Oscar Health Insurance is a tech-driven health insurance company that aims to make healthcare simpler, more accessible, and more affordable. Offering individual, family, and small group plans alongside Medicare Advantage options across 20 states, Oscar combines competitive health coverage with a highly rated mobile app, 24/7 virtual care, and a dedicated Care Team. This guide covers Oscar’s plan options, premiums, deductibles, prescription drug coverage, the claims process, how to enroll, and how Oscar compares to other health insurers in 2026.
Key Takeaways
- Oscar Health serves over 420,000 members across the United States in 20 states.
- Plans are available as individual, family, and small group health insurance, plus Medicare Advantage.
- Plan types include HMO, EPO, and PPO with varying levels of coverage, copay, deductible, and out-of-pocket costs.
- The average out-of-pocket cost for Oscar members is $1,240 per year, below the industry average.
- Commonly prescribed medications are available for as little as $3 through the Oscar app.
- 78.3% of Oscar Health customers report high satisfaction with customer service.
- 62.5% of policyholders use the Oscar mobile app for claims management and health tracking.
Understanding Oscar Health Insurance
Oscar Health Insurance was founded in 2012 and is headquartered in New York City. It operates as a tech-based health insurance company with a mission to provide comprehensive coverage that is easy to understand and use. Oscar offers individual and family health insurance, small group employer plans, and Medicare Advantage plans across 20 states in the U.S.
Unlike traditional insurers, Oscar builds its services around technology, giving members access to healthcare services through a mobile app, a virtual care platform, and a Care Team of dedicated health advisors available to help with everything from finding a doctor to understanding treatment options.
Oscar’s average annual premium increased by only 3.7% between 2023 and 2025, making it one of the more cost-stable health insurance options in the marketplace for individuals and families seeking affordable coverage.
Oscar Health Insurance Plans and Coverage
Plan Options by Type
Oscar offers three main plan structures, each with different network access, cost, and flexibility levels:
- HMO (Health Maintenance Organization): Requires members to use in-network providers and get referrals from a primary care physician before seeing specialists. Lower premiums and deductibles than PPO plans. Best suited for individuals who want predictable costs and have a preferred care team.
- EPO (Exclusive Provider Organization): Similar to an HMO in that coverage is limited to network providers, but does not require a referral to see specialists. Offers a balance of cost savings and flexibility.
- PPO (Preferred Provider Organization): Allows members to see both in-network and out-of-network providers without referrals. Higher premiums and out-of-pocket costs but greatest flexibility for individuals who travel frequently or need specialist access across a wider network.
Oscar also offers Medicare Advantage plans for eligible seniors, which combine standard Medicare benefits with additional services including dental, vision, and wellness programs depending on the plan and state.
Pricing and Premiums
Oscar plan premiums start as low as $0 per month for individuals who qualify for marketplace subsidies based on income. For individuals who do not qualify for federal assistance, monthly premium costs vary based on age, state of residence, plan tier (Bronze, Silver, Gold, Platinum), and selected coverage level.
Factors That Affect Your Oscar Premium
- Age: Older individuals typically pay higher monthly premiums than younger adults for the same plan.
- State: Premium rates vary by state due to regulatory requirements and regional healthcare costs.
- Plan tier: Bronze plans carry the lowest premiums but highest deductibles and out-of-pocket costs. Platinum plans carry the highest premiums but the lowest deductibles and copay amounts.
- Income and subsidies: Individuals who enroll through the ACA marketplace may qualify for premium tax credits and cost-sharing reductions that lower both monthly premium and out-of-pocket expenses.
- Tobacco use: Some states allow insurers to charge higher premiums for tobacco users.
The average out-of-pocket maximum for Oscar members is $1,240 per year, which is below the industry average and reflects Oscar’s focus on keeping healthcare costs manageable for its members.
Prescription Drug Coverage
Oscar Health Insurance ensures members have easy access to medications at affordable costs. Commonly prescribed drugs are available for as little as $3 through Oscar’s pharmacy network, and prescription delivery services are available directly through the Oscar app. Members can fill and refill prescriptions from thousands of in-network pharmacy locations nationwide or have medications delivered to their home.
Each Oscar plan includes a drug formulary that lists covered medications and their associated copay or coinsurance amounts. The formulary is organized into tiers, with generic drugs typically carrying the lowest cost and specialty medications carrying the highest. Members should review their specific plan’s formulary to confirm coverage for any medications they currently take before enrolling.
Common Prescriptions and Costs
Many commonly prescribed medications for chronic conditions such as high blood pressure, diabetes, and cholesterol management are available at the $3 tier through Oscar. Short-term prescriptions for infections or acute conditions are also available at low cost through the Oscar app’s pharmacy network. Members managing long-term treatment plans can use the app to set up automatic refills, ensuring they never run out of essential medications.
Hospital, Doctor Services, and Provider Network
Oscar provides access to a wide network of high-quality providers including hospitals, primary care physicians, and specialists. The provider network varies by state and plan type. HMO and EPO plans are limited to in-network providers, while PPO plans allow access to both network and out-of-network care with varying cost-sharing levels.
Oscar prioritizes matching members with providers who understand their language, cultural background, and health history. This personalized approach to provider matching is facilitated through the Oscar app, which allows members to search for in-network doctors by specialty, language spoken, and location.
Virtual Care and Mobile App Features
Virtual care is one of Oscar’s most used features, with 62.5% of policyholders accessing health services through the app. Members can connect with a licensed healthcare provider within minutes through the app or online platform, eliminating the need for in-person visits for non-emergency concerns.
The Oscar mobile app includes:
- 24/7 virtual doctor visits: Connect with a provider for symptoms, diagnoses, and prescription requests without leaving home.
- Care Team access: A dedicated team of health guides available to help members find doctors, understand their benefits, and navigate the healthcare system.
- Step-tracking rewards: Members earn rewards for meeting daily activity goals, encouraging preventive health behaviors.
- Prescription management: Fill, refill, and track prescriptions directly through the app with delivery available.
- Claims management: View and track claims, understand Explanation of Benefits documents, and monitor deductible and out-of-pocket spending in real time.
Claims Process and Customer Service
Oscar has simplified the claims process through its app and online member portal. When a member receives care from an in-network provider, claims are typically submitted automatically by the provider and processed without any action required from the member. Members can track claim status, review Explanation of Benefits documents, and identify any out-of-pocket amounts owed directly through the app.
For out-of-network claims under PPO plans, members may need to submit a claim manually with supporting documentation. Oscar provides guidance through the Care Team for members who need assistance with the claims submission process.
Customer service at Oscar receives strong marks overall, with 78.3% of members reporting high satisfaction. The Care Team is available by phone and through the app, providing personalized support for coverage questions, provider searches, and claims assistance. Members who prefer self-service can manage most account tasks through the app without needing to contact support.
How to Enroll in Oscar Health Insurance
Oscar health plans are available through the ACA marketplace during the annual open enrollment period, which typically runs from November 1 through January 15. Special enrollment periods are available for individuals who experience a qualifying life event such as losing employer coverage, getting married, having a child, or moving to a new state.
To enroll, visit the Oscar website or the federal marketplace at Healthcare.gov and compare available plans for your state. Select the plan that best matches your coverage needs, premium budget, and preferred provider network. Confirm that your current doctors and any needed specialists are included in the plan’s network before finalizing your selection.
Small group employer plans can be purchased directly through Oscar outside of the marketplace enrollment window. Individuals who are eligible for Medicare can enroll in Oscar Medicare Advantage plans during the Medicare Annual Enrollment Period each fall.
See also: Oscar Insurance Reviews | Browse All Health Insurance Reviews
Oscar vs Other Health Insurers
| Factor | Oscar Health | Blue Cross Blue Shield | Aetna | UnitedHealthcare |
|---|---|---|---|---|
| Plan Types | HMO, EPO, PPO, Medicare Advantage | HMO, PPO, EPO, Medicare | HMO, PPO, EPO, Medicare | HMO, PPO, EPO, Medicare |
| State Availability | 20 states | All 50 states | All 50 states | All 50 states |
| Virtual Care | Yes, 24/7 via app | Yes | Yes | Yes |
| Mobile App | Highly rated | Available | Available | Available |
| Starting Monthly Premium | From $0 with subsidy | Varies by state | Varies by state | Varies by state |
| Rx from $3 | Yes | Varies by plan | Varies by plan | Varies by plan |
| Care Team Support | Yes (dedicated team) | Limited | Limited | Available |
Oscar’s primary advantage over larger national insurers is its technology-first approach, particularly the mobile app, dedicated Care Team, and low-cost prescription access. The main limitation is geographic: Oscar is only available in 20 states, so individuals outside those areas must consider alternatives. For eligible individuals within Oscar’s service area, it represents a strong option for cost-effective and accessible health coverage.
Visit Website: Oscar Health Insurance
Frequently Asked Questions
What states does Oscar Health Insurance cover?
Oscar Health Insurance is available in 20 states across the U.S. Availability varies by plan type, so visit the Oscar website or Healthcare.gov to check which plans are offered in your state during the current enrollment period.
How much does Oscar Health Insurance cost?
Oscar plan premiums start as low as $0 per month for individuals who qualify for ACA marketplace subsidies based on income. Actual premium costs depend on age, state, plan tier, and income level. The average out-of-pocket cost for Oscar members is $1,240 per year, below the industry average.
Does Oscar cover pre-existing conditions?
Yes. Under the Affordable Care Act, Oscar Health Insurance cannot deny coverage or charge higher premiums based on pre-existing conditions. All ACA-compliant plans including Oscar’s individual and family plans cover pre-existing conditions from the start of coverage.
How do I file a claim with Oscar Health Insurance?
For in-network care, claims are typically filed automatically by the provider and processed without member action. Members can track claim status and review Explanation of Benefits documents through the Oscar app. For out-of-network PPO claims, members may need to submit documentation manually through the member portal.
Does Oscar have good customer service?
78.3% of Oscar Health members report high satisfaction with customer service. The Care Team provides personalized support by phone and through the app for coverage questions, provider referrals, and claims assistance. The app also allows most account management tasks to be completed without contacting support.
