.
Christine Kessler Pierce
Signed up for Oscar Gold plan due to need of medical equipment. Trying to order a wheelchair since January 2016 and STILL getting the run around. They've been caught in lies blaming everyone else for the delay. They don't pay for most medications, including my son's inhaler or any kind of inhaler. They call it an uncovered script that is out of network and all inhalers are out of network - so if you have asthma DON'T CHOOSE OSCAR!! My Dr. said he is having the same issue with his other patients who have this insurance. THEY DON'T HELP THE OSCAR MEMBER - THEY ONLY TAKE YOUR MONEY, LIKE MY $712 A MONTH. SHAME ON THEM. OSCAR IS A RIP OFF COMPANY IN MY OPINION - However, they did pay for my 24 hour hospital stay for a minor procedure after I paid the first $3,000 so I will rate them a 3. I am very disappointed with Oscar - more because their phone/email assistants have "canned responses" to why they are dragging their feet on getting my son his wheelchair. Their delay is physically hurting my son. I'm thinking of seeking an attorney for the irreversible damage they are causing my son to incur.
I was initially sold on Oscar due to their marketing towards millennials and claims to be different than other health insurance companies. However, from the first day that my insurance plan with Oscar went into effect, I realized that they are all smoke and mirrors. It took me hours of calling providers listed on their website as "in-network" to find a doctor that actually took Oscar insurance. Finally, after finding a doctor that took Oscar, there were issues with figuring out which services were covered. Literally every single time I have contacted the customer service phone number, I have received complete misinformation from customer service representatives. They are clueless about everything. I am currently pregnant and after contacting Oscar representatives I was specifically told where to order a breast pump from, and when I went to place the order, the company said they don't work with Oscar!! Of course this was frustrating, but imagine my frustration, when, 7 months pregnant... And now the SECOND company Oscar reps told me to order from also denied me for a breast pump saying they are not contracted through Oscar! The severe lack of communication across the board, from educating physicians offices they are listing as in-network to providers of government mandated medical supplies to communication with customers... Oscar should be embarrassed of themselves for how horrible their service is.
They seem to lose information often and take FOREVER to process claims (still waiting for mine almost 5 months later, while receiving collection demands from the provider). Dollar amounts owed change at random. Nothing is made clear on plan documents or when calling customer service. Terrible.
I have sent personally and had my doctors send claims to Oscar for 7 months now and multiple times per claim. Each and every time, Oscar "loses" the information. I'm not even asking for money, just an Explanation of Benefits that they are required by law to provide me. At first I thought it was simple incompetence, but it's clear that they are intentionally not processing the information. I've had to refer the matter to the Attorney General.
Oscar has paid per the terms of my insurance for some visits/procedures, but for others, refuses to pay for ridiculous reasons. With regard to one specialist, I checked the Oscar website before my visit to make sure she was listed as in-network, and her receptionist confirmed that she was in network at the time of my visit. Oscar then denied the claim, saying that the provider was out of network. I pointed the customer service rep to their website, and they eventually admitted that the provider was, in fact, in-network and the claim was covered. Now, more than three months after the visit, they are now claiming that, while the provider is in-network now, she wasn't at the time of the visit, even though their website plainly listed her as a provider at the time. With regard to the other specialist, an ophthalmologist, I also checked to make sure the provider was in-network before my visit. Oscar, however, denied coverage for the eye exam performed by the doctor on the grounds that eye exams are not covered by their policy, although this is nowhere stated in their policy. I have appealed this decision, but I have no doubt that Oscar will continue to deny coverage for whatever reason they can make up.
I had to cancel my service because I got a new job with a new plan, and received a bill after my insurance was terminated- when I tried to pay the bill, I was not able to log in to the site nor access the billing information because my account was no longer active. When I told this to the operators who answered the call, they told me "there was nothing they could do" and were not able to provide me with the information as to how to pay my bill. All I was trying to do was pay my bill. It took about 2 hours to resolve this ridiculous issue. Not to mention, their deductible is preposterously high and there are no good doctors that accept their plan. THIS IS THE WORST HEALTH INSURANCE I HAVE EVER HAD.
Terrible insurance company. If you call you will wait on hold for long periods of time. You will get hung up on and transferred around. Forget trying to get actual medical care. NO ONE takes Oscar. When I was first looking for a primary care physician I spent 6 hours calling doctors from the list that was provided on their website. 3 of the phones were disconnected. I called a realty office, a florist and an auto body shop. I thought maybe I misdialed. No such luck. One doctor on the list had didn't work at the practice at the number provided for 3 years. Oscar hasn't even been around that long. So after calling trying to find a doctor I called Oscar customer service livid. I said I spent the day calling to try to find a doctor and was unsuccessful and that they were going to have to find me a doctor. The next day I get an email with 3 phone numbers on it. I call them. One was a rheumatologist. One was a pediatrician. only one was a primary care doctor. When I called the primary care doctor they said they were taking new patients but they couldn't get me in for a month. I said thank you no. I called customer service again. They at least said they were sorry. To make a long story longer I did finally find a primary care physician. Oscar did find the doctor and they did set up the appointment. I am no longer with that doctor because a full blood panel isn't covered at by Oscar from the lab they use. I am financially unable to pay over $300 for a full blood panel. The prescription care is laughable. I was prescribed eye drops and an inhaler for allergies. The eye drops weren't covered at all and the pharmacy said they would cost over $300. The first inhaler was going to cost over $200. Apparently seeing and breathing isn't a priority for Oscar insurance. They just want my money.
Card never received (call twice asking for it) Got message on their website saying plan was cancelled then a new message saying it was an error (miss communication) Now they want me to pay for the months I didn't have a card after cancelling my plan! never used it, never will use Oscar again. Worst customer service I ever seen as well. Rude and inattentive.
I spoke with my provider and they had a list of tests I needed that were approved by Oscar but that they could only give me their "standard" prices on, not the negotiated prices. For that I would have to call Oscar. So I did. Talking to Oscar the woman I spoke with just kept insisting that those costs were not available. Which seemed strange as they are the company that negotiated them. So they exist, but they just choose not to share them. So now, I have no way of knowing how much I will have to pay for these procedures in advance which is ridiculous. What other product/service can you be refused knowledge of the price before you buy? They did offer to give me ballpark prices for procedures which I was NOT having done. Which was, as you can imagine, extremely helpful.
The only good part about Oscar was the Dr on call feature, which I took advantage of when I knew I had an ear infection and needed antibiotics. For anything else, beware. I had the cheapest most basic coverage because I'm generally healthy person. One day, I had to call 911 to go to the ER for what I thought was appendicitis. The ER doctor wasn't sure but was worried, so they admitted me for observation and further testing. At first, Oscar only covered my ambulance ride and told me I should have been treated outpatient, that my life was not in danger. Clearly my life was in danger if they felt it necessary to admit me. I fought their lack of coverage, which was a huge time and energy suck. Customer Service reps would often open my file and end up saying "You know what, I really want to investigate this further. Can I call you back tomorrow?" and then never call. Oscar ultimately ended up with them covering my stay (I mean, at least I think they have...with Oscar, you never know when you're going to receive a new EOB or bill!)
I signed up with Oscar because of the providers in their network. However, when I tried to access the pediatricians in their network half of them (about 40 doctors) would not take Oscar. It has been over a month and Oscar has not resolved the issue. When I call, they say they are waiting to hear back from the clinic the doctors work from. But it has been over a month and each time I call, the representative doesn't understand the issue.
Not helpful when you call them. make excuses not solve problem, unable to get on oscar website and they suggest you try other programs to access their site, or that the public servers are not working. Total bull. Not helpful when trying to fill first drug order for the year - they have collected money for 6 months with no pay out...now they are not interested in correcting the website problem so I can get online to order my meds. Did finally manage to get them to give me the phone number to caremark cvs to do mail in medication renewal..Course I will be without my medications for a couple of weeks because of this.
The absolute worst health insurance company imaginable. I'm a 60 year old man who has dealt with 10 health insurance companies during my lifetime. Their customer service is horrible, compliance is a joke and concern for the customer is non-existent. I'm dealing with the Attorney General of NY to resolve my issues.
Total slime, this insurance company. Does not have it together at all. Runs about 100 dollars more a month than most comparable insurance but with a deductible nearly twice as high. Canceled my insurance without notifying me due to a payment that was just a few hours late but still accepted my payment. They said they are refunding me for the payment but still haven't seen it. Will be hiring a lawyer.
I live in Texas, and signed up for Oscar in January. They have been awesome so far. Got sick, had a doctor call me, diagnose me over the phone, and had meds (generics and FREE) in less than an hour. Amazing service. Love these guys.
HiOscar has the tendency to bill you monthly then suddenly demand 6X the price for no reason. I didn't even use my plan. They spelled my name wrong, and got my address wrong from day one and it's still NOT fixed. I cancelled them. DO NOT BOTHER SIGNING UP.
BE AWARE PEOPLE. This insurance company is a big scammer in the market. if you visit their so called "In Network Doctor" they send testing (like blood, urine) to out of Network labs without telling you and decline the claim. I would say stay away with this insurance company.
George cancelled OSCAR
OSCAR Health Plan in CA is nothing other than a list of providers that don't even know they signed up to accept the plan. Impossible to get any doctors to accept the plan in spite of their supposedly being a provider. OSCAR customer service is always apologetic and says their new in CA, but at the end of the day, it's the members who pay the horrible price of not getting care when and where they should. Additionally, the customer service is on the east coast and totally unaware of the logistics in CA which results in their trying to help send members to doctors, in some cases, hours away. Call backs from complaints and resolutions are two days from the day you help but you'll be luck to get a call back to resolve the issue completely. This plan should be rejected from being offered in CA. It's been an awful experience all the way around.
They hardly have providers and experienced tough time and also got delayed for my treatment because of lack of providers and all they have is only BAYLOR/SCOTT and WHiTE network who are expensive. I will be changing the insurance the first chance i get.
Totally terrible company. In Texas there were only 4 endocrinologists listed for San Antonio, a city over 1 million people. One, when called said they were mislabeled and not endos, another only took existing patients. I had a gastric emptying study cancelled twice day before procedure because it was suddenly "private pay", same for a nerve conductivity study and 1 appointment with one of their listed endos. I paid $600 out of pocket for a gastric emptying test out of need, and now? I went to pick up insulin from Walgreens today. Doctors office verified it was a tier 2 preferred drug. I checked Hioscar.com and same thing. Tier 2 preferred are $35 each. Walgreens charged me $100 and $70 and said it was oscar's formula. I call and of course there's no CS after hours, I even posted to the bbb and shocker.... They're not accredited. I can not imagine how people in need are surviving. Such is the greatness of America I
My wife an I are both 57 years old, and bought Oscar plan after selecting it from the marketplace. We pay $1,250 a month for the two of us. The particular plan we selected outlines "free" primary care visits and $50 co-pay for visiting specialists that are in their network. My wife needed to visit an ophthalmologist specializing in retina disorders. We carefully checked and confirmed with Oscar that the doctor is a part of the network. In a month we received a bill from the doctor's office for $136 for services that Oscar didn't cover, that are in addition to $50 co-pay. Spoke with Oscar, and they explained that the procedures were diagnostic in nature and therefore are outside the scope of covered procedures. I suggested to them that going to a specialist is by definition diagnostic, and asked them to give me an example of a reason to go to a specialist so that they would not need to diagnose the issue. Specifically, we suggested that an eye doctor checks eyes using various machines that do not perform and "preventive" procedures. So what is the $50 co-pay intends to cover? They said is it for the office visit. We told them that we went to the doctor, not to the office, and suggested to clarify the scope of covered procedures with an "in the network" specialist, and asked to show to us specific language we should have been aware of when buying insurance that would clearly distinguish between services that are covered and not. Al they kept repeating is that $50 is for the office visit (I suppose there would be a different charge if the doctor would see us in a garage as opposed to an office). And that is all after the humongous monthly premiums!!! Be aware of what you are buying because Oscar's marketing is deceiving!
I called 5 docs listed on their site and none could see me for weeks if not months. I used a different UCLA doc assuming UCLA docs all accepted Oscar. Apparently not. Stuck with a $1000 bill now. Will be switching plans in the open enrollment window. Oscar is worthless.
They are great until you get cancer! I was diagnosed with breast cancer in November 2015 while I was insured by Oscar Health. My breast surgeon was an in-network provider with privileges at Mount Sinai Beth Israel Medical Center in New York City. At the time, Oscar Health had no plastic surgeon that specialized in breast reconstruction with privileges at Mount Sinai Beth Israel Medical Center in their network. In other words, Oscar Health did not have an in-network provider with the appropriate training and experience to meet my needs. As I understand my position as a health care consumer, I have the right to go out-of-network when my health plan does not have an in-network provider suitable for my needs. To that end, on December 15, 2015, my breast surgeon's assistant submitted paper work, and supporting documentation, on my behalf to Oscar Health requesting an out-of-network authorization so that I may see a plastic surgeon who specializes in breast reconstruction, and has privileges at Mount Sinai Beth Israel Medical Center. I had breast cancer and this was a timely matter that needed to be handled quickly. In the following days, my surgeon's assistant and I repeatedly called Oscar Health to inquire about the status of my out-of-network request. The customer service agents at Oscar Health frequently put us on hold for long periods of time, and often our calls were disconnected entirely. Repeated requests to speak with a supervisor were declined, and promises were made that a supervisor would return our calls. No supervisor ever called. As the days wore on, I became more and more anxious about the status of my request. I could not move forward with my breast cancer treatment without first consulting with a plastic surgeon who specialized in breast reconstruction. I feared it would be weeks or months before I could move forward with treatment, meanwhile I continued to live with cancer and the uncertainty of my diagnosis. Ultimately, I was compelled to pay $450.00 to consult with a plastic surgeon on December 24, 2015 while I was still covered by Oscar Health. I was desperate to move forward with treatment. To this day, I am still waiting for that authorization and the subsequent reimbursement of part or all of the $450.00 consultation fee. It is fortunate for me that I was able purchase a new health care policy from a different insurance company and move forward with my treatment. I have no doubt that if I were still insured with Oscar Health I would be waiting to receive my out-of-network approval, and I would still be living with cancer. Oscar Health acted negligently, and I venture, unethically, in this matter. I fear for health care consumers who have neither the resources nor faculty to purchase a new policy. They are at the mercy of a negligent company, Oscar Health.
If your not healthy don't use this company! I have an electrical issue with my heart. Only one brand name pill works for me which I have been on for years. I was promised I would be covered and have to pay 60 a month which was fine. Go to refill my pill and they told me it would cost 1800 a month. My dr appealed it, after hours of back and forth and questions. Now they approved my appeal. Once again I go to refill it since its been approved. Now they tell me it's 1,600 a month Bc I will have to pay a Dispense as written penalty! Told me my dr again has to appeal. Basically they are playing games with my HEART pills and my life! Also no eye vision care which who would think to ask? The worst is not being able to get my heart pills to live. Also my EKG HAS BECOME WORSE BC I WAS FORCED ON GENERICS! They lied!!!!! They are still playing games. Who has ever heard of a DAW PENALTY! This has been going on now for 3 months!