Oscar Health Insurance Options for Individuals & Families in AZ
For individuals and families who are looking for health insurance options on the Affordable Care Act (ACA) Marketplace, one provider to consider in Arizona is Oscar. This innovative, technology-forward insurer offers a variety of health plans for various healthcare needs and diverse individual/family budgets.
If you’re interested in Oscar (or any other health insurance plan on the ACA Marketplace), open enrollment begins November 1 and lasts through January 15. There are also several qualifying events, such as moving or losing health insurance coverage through work, that could qualify you for a special enrollment period at any time of year.
This guide explains how Oscar coverage through the
ACA Marketplace works. If you want to learn about all the ACA Marketplace health insurance options available to you and your family, fill out our
free form to compare yours. You’ll gain access to a personalized ACA insurance expert who can answer any questions you have about your options.
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 an exclusive provider 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 exclusive provider organization (EPO). 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 EPO like 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. Plan breakdowns are as follows.
- 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.
Oscar 2025–2026 Rate Changes in Maricopa County
Oscar has adjusted plan rates for 2026 to reflect overall medical usage and higher prescription costs. Here’s how average monthly premiums have changed for a 40-year-old individual in Maricopa County (before subsidies):
Within each metal tier, Oscar offers three types of plans. Each type presents different coinsurance and copay options, as follows.
- Standard
- Lowest monthly cost
- Highest coinsurance
- Mostly available in Bronze and Silver metal tiers
- Available for condition-specific plans, including diabetic and COPD plan options.
| Metal Tier | 2025 Avg. Premium* | 2026 Avg. Premium* | % Change |
|---|---|---|---|
| Bronze | $355.56 | $413.98 | +16% |
| Silver | $390.58 | $504.15 | +29% |
| Gold | $475.96 | $546.82 | +15% |
*Based on unsubsidized Marketplace premiums for a 40-year-old individual in Maricopa County. Actual costs vary by age, income, and household size.*
Tayler Busack with AZ Health Insurance Brokers
“Oscar’s plans are priced more competitively compared to other carriers. When you factor in their strong network and easy-to-use app, this will be one of the more popular Marketplace carriers for 2026.”
Within each metal tier, Oscar offers three types of plans. Each type presents different coinsurance and copay options, as follows.
- Simple
- Lowest monthly cost
- Highest coinsurance
- Mostly available in Bronze and Silver metal tiers
- Available for condition-specific health insurance plans, including COPD and diabetic plan options
| Oscar Simple Gold, Silver & Bronze |
|---|
| Deductible | Out-of-pocket maximum | Coinsurance | Primary care provider copay | Specialist copay | |
|---|---|---|---|---|---|
| Gold | $3,300 | $9,950 | 80%/20% | $5 | $10 |
| Gold Diabetes | $2,000 | $9,800 | 80%/20% | No charge | $40 |
| Silver PCP Saver | $5,750 | $9,400 | 60%/40% | $20 | $70 |
| Silver Diabetes | $6,500 | $10,000 | 50%/50% | No charge | $40 |
| Silver Chronic Care | $5,900 | $10,150 | 50%/50% | No charge | $35 |
| Silver Specialist Saver | $6,500 | $9,600 | 50%/50% | $35 | $40 |
| Silver Women’s Health | $6,000 | $10,150 | 50%/50% | No charge | $40 |
| Bronze Simple | $9,000 | $10,600 | 60%/40% | After meeting the deductible, no charge | After meeting the deductible, no charge |
| Bronze Breathe Easy | $5,500 | $10,150 | 50%/50% | $50 | $150 |
| Bronze Chronic Care | $5,500 | $10,150 | 50%/50% | $50 | $150 |
| Bronze Buena Salud | $5,500 | $10,150 | 50%/50% | $50 | $150 |
- Classic
- Mid- to high monthly cost
- Mix of coinsurance and copays – for example, there may be copays for labs and coinsurance for a hospital stay
| Oscar Classic Gold, Silver & Bronze |
|---|
| Deductible | Out-of-pocket maximum | Coinsurance | Primary care provider copay | Specialist copay | |
|---|---|---|---|---|---|
| Gold Classic | $3,500 | $7,750 | 70%/30% | $30 | $35 |
| Gold Classic Standard | $2,000 | $8,200 | 75%/25% | $30 | $60 |
| Silver Classic Standard | $6,000 | $8,900 | 60%/40% | $40 | $80 |
| Bronze Classic Standard | $7,500 | $10,000 | 50%/50% | $50 | $100 |
- Elite
- Highest premium
- Mostly copays, lower coinsurance
- $0 medical deductible with Silver plan
- Prescription deductible included
| Oscar Elite Silver & Bronze |
|---|
| Deductible | Out-of-pocket maximum | Coinsurance | Primary care provider copay | Specialist copay | |
|---|---|---|---|---|---|
| Silver | $0 | $8,500 | 50%/50% | $80 | $100 |
| Bronze | $7,500 | $10,150 | Urgent care: $75 Emergency room: $2,500 copay Ambulance: $2,500 copay Hospital stay (facility): $3,000 per day Hospital stay (physician): $350 Outpatient procedure (facility): $1,200 copay Outpatient procedure (physician): $350 Physical rehabilitation: $130 | $50 | $130 |
If you need help navigating all these metal tier and plan type options, fill out the ACA Marketplace insurance form. It’s free, and you’ll receive personalized service from an experienced health insurance professional who can answer any questions you have about all your options.
Who Oscar Is Best For in Arizona
- Tech-savvy members who want to manage care through a mobile app
- Families who use providers in the Banner, HonorHealth, or Abrazo systems
- People who prefer no-referral access to specialists
- Members looking for low-cost virtual care and $3 prescription options
- Snowbirds who split time between Arizona and other Oscar-covered states
How to Get Oscar ACA Marketplace Insurance in AZ
Open enrollment for Oscar ACA Marketplace insurance is upon us. If you want to sign up for health insurance through the ACA Marketplace and see how your options with Oscar compare to other health insurers in AZ, we can help. Fill out our free form to see your options and get personalized guidance throughout the signup process.
You can also call us at 602.617.4107, email quotes@azhealthinsurancebrokers.com or message us online, and we’ll contact you shortly.
Oscar Individual & Family Insurance FAQs
Is Oscar real health insurance?
Yes, Oscar is a real health insurance provider serving Arizona residents and others throughout the country. This technology-driven company makes accessing healthcare services easy, through a free mobile app that includes virtual care, prescription refills and a personalized team to help guide you through your healthcare coverage needs.
What ACA Marketplace plans does Oscar offer?
Oscar offers ACA Marketplace plans in four metal tiers: Bronze, Silver, Gold and Platinum. Each plan varies the percentage the insured pays for coverage, versus the health insurance company. Within each metal tier, there are three plan types: Simple, Classic and Elite. These plan types further affect factors like premiums and deductibles.
What type of providers can you see when you use Oscar?
Oscar is an exclusive provider organization (EPO), which means you receive coverage when you see a doctor in the network. Doctors who are outside of the network aren’t covered, other than in certain situations, such as in an emergency, when there aren’t in-network options available. You don’t need a referral to see a specialist.
When is open enrollment for Oscar ACA Marketplace health insurance?
Open enrollment for Oscar health insurance on the ACA Marketplace is between November 1 and January 15. If you enroll by December 15, 2025, coverage will start January 1, 2026. If you enroll after December 15, 2024, and by January 15, 2025, coverage will begin February 1, 2025.
Can you apply for Oscar health insurance on the ACA Marketplace outside of open enrollment?
Yes, it may be possible to qualify for a special enrollment period and sign up for Oscar ACA Marketplace health insurance outside of open enrollment. Qualifying events generally include divorce, moving, getting married, having a baby, adopting a child, losing health insurance through work or if your household income falls below a certain amount. You typically have 60 days before or after the event to enroll in Oscar during the special enrollment period on the ACA Marketplace.
Is Oscar good health insurance?
Oscar has a net promoter score (NPS) of 69, which the health insurance provider reports is 21 times higher than the industry average. Positive reviews come from customer service, ease of app use and healthcare assistance.
Where is Oscar health insurance available?
Oscar health insurance is currently available in 18 states: Arizona, Georgia, Iowa, Pennsylvania, Illinois, Kansas, Florida, Missouri, North Carolina, Nebraska, New Jersey, New York, Ohio, Oklahoma, Tennessee, Michigan, Texas and Virginia. For snowbirds who share residences between Arizona and a home in another covered state, Oscar could be a good health insurance choice.
How does the Oscar healthcare app work?
With the Oscar healthcare app, members can find doctors using filters like condition or location, see in-network options, request consultations 24/7 with Virtual Urgent Care, message the Care Team, refill prescriptions, see lab results and more.
What are the pros and cons of Oscar health insurance?
Oscar is a technology-forward, exclusive provider organization (EPO) health insurer that doesn’t require a referral from a primary care physician in order to see a specialist. Most providers who are covered by Cigna insurance plans are also covered by Oscar. Oscar offers many prescription drug options for as little as $3. A potential downside of Oscar is that only in-network doctors are covered by Oscar. If you want to see a provider outside of the network, you’ll have to pay out of pocket.
How can you sign up for Oscar?
To sign you and/or your family up for Oscar health insurance, contact the AZ Health Insurance Brokers team. We can sign you up for free during ACA open enrollment, or explore signup options if you’re outside of the open enrollment period.
