Oscar health plan overview for 2018.
Oscar has expanded their network of hospitals in Los Angeles County. Oscar EPO health plans will be offered through Covered California and off-exchange in San Francisco, Los Angeles, and Orange counties.
Oscar has added the following hospitals to their existing network in Los Angeles County.
- Foothill Presbyterian Hospital
- Inter-Community Hospital
- Queen of the Valley Hospital
- Keck Hospital of USC
- USC Norris Comprehensive Cancer Center and Hospital
- USC Verdugo Hills Hospital
The Exclusive Provider Organization (EPO) health plan type allows members to see any doctor in the network without a referral. However, there is no out-of-network coverage like a traditional PPO health plan type.
Oscar Off-Exchange Health Plans For 2018
All of the health plans Oscar offers through Covered California will be mirrored off-exchange. The off-exchange mirrored plans are called the Classic series and include the Bronze, Silver, Gold, Platinum, and Minimum Coverage standard health plan design.
Oscar will offer two additional series of health plans called Simple and Saver.
Simple Bronze has $7,350 individual deductible and virtually nothing is covered until you have met individual deductible amount. This excludes the no-cost ACA preventive care and$50 copay for urgent care not subject to the deductible. Once the deductible is met, which is also the maximum out-of-pocket amount; the member has $0 copays for most all services.
Simple Silver also has a $7,350 individual deductible like the Simple Bronze plan. However, there is fairly long list of services with set copayments not subject to the deductible such as office visits at $25, labs at $25, and Tier 1 and Tier 2 drugs copayments not subject to the deductible. The maximum out-of-pocket amount is $7,350 and once that is met (a combination of copayments the negotiated rate for all other health care services) the health plan covers virtually all the plan benefits at $0 to the member.
Simple Gold follows a similar pattern to the Simple Bronze and Silver plans in that the deductible is also the maximum out-of-pocket amount. For Simple Gold the deductible is $3,400. The copayment structure is very similar to the Simple Silver with $25 office visits and Tier 1 and 2 drug copays not subject to the deductible.
The least expensive series of Oscar plans are in the Saver category.
Saver Bronze is the standard High Deductible Health Plan (HDHP) that is health savings account compatible. It has a $4,800 individual deductible and nothing is covered until you reach that amount, excluding no cost ACA preventive services. After the deductible is met, the member pays 40% coinsurance until the maximum out-of-pocket is met. The maximum out-of-pocket is $6,550.
Saver Silver has a $4,500 individual deductible, which is also the maximum out-of-pocket amount. Once the member has met the deductible/MOOP, the health plan covers virtually all health care expenses at 100%.
Saver Gold has a $1,500 individual deductible and a $6,000 maximum out-of-pocket amount. Once the deductible amount is met, the member will typically pay 10% coinsurance up to the maximum out-of-pocket amount.
The Simple and Saver plans do not include any Platinum plans. All plans include pediatric dental and vision benefits. The Oscar website does not have a way to print a provider list for geographic locations. They also don’t provide rate sheets by age and plans. The Summary of Benefits and Coverage are available, but they don’t release their Evidence of Coverage documents on their website.
Covered California Summary of Benefits and Coverage
Classic Plans
Simple Plans
Saver Plans