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Texas health insurance    Oscar Health in Texas

 

Oscar Expanding In Texas For 2018 Open Enrollment

 

With all of the negative news in advance of the 2018 Open Enrollment it is a relief to finally get some good news.

This year Texas consumers in Comal, Hays, Travis and Williamson counties will have a new carrier to consider when making a health insurance decision.

Oscar is expanding their service area from Bexar county, which the carrier operated in last year’s Open Enrollment, to the additional four Texas counties.

Oscar is a technology advanced insurance company offering a competitively priced EPO instead of a HMO for both off-exchange and on-exchange clients.

 

What Does Oscar Bring to the Market

 

Stateside wrote Oscar polices during this year’s Open Enrollment in Bexar county and found their coverage was competitively priced and we received very positive comments from our clients regarding Oscar’s customer service.

 

The following are a few aspects of Oscar coverage that you should be aware of as you evaluate your Blue Cross Blue Shield renewal.

 

  • Network - Central Texas network partners will include Seton, Baylor Scott and White, and Austin Regional Clinic.

 

  • EPO Instead of a HMO - you will not need to designate a primary care physician or need a referral for a specialist. One must stay in the EPO network to obtain benefits but the size of the central Texas network is substantial. Included in the Oscar coverage is a National Urgent Care network that will offer benefits when traveling out your home state and thereby be out-of-network.

 

  • Concierge Team - dedicated to assist you with accessing Oscar benefits. Team members are assigned to assist you with identifying network providers, providing cost estimates for medical services, and claims assistance. You’ll talk to one of the same four people each time you contact the team and each team includes a registered nurse.

 

  • Doctor on Call - available 24/7 for free. You can access board-certified doctors for medical advice and prescriptions through your Oscar web account or use the mobile app to request a phone call. Face Time and Skype is available to provide additional information for rashes, sore throats or allergic reactions. 

 

  • Oscar App Manages Your Plan – access your plan details, labs, prescriptions, health history, bills and identification cards all through your phone app.

 

  • 2018 Oscar Plan Design

 

 

Oscar will offer both Off Exchange (no subsidy) and On Exchange (subsidy) plans in bronze, silver and gold metallic categories. Coverage is divided into Classic, Simple and Saver plan types.

 


 

Classic Oscar Plans

 

 

Bronze Plan

Individual Deductible $3,500

Family Deductible $7,000

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700


Primary Care Office Visit – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.


Specialist Office Visit – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Labs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Generic Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after
deductible and until maximum out-of-pocket is reached.

Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after
deductible and until maximum out-of-pocket is reached.

 

 

Silver Plan

 

Individual Deductible $4,500

Family Deductible $9,000

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700

Primary Care Office Visit $50


Specialist Office Visit $75

Labs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Generic Drugs $15

Preferred Brand Drugs $100

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after
deductible and until maximum out-of-pocket is reached.

 

 

Silver $10 Generic Rx Plan (Off Exchange Only)

 

Individual Deductible $4,500

Family Deductible $9,000

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700

Primary Care Office Visit $50


Specialist Office Visit $75

Labs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Generic Drugs $10

Preferred Brand Drugs $100

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after deductible and until maximum out-of-pocket is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 50% after
deductible and until maximum out-of-pocket is reached.

 

 

Gold Plan

 

Individual Deductible $1,500

Family Deductible $3,000

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700

Primary Care Office Visit $25


Specialist Office Visit $50

Labs $25

X-Rays and Imaging Negotiated rate until deductible is reached. Oscar pays 80% after deductible and until maximum out-of-pocket is reached.

Generic Drugs $10

Preferred Brand Drugs $50

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 80% after deductible and until maximum out-of-pocket is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 80% after deductible and until maximum out-of-pocket is reached.

 

 


 

Simple Plans

 

 

Secure Plan

 

Individual Deductible $7,350

Family Deductible $14,700

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700


Primary Care Office Visit – 3 for $0 copay. Visit 4 and more negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.


Specialist Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Labs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Generic Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after
deductible is reached.

 

Bronze Plan

 

Individual Deductible $7,350

Family Deductible $14,700

Individual Maximum Out-Of-Pocket $7,350

Family Maximum Out-Of-Pocket $14,700

Primary Care Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.


Specialist Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Labs – $100 copay until deductible is reached. Oscar pays 100% after deductible is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Generic Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after
deductible is reached.

 

Silver Plan

 

Individual Deductible $7,000

Family Deductible $14,000

Individual Maximum Out-Of-Pocket $7,000

Family Maximum Out-Of-Pocket $14,000

Primary Care Office Visit $25


Specialist Office Visit $50

Labs $50

X-Rays and Imaging Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Generic Drugs $20

Preferred Brand Drugs $100

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after
deductible is reached.

 


 

Saver Plans

 

 

Bronze Plan

Individual Deductible $6,500

Family Deductible $13,000

Individual Maximum Out-Of-Pocket $6,500

Family Maximum Out-Of-Pocket $13,000

Primary Care Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.


Specialist Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Labs – Negotiated rate until deductible is reached. . Oscar pays 100% after
deductible is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Generic Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after
deductible is reached.

 

Silver Plan

 

Individual Deductible $5,000

Family Deductible $10,000

Individual Maximum Out-Of-Pocket $5,000

Family Maximum Out-Of-Pocket $10,000

Primary Care Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.


Specialist Office Visit – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Labs – Negotiated rate until deductible is reached. . Oscar pays 100% after
deductible is reached.

X-Rays and Imaging – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Generic Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Non-Preferred Brand Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after deductible is reached.

Speciality Drugs – Negotiated rate until deductible is reached. Oscar pays 100% after
deductible is reached.

 

Oscar Network

 

The biggest difference between Oscar and the other carrier in Central Texas is Oscar will be offering a Exclusive Provider Organization (EPO) instead of the current Health Maintenance Organization (HMO). An insurance plan based on a EPO network does not require the member to designate a primary care physician (PCP), which is required by a HMO plan. EPO plans will also let the insured member select an in-network specialist without a referral from their PCP. Both plans, EPO and HMO plans, will have networks that are very similar in the number of healthcare providers and both plans do not offer out-of-network benefits unless in an emergency situation, which is defined as the potential loss of life or limb.

 

Will Oscar Participate In the Exchange?

 

All of the plans that Oscar offers Off Exchange will be offered On Exchange with the exception of the Classic Silver $10 Generic Rx plan. Regardless if the coverage is purchased Off Exchange or On Exchange the insured member will receive the same benefits such as no doctor on call, conciegre team and the Oscar online ap to easily access details on your coverage. Oscar will be the only carrier offering a EPO plan on exchange.

Federal premium assistance is available by submitting an application through Health Insurance Subsidy Application Made Easy. The hyperlink will allow you access to a streamlined application process that will enable you to complete the subsidy application, receive a subsidy determination and apply for the plan you select in under 10 minutes. No longer do you have to spend 60 minutes trying to navigate the Health Insurance Exchang’e cumbersome subsidy application. Health Insurance Subsidy Application Made Easy is fast, easy and accurate.

 

Is My Doctor In the Network?

 

Oscar is building their EPO network in Central Texas from scratch, which means there may be gaps in their network initially but these deficientcies should be overcome by the start of new plan year January 1. The size of the Oscar network in Central Texas will be greatly enahnced by Oscar’s contract with the Seton Healthcare System and Austin Regional Clinic. In advance of the 2018 Open Enrollment Oscar has over 200 primary care physicians within 10 miles of downtown Austin. 

You can search for medical providers using the online directory Find out which Texas Doctors Participate with a Carrier.

Before selecting a health insurance plan for 2018 be sure to confirm that your medical provider participates in the plan network. Since none of the carriers providing coverage in 2018 offer out-of-network benefits it is important to confirm that your provider participates in the plan network or the services you receive will not be covered.

 

Quoting Oscar Plans

 

Quoting coverage in Texas is easy.

 

  1. Click on Quote individual and family Texas health insurance.
  2. Complete requested census information.
  3. Provide number of individuals in household and estimated 2017 household income.
  4. Select either Health Off-Exchange or Health On-Exchange. If you select Health On-Exchange be sure to include your estimated income for 2017.
  5. Review plan options. If you would like to schedule a phone appointment to discuss your health insurance questions, click on Appointment Scheduler or email info@texasplans.com

 

 

How to Apply for Oscar Coverage

 

Applications are now submitted online without the hassle and inaccuracies of paper applications. To access the online application for Oscar:

 

  1. Click on Texas health insurance applications and online application.
  2. Select the carrier from the list.
  3. You should have the following information available when submitting the application:
    1. Plan selection
    2. Social Security number
    3. Credit card information for initial premium payment
    4. Bank account information for renewal premium payments



 

You can run your Oscar Health Quote here to view rates and plans.

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