Credit: Richard Perry/The New York Times/Redux
For most health insurance carriers in California, we are seeing little change in the provider networks or plan offerings. For Oscar, things have certainly changed over the course of 2018. Oscar started offering business plans in Los Angeles & Orange County on June 1st, 2018 and will start offering group plans through the CalChoice exchange starting December 1st, 2018. Not only has Oscar stepped into group health insurance, but they have also heavily invested in insuretech by building their own claims management system from the ground up as well as personalizing the member experience by continuously updating and upgrading the Oscar mobile app which features a care guide concierge team and free calls to doctors 24/7.
Oscar was founded in 2012 by Mario Schlosser after he experienced the complicated hospital billing systems first hand during his wife’s pregnancy. As a reaction to the convoluted billing, Mario and his partners founded Oscar Health. They named the company after one of their founder’s great-grandfathers to give the company a more personal, human element. Oscar is privately held and in its latest round of funding, it secured $375 million dollars from Alphabet (Google), another company heavily focused on big data.
For Los Angeles, Oscar covers some of the largest hospital systems such as UCLA Santa Monica, UCLA Ronald Reagan, Keck of USC, USC Verdugo Hills, and Providence with many of their affiliated doctors in-network. In Orange County, Oscar has Hoag Memorial, Mission and other smaller hospital systems in-network.
Oscar’s plans are strictly EPO plans or Exclusive Provider Organization plans. Like a PPO, you can go and see any in-network specialist without a referral; however, like an HMO, you are only covered within Oscar’s provider network except for in a major medical emergency. EPO plans make practical sense because they are more affordable than PPO options and provide more flexibility to patients who want to go to see an in-network specialist without a referral from their primary care doctor.
If you are someone who has dual residencies or travels outside of California for long periods of time, it is not advisable to choose a carrier such as Oscar or even the HMO options available to you. For heavy travelers, they should stick to PPO plans to avoid the possibility of going out-of-network. Keep note that individual and family PPO plans in California do not cover out-of-network doctors or facilities until you meet a $5,000 to $12,600 out-of-network medical deductible so it is extremely important for all health insurance members to stay in-network unless absolutely necessary.
If you are interested in seeing what health insurance plans make sense for your budget and preferred providers, please do not hesitate to contact us. The annual Open Enrollment Period is in full swing and we are happy to help you find the right plan for both your budget and medical needs. Our services are free of charge and as your dedicated broker of record, we can call the insurance carriers on your behalf to handle a variety of tasks.
At Solid Health Insurance Services, we will always strive to keep our clients informed about the healthcare trends and changes to the state and federal legislation around the Affordable Care Act. Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com.