3.5
7.3
Overall Score
Author: Kaitlyn Short
Founded by Mario Schlosser, Joshua Kushner, and Kevin Nazemi, Oscar is a newer name among health insurance providers. 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.
Another distinguishing feature of Oscar insurance is its Concierge team. Each team includes a registered nurse and a care guide who are available to assist you in finding network providers and answer basic health questions.
Open Enrollment for 2021 health care plans runs November 1, 2020-December 15, 2020. If you missed the open enrollment period, check to see if you qualify for a special enrollment period.
Oscar has received many positive customer reviews on BestCompany.com. Reviewers frequently praise Oscar for its concierge team, customer support, and telemedicine access.
Customer Review: Penny Altman from Van Nuys, California
"Oscar has always been there when I needed them. Their concierge team has answered all of my questions and they're always available. They pay their claims without any problems. Good network of doctors available. Overall, I have been very happy with Oscar compared to other insurance companies I have had in the past."
The insurance provider tries to ensure that each Oscar customer finds 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, it'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.
A bronze plan puts the most cost-sharing on policyholders and tend to have a lower monthly premium, while platinum plans put the least and tend to have a higher premium.
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.
Coverage for telemedicine is a rising trend in health insurance, so this offering makes Oscar a competitive insurance provider.
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 for an Oscar Simple plan 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.)
Some 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 and Secure 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 quotes on 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 Oscar members pay the first premium, they receive 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.
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. Each Concierge team consists of a care guide and a registered nurse. This unique model provides customers with additional support.
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. This assistance with scheduling appointments, finding a doctor, and care coordination are benefits of working with Oscar.
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.
The access to a concierge team to help you navigate your health plan and receive the care you need makes Oscar stand out as an insurance carrier. Other insurers offer similar case management services to members who meet eligibility criteria.
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.
While a majority of Oscar's reviews are positive, it has also recieved a high percentage of 1-star reviews. Negative reviews are common for the health insurance industry. 1-star reviews mention difficulties with communication, finding an in-network doctor in the area, scheduling appointments, and billing issues. These issues are concerning, and Oscar is responsive to these reviews.
As you consider working with Oscar, pay attention to where reviewers are from. If reviewers in your area have good experiences, that's an indicator Oscar may be a good fit. If reviewers in your area are mostly negative, you may decide to work with another company.
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.
Finding affordable health insurance and a trustworthy insurer is an important step for finding affordable care. There are plenty of plans and health insurers to choose from. How good is Oscar health insurance?
While Oscar is a newer health insurance company, its plan offerings and simple process make its health insurance plans worth considering. If Oscar has a good network and a plan that meets your health and budgetary needs, it's a good option. Pay attention to what reviews from customers in your area say about Oscar.
Be sure to understand how a plan's network and coverage work before enrolling. If Oscar doesn't offer the kind of network plan you're looking for, you may need to consider another insurance company.
Because Oscar does not offer Medicaid, those seeking a Medicaid insurance policy should also find another health insurer.
Oscar offers a wide array of member tools and support options. Its mobile app and Concierge Teams offer customers abundant and easily accessible customer service.
For customers in the available states who are looking for these types of plans, however, an Oscar health plan is a fantastic option. Oscar boasts reasonable rates, several customer service contacts, a fast enrollment process, and offers free services with every health insurance plan.
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