Oscar Health Insurance Options for Individuals & Families in AZ

Key Takeaways

• Oscar is a technology-forward insurance carrier in Arizona that has been around for a little more than a decade. Oscar offers an extensive network of providers in the state who are covered under their plans, most of who are also covered under Cigna insurance plans.
• Oscar is contracted with Arizona healthcare providers including Abrazo Health, Banner Health, HonorHealth and various Valley hospitals. Those who are insured under Oscar have lots of in-network provider options. 
• You don’t have to get a referral from a primary care physician in order to see a specialist with Oscar health insurance. This may be a potential benefit for individuals and families who want more healthcare provider choice and control. However, since Oscar is a health maintenance organization, members are limited to in-network providers if they want their care covered.
  

Benefits of Oscar Insurance for Individuals & Families

Oscar was created to make healthcare more affordable and convenient for individuals and families in states like Arizona. Some of the benefits of using Oscar for health insurance include the following.

• Convenient app: You can use the Oscar app to find doctors, hospitals and pharmacies nearby that accept Oscar healthcare plans. You can also filter providers and get matches based on your unique language preference, race, ethnicity and health history. 
• Free 24/7 virtual urgent care: Oscar members can get free virtual urgent care in as few as 15 minutes, for common issues such as skin conditions, sore throat, allergies, sinus infection, nausea, vomiting and UTIs. You can use the service to get a diagnosis, refill a prescription or get a new prescription, all without having to pay a copay or go somewhere.
• Virtual primary care: Oscar members in Arizona can also schedule free virtual primary care visits via video. Members can also message their medical teams – which consist of a provider, a nurse and a medical coordinator – at any time through the app. 
• Low-cost prescriptions: Oscar members can get many commonly prescribed drugs for as low as $3. You can get prescriptions filled or refilled directly in the app, as well as get potential same-day delivery to your home, making prescription management easy and convenient with Oscar. Pharmacy options include CVS, Costco Wholesale, Safeway and Walmart.

Oscar also has a lab network with Sonora Quest Laboratory, a common lab in Arizona. With extensive network coverage and low-cost healthcare options, Oscar may be a newer name on the scene, but it’s already gaining popularity among Arizonans. 

Considerations for Oscar Insurance

There are also some things to consider before choosing Oscar as your health insurer. Oscar health insurance is an Health Maintenance Organization (HMO). That means:

• Only in-network doctors are covered under the Oscar health insurance plan.
• If you see an out-of-network doctor, you’ll likely have to pay for services out-of-pocket.
• There are certain exceptions, such as when a plan holder needs emergency care, and an in-network doctor isn’t available. 
• You don’t need a referral to see a specialist. In-network specialists are covered under Oscar.

An Oscar may not be your preferred health insurance choice if your preferred doctors aren’t covered in-network. Generally, if a physician is covered under the Cigna network, they’ll probably also be covered under Oscar.

If you know you have doctors you want to continue to see, you should check if they’re in-network with Oscar so you understand what your costs will be.

What Oscar Health Insurance Plan Tiers Are Available on the ACA Marketplace?

Oscar ACA Marketplace health insurance plans are divided into various metal tiers, each of which have varying percentages of what the insured pays and what Oscar covers. All the plan benefits are the same – the only differences are the premium prices and the out-of-pocket costs. Here's a breakdown of the metal tiers:

• Bronze plan: This plan has a lower monthly premium, with higher out-of-pocket expenses. With this plan, 60% of covered health costs are paid by Oscar, and 40% are paid by the plan holder. This can be a good choice if you want emergency coverage but don’t expect to use your healthcare coverage that frequently.
• Silver plan: This plan has a moderate monthly cost and moderate out-of-pocket expenses. With this plan, 70% of covered health costs are paid by Oscar, and 30% are paid by the plan holder. You may be eligible for cost share reductions on this plan, which could be a good choice if you’re willing to pay a slightly higher monthly premium than a bronze plan and get more healthcare covered.
• Gold plan: This plan has a higher monthly premium with lower out-of-pocket expenses. With this plan, 80% of covered health costs are paid by Oscar, and 20% are paid by the plan holder. This plan may be a good choice if you use healthcare coverage frequently.

Within each metal tier, Oscar offers three types of plans. Each type presents different coinsurance and copay options, as follows.

• Classic
• Mid- to high monthly cost.
• Mix of coinsurance and copays (e.g., copays for labs and coinsurance for hospital stays)

• Elite
• Highest Premium.
• Mostly copays, lower coinsurance.
• $0 medical deductible
• Prescription deductible included...