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.
best service ever! Oscar comes with great customer service, reasonable price tag, very easy to use
I've had Oscar for 3 years. It's great EXCEPT for ONE major flaw: The provider network is much too small. It can be difficult to find doctors that accept Oscar. Perhaps in smaller communities with a smaller pool of doctors, it is easier, but in the NYC area, the ratio of Oscar doctors to everyone else seems tiny. One note about people who suspect fake positive reviews in October: Perhaps there are more reviews in October because that is when everyone starts shopping for new insurance. I know I found this site because of that....
Oscar isn't accepted by almost any doctor I've contacted and their Oscar clinic doctors left me disappointed. I felt my issues were left untreated and the doctor was not thorough. My high deductible has left me unable to get multiple prescriptions I've needed. Oscar tried to charge me over $300 for copays on meds. I give them two stars simply for their marketing and easy to contact customer service. Overall I would NOT recommend purchasing this insurance.
We have had Oscar for 2 years. Our experience was pretty good, until they raised our plan from $1200 a mo to $1600 and it's going up again. Then, my daughter hurt her shoulder in volleyball and to see an physical therapist ( approved by doctor) has taken us more than a month. They are insane. Stay away and find another provider.
Reply from Oscar
Nov 29, 2018
Hi Chris, we’re sorry to hear you’re frustrated. Due to privacy laws, we're unable to discuss the specifics of your daughter's private health information here, but we're happy to address your general concerns. The rising cost of health care is an industry-wide issue. As the cost of doctors, hospitals, and drugs have increased, we have had to increase our premiums slightly. If you have questions about how to find the best care at the best price, reach out to your Concierge Team for support. Note that if a recommended provider is out of network, your team can work with your provider to update the prior authorization with an in network option. We've escalated your message to get this process started for you. If you'd like to speak directly to your Concierge Team don't hesitate to reach out at 855-OSCAR-55.
I believe as a Health Plan it should cover ALL diagnosis not just some. I know people that have Hemophilia A and OSCAR does not cover any factor (medication) or have any doctors that take care of that specialty. It's reasonably priced but what good is it to people that suffer from that diagnosis? I think that if they were to cover that diagnosis they would have a bigger member enrollment.
Reply from Oscar
Nov 29, 2018
Hi Gmm, we appreciate that you shared this feedback with us. We do recommend that members reach out to their care team in this situation. Note that our Network Navigator team can assist members if there is an access gap or they cannot find a provider. For medications that are not in our formulary, we can work with your provider to start a prior authorization. If you have additional questions or would like help, call us at 855-OSCAR-55 to be connected directly to your care team.
I was somewhat apprehensive about signing up with Oscar for 2018 because of negative reviews mostly from people in NY. But then I looked at the negative comments made more closely and noted that in every single case the critics should have been mad at themselves for not taking the time to understand what the Oscar policies cover and don't cover, what deductibles and co-pays mean and what doctors are in network BEFORE they signed up for their policies and/or went in for medical care. I live in the Austin, TX area and find those who are critical of Oscar have largely made the same mistakes as did the critics in NY. Anyway, having almost a year under my belt with Oscar now I can confidently state that I've been very pleased with my policy. Oscar processes claims quickly and accurately, has reps who have been very helpful and courteous on multiple occasions and their doctor on call has been a great free service. There is a wide selection of doctors (both general and specialists) and medical facilities to chose from and I can see anyone of them that I want to without having to select a primary care provider and don't need to get a referral for a specialist. And, since I took the time to understand my policy beforehand, there have been absolutely no bad surprises. Oh, yes, Oscar did raise their premiums by about 17% for 2019 and did increase their deductibles and max-out-of-pocket amounts but they are still the best cost insurance option on the ACA exchange, especially for those whose incomes qualify them for insurance premium subsidies. My only complaint: They do not provide medical procedure or prescription cost estimating tools. Most major insurers have these tools so their policy holders can make better, informed decisions regarding their health care options. It's important enough for me to take off 1 star for this reason.
After being laid off, I enrolled in an Oscar plan to start 10/1/18, paid my premium and uploaded paperwork showing no lapse in coverage. On November 1, I logged on to pay my next premium only to find that I had been un-enrolled. In a panic, I called customer service and was told that, at some point in mid-October, the decision had been made that my coverage paperwork was missing a letter...but nobody had reached out to let me know that! I immediately uploaded the letter in question. It is now 11/14/18, and I still do not have retroactive coverage, despite being assured it would be taken care of by the 12th. If somebody had simply let me know I needed to submit a single document back in mid-October, none of this would be happening. As you can imagine, it is unbelievably stressful in the current political climate to be in limbo about health insurance coverage, especially for a middle-aged person like me who hasn't had a coverage lapse in decades. I now have no faith whatsoever that Oscar will communicate with me about important matters like this. While everyone I've talked to on the phone has been very nice, I have not received any kind of explanation as to how this situation happened in the first place. I have also spent a considerable amount of time trying to fix it, and an immeasurable amount of fear and stress. And it's still not resolved.
Love the doc on call, the ease of service, the incentive to get steps in
Oscar started out with good offering, but now after the first year they are jacking up premiums by 15% and raising the deductibles by almost 40%. So much for their, we are here to help and care. Now it is how do we grab more money without providing any additional benefits.
Reply from Oscar
Nov 07, 2018
Hi AliceStars, we're sorry to hear you're disappointed. The rising cost of health care is an industry-wide issue. As the cost of doctors, hospitals, and drugs have increased, we have had to increase our premiums slightly. Going forward, we are actively finding ways to slow the trend of rising health care costs, which is why we work closely with our provider partners and offer benefits like free telemedicine to try to make health care more affordable to you. If you have questions about how to find the best care at the best price, reach out to your Concierge Team for support.
Oscar has been the best health insurance plan I have ever had. Have an issue with a provider? Tell Oscar and it gets resolved quickly. Need to find a doctor in network? No problem - just use their search engine and several doctors are shown.
Oscar provides a competitively priced insurance for the New York market, which is widely accepted with multiple pcp and specialists. Additionally, their digital platform allows you to speak with a dedicated concierge team and medical professionals on demand for minor inquiries, which are both time saving and very efficient, as well as helping you save on the co-pays with the doctors.
Terrible company, terrible coverage. I thought Idealcare was the worst insurance on the marketplace, I was wrong. Oscar is a horrible company, they use marketing and a flashy phone app to hide the fact that they are greedy and unethical. They pay for nothing, and even when they've "guaranteed" a service is "covered at 100%", they still send me a large bill several weeks later. Their "consierge" messagaing system is a joke, it's just a buffer to keep customers from getting any straight answers or any medical services from being covered. Companies like Oscar really highlight how corrupt and broken our healthcare system is. Oscar doesn't care about anything other than their bottm line. Do yourself a favor, pay a little more for better insurance this year, that's what I'm doing.
Reply from Oscar
Nov 29, 2018
Hi Matt, we're sorry to hear you had a disappointing experience with Oscar. We'd like to learn what we could have done better. If you're comfortable with it, please send us your Oscar ID in a direct message and we'll have a member from our team reach out.
Positive health isurance. I can go to the clinic I like. Very Afforable.
OSCAR has been extremely easy to use overall. It is easy to find doctor's and specialist with the help of the app, which I love. I've never had insurance till the past two years, and OSCAR has made it a great experience.
Terrible company greedy business model. They have fake paid review trolls all in October to deceive and distort before open enrollment . Read the real reviews throughout the year January until September of their insured getting screwed. Very few doctors accept this insurance combined with sky high premiums and ridiculous copays deductibles and coinsurance. Don’t be fooled
Reply from Oscar
Nov 05, 2018
Hi Bob, we're sorry to hear this. DM us your Oscar ID number and we'll be happy to have someone from our team get in touch to further address your concerns.
Positive reviews are fake. The positive reviews in October are ALL corporate impersonators. They are employees of the company reviewing before Open Enrollment to entice unsuspecting consumers. This is absolute fraud. The real people reviews from January until September were almost all universally negative. You know, when actual real people use the insurance and get huge bills, denied claims, and massive premium hikes. Just look back, mostly negative reviews Jan until September, then suddenly 40% of the total reviews all year, all 5 stars, come in October with similar language? What a joke, scam, and outright dishonest fraud
Reply from Oscar
Nov 08, 2018
Hi Marian, we're sorry to hear you feel this way. Know that if you’ve signed up for a high-deductible plan, preventive services are covered in full, but any non-preventive services will be subject to the deductible. This means that you'll be responsible for the full negotiated rate of those services up until the amount of your deductible is met. For questions on your plan or billing, our team is here to help. Please call us at 855-OSCAR-55 to be connected directly with your Concierge team.
The authorizations for pain management procedures are taking too much time. I couldn't keep my appointments because of this.
Reply from Oscar
Nov 12, 2018
Hi Galina, we're sorry to hear you're frustrated and we'd like to look into this for you. Due to privacy laws this isn't something we can help with via Best Company, but send us a private message with your Oscar ID number and we'll be happy to have someone from our team get in touch with you to help. If you'd prefer, you can also call us at 855-OSCAR-55 to be connected directly to your Concierge team.
I have been with Oscar since its inception with Obamacare in 2014. It start ed off great with a large network and low cost and low deductible. Now I can piece together good specialists, but they are fragmented and some doctors just do not spend much time in an examination. The fragmentation of the network is the real loss. But my major complaint is that I had to do so much work to get coverage of an MRI that one specialist prescribed and I am still fighting to get coverage for a hospital admission after an emergency room visit. The hospitalization ensured that I did not have a stroke or heart attack and Oscar said because I did not , they will not cover the hospitalization. It is now in dispute with the DFS. Oscar is more concerned with cutting costs than my health.. I will most likely choose another company next year
Reply from Oscar
Nov 05, 2018
Hi B, we're sorry to hear about the frustration. We escalated your message to a supervisor, who noted that we're currently working with you to resolve this issue. We’re always looking for ways to improve the quality of care our members receive, so we appreciate it when our members give us feedback on their provider experiences. We encourage all members to send a message to their Concierge team if they have an experience that did not match their expectations.
I had a Medical year that most people fear. All but one surgery was completely unforeseen. Oscar realized quickly that I was facing a medical nightmare. I was assigned “Concierge Nurse”, who has literally held my hand and made sure my care was approved QUICKLY and efficiently (Mary Jane - I am forever grateful). There were NO delays in care. I am beyond impressed. I can not recommend Oscar enough (I am a health insurance broker and am familiar with all the different companies and how they operate - I can not impress enough how important it is when your insurance company really has your back when needed)
Reply from Oscar
Nov 06, 2018
Thanks for the love, Greta! We're glad to hear this. Don't hesitate to reach out if there's ever anything we can do to help.
At the beginning of 2018 I had to change ins companies due to the fact mine wasn’t handling self employed anymore. I had two choices and one was Oscar. Never heard of them. Did research and saw they were fairly young, but had good reviews and thought to take a chance. My wife did all the research and decided to go with them. And what a BLESSING, then she developed stage four lung cancer and we have paid no more than $1000, if that for the whole year! Now, Oscar may not like me, but I LOVE them and appreciate them. Had a small issue at the beginning of yr getting things paid, but when that got worked out all has gone so smoothly. It was just paperwork a little slow, no debating or anything. If they don’t drop us we will stay with them forever and ALWAYS refer them to others. Thanks Oscar!
Reply from Oscar
Nov 09, 2018
Thank you for the kind words, Howard! We're here for you and your family if you need anything.
Oscar has been a very good insurance for our family. We've had no problems at all with getting Dr. bills paid and it's easy to track claims and payments through the website. I am giving 4 stars instead of 5 because most communication with Oscar is by text or email. Sometimes you just need to talk to someone on the phone.
Reply from Oscar
Oct 26, 2018
Thank you for the kind review! Note that you can always call us at 855-OSCAR-55 to be connected directly with your Concierge team if you prefer to talk on the phone.
I'm really impressed with the providers on my plan. This year I had to have shoulder surgery. The orthopedist, surgical facility and physical therapist were all top notch.
I like it. The people nice and it helps. It easy and you can understand all the information they put it online and love it thanks,
Very satisfied customer
I love Oscar and have been raving about you to everybody including colleagues and clients — and to medical professionals! I love how easy it is to get questions answered via your app and how caring your company is! I love how you reward members like me who take steps to be on great health like your reward for those who walk! Thank you! A very satisfied customer
Oscars is a great insurance company so far the best they make it affordable easier to get and pay for medicine visit great keep up the good work
Edward St John Jr
I’ve been a paying customer of Oscar, and have been nothing below satisfied with every customer service call. I’ve never had to call customer service more than once to make a payment, and every customer service representative that’s answered the phone has been knowledgeable, prompt, and courteous. Everyone that’s been contacted by me at Oscar has followed through and met expectations by completing objectives they have set for themselves through conversation with me. If a customer service representative says they are going to process a payment and I’ll be sent a confirmation number for the payment then that’s exactly what the customer service representative does. Everything is usually completed in a few minutes. I’ve never had a phone call that lasted more than a few minutes with Oscar.
Oscar representatives ALWAYS take care of any medical requirements I might have upcoming. I currently have Stage 4 Cancer, and it is nice that my health care is one less thing to worry about! Thank you!
I love Oscar! They are very friendly and helpful ;)
The Oscar Center is the best treatment you can find in the most hospitable environment.
I have been extremely happy with the benefits of having OSCAR! I am only leaving now because I have reached Medicare age and am moving to Medicare. I have utilized the Doctor on call a couple of times and messaging someone to be given further instruction on how to do certain things with my OSCAR account. I am pleased that I found OSCAR!
Customer service is by far the best. Working with my concierge team is almost like talking to family. I simply couldn’t ask for better.
I love the app. It is very convenient and easy to navigate. I've used the doctor on call service and it was quick and helpful. I've also reached out regarding admin questions and although it takes a little more time to get a response, I've always gotten a good response which clarifies my questions. I love the step counter and how it's synced with Amazon! I brag about that to all my friends. I am giving 4 stars mainly because the plan itself which is most affordable is still very limiting. And when I need more medical attention than normal, I feel I'm eating a lot of the costs. I appreciate the low monthly premiums very much, but the deductible is the sacrifice for such low payments. I think it would be a good idea to include other plan options on the app to make it easy for a member to switch if they feel they need different coverage.
Super convenient & easy to use! Everyone I've spoken with has been really friendly and willing to help too!
I would NOT recommend. I was excited to try Oscar, but have not had a good experience. They refused to pay any costs associated with my broken arm I got while skiing, because I did not go through the correct emergency room entrance. (The clinic on the ski slope had called ahead to arrange an Operating Room for my emergency surgery - because I wasn't admitted through the ER, Oscar wouldn't pay. ) Despite breaking my arm and needed emergency surgery, Oscar cared more about the billing codes, leaving me with a $20K+ bill. I would NOT recommend.
Reply from Oscar
Oct 26, 2018
Hi Marie, thank you for sharing this feedback. Due to privacy laws this isn't something we can help with on Best Company, so we passed your message to your Concierge Team. They've notified us that a supervisor has been assigned to work with you and explain the plan of action. We apologize for the negative experience, and look forward to working with you to resolve it. If you have questions or would like help, call us at 855-OSCAR-55 and you'll be connected directly to your Concierge team.
Great customer service. Reasonably priced and very convenient.
I found Oscar health insurance to be very efficient . Good communication, excellent healthcare coverage, and a willingness to research questions and respond- either by email, or phone call. I am hoping they will enter the Medicare field, so I can continue to have such excellent service. Thanks, Oscar!!!!!
Reply from Oscar
Oct 24, 2018
Hi Patty, thank you for leaving such a kind review! We have announced that we will be entering the Medicare Advantage market in 2020, but stay tuned for further details and timeline.
Good insurance. Would be better if more providers were available. A great physical therapy office no longer takes Oscar because they state that the paperwork and phone calls take up too much time (difficult to work with) compared to other insurances.
Super fast and complete responses to messages. Excellent doctor network. Great plans. Terrific autopay. Fast paperwork processing. All around best in class.
I've been nothing but pleased with Oscar. Everyone has been super nice and friendly. The website is easy to use. Looking for care is great. All of my doctors are in network. I hope to stay with you.
Very good insurance. They help however they can, and also very affordable.
The app is very easy to use. The docs on call have all be very helpful the handful of times that I have requested a call.
You are very efficient. This is extraordinary in the Health industry.
So far Oscar Health is a great coverage program and very convenient access to the network I am familiar with. I was looking for a program that would allow me to stay with CCF and Oscar Health was it! I look forward to exploring more of what Oscar Health has to offer in the future.
Very nice customer service ! Quick to help and on phone return calls ! Nice !
So far, so good :) I haven’t had to use my insurance too much but when I have it has been an easy process.
Very helpful,answered all my questions. Called the Pharmacy to check the status on my order that had been taking long to get delivered. Reassured me that he would keep me updated . I'm very happy with how I get taken care of
Everything has been wonderful with Oscar. They always keep you up to date on things. The cost is decent and affordable. I have not had any problems with Oscar in the in the two or three years that I have been with them. They also bill you on time.
Easy to get answers from real people using the app.
The website is easy to use. The chatting feature is super quick and responsive so I like the fact I'll hear back within a day usually. The Amazon rewards program is the best.
I've had Oscar for a couple of years now a think it is fantastic. The App and concierge is very helpful. My favorite function of the App is that it keeps track of my steps and then pays me with an Amazon gift cars.