California Health Care
By Wendy Barnett
The Drug Price Standards Initiative, Proposition 61, will appear on the ballot this November as an initiated state statute for Californian voters. A “Yes” vote on Prop 61 supports regulating drug prices by requiring state agencies to pay the same prices that the U.S. Department of Veterans Affairs (VA) pays for prescription drugs. While a “No” vote on Prop 61 opposes this measure.
This measure is all about drug costs for California state agencies such as Medi-Cal and the Public Employees’ Retirement System (CalPERS). It does not apply to drug costs paid by individuals but only state agencies. Currently in California, state agencies negotiate drug prices with manufacturers to try to get discounts and lower prices. It was estimated in 2014 – 2015 that we spent almost $3.8 billion on prescription drugs statewide. Of that $3.8 billion, nearly 83% was spent for Medi-Cal and CalPERS. Proposition 61 is aimed at putting restrictions on the amounts that stat...
by John Hansen
If you are a health insurance broker in California, you need to know about this new up and coming health insurance company. Currently, Oscar is only available in Orange County and part of Los Angeles County, but in 2017 they will be expanding to include San Francisco, San Mateo and Santa Clara counties. We expect them to keep expanding their reach in the golden state, especially in big cities and more populated areas.
If your agency is in any of these counties, get ready to sell Oscar in 2017. They offer highly competitive pricing, easy-to-understand plans, and great customer service. Their one big drawback is that they pay low broker commissions.
In 2016, they were priced too high to be competitive for on-exchange coverage, but in 2017 their Covered California plans will be priced affordably. With increased brand recognition and lower prices, we expect Oscar to compete well for market share during the 2017 Open Enrollment Period.
Oscar Health Care is beating out Anthem Blu...
by John Hansen
Oscar Health Care CEO, Mario Schlosser, is known for being super smart and very tech-savvy. However, he hasn’t been the biggest advocate of the broker.
Schlosser has made some anti-broker comments. He spoke of agents as if they were a necessary evil. Light on the necessary, heavy on the evil. He went so far as to say that brokers make a “shit load of money”, and he acted like brokers do little more than confuse customers.
Even though I am a broker myself, I understand where Schlosser is coming from. He’s running a health plan. It’s difficult to make a health insurance company profitable, especially now that the Affordable Care Act in California and across the country has outlawed health insurance denials.
Guarranteed issue coverage means that health plans like Oscar have to insure anyone who applies. That includes people who are already taking extremely expensive prescriptions drugs on a monthly basis. That includes consumers who are dealing with expensive chronic...
by John Hansen
Simple. Intuitive. Easy. These are not usually words you see connected with health insurance. However, Oscar Health Care, a new up and coming carrier of health insurance in California, is making medical care easier in the golden state. When you get to the Oscar website, you are immediately greeted… “Hi, we’re Oscar. Smart, simple health insurance.”
Oscar health insurance is run by intelligent, technology-savvy leadership that is determined to make health care easier to understand and utilize.
CEO, Mario Schlosser, argues that it is a very strange thing for your health care to be connected to your employer. This odd connection causes the health insurance industry to cater more to HR departments than they do to consumers who actually use the health care plans.
Schlosser points out how Oscar Health Care is different. He says, “There is a reason why insurance companies are run the way they do. It is because they don’t actually sell to you or to the average guy on the...
by John Hansen
Oscar health insurance claims to offer better plans, better health care and a better experience for their members. Basic question… Is this true? Obviously, that may depend on who you are comparing them to.
So… Let’s discuss these three bold claims that you can find on the home page of the Oscar website.
We would rank Oscar as #1 with regard to customer-service technology. Their user-experience on the web and on their phone app is pretty incredible, simple and intuitive.
However, when it comes to physician-information software, the Kaiser Permanente California electronic medical records systems is hard to beat. EPO’s like Oscar and PPO’s like Anthem Blue Cross and Blue Shield have nothing that can compare.
Their medical coverage has deductibles, copays, coinsurance, pricing for doctor/hospital visits, etc. just like everyone else.
So, when it comes to basic benefits, in many ways they are just another health plan.
However, they shine in two main areas:
What does my...
by John Hansen
In a meeting with Oscar California Healthcare Sales Leader, Dennis Negron, on Wednesday, August 24, I asked him why the carrier is pulling out of the Dallas and New Jersey markets. I wanted to know how stable the company was going to be in California.
Recently, we found out that UnitedHealthcare was pulling out of the California Health Exchange. In light of Oscar Health Care leaving Dallas and New Jersey, we wanted some assurance that they would be sticking around in California.
Our agency, Health for California Insurance Center, only sold 31 Oscar medical insurance plans during the 2016 Open Enrollment. We focus on selling the Covered California plans, and they just weren’t very competitive this year in the on-exchange market.
Negron not only assured us that Oscar California would be competitive, but he said that they would be very competitive. In 2017, they would offer the cheapest health insurance in San Francisco and Orange County in the off-exchange market.
In Los An...
by John Hansen
When you land on the Oscar insurance official website home page, there is a humble, yet bold greeting: “Hi, we’re Oscar.” The health plan was founded in 2012 by Mario Schlosser, Kevin Nazemi and Joshua Kushner.
Kushner was a big part of the financial backing right away. He is one of the famous Kushner brothers. His brother is married to Donald Trump’s daughter. And, it has been said that Trump seeks advice on the ACA and health care from Joshua Kushner.
Oscar Health Care brags, “Our members love us! They like our plans. They use our tools. They come to us when they get sick. They recommend us to friends and family.”
Word of mouth is the #1 way people hear about Oscar health insurance. The health plan’s net promoter score is 30+, where the industry average is 10.
So far the company has raised over $750 million to date. That includes a fairly recent $400 million from Fidelity. Even after showing losses of over $100 million in 2015, Fidelity was willing to inves...
by John Hansen
Anthem Blue Cross and Blue Shield of California better watch their back. The new guy is coming. And, he’s coming on strong.
So far, Oscar Plans are only in a handful of California regions. However, in every region where they exist, they are becoming more and more competitive. They have already been competitive in the 2016 off-exchange markets, but in 2017 they will be tough to beat in the EPO products offered through Covered California.
Oscar Health Care is building a high quality network in California in the regions they service. Anchored by the partnership with Providence Health Network, their network includes:
In 2016, participating hospitals included:
In 2017, they will be adding more. In many cases, Oscar plans have similar or better networks than Anthem Blue Cross and Blue Shield of California.
Oscar offered their health plans only in Los Angeles County and Orange County in 2016. In 2017, they will be expanding to include San Francisco, Santa Clara and San Mateo cou...
by John Hansen
Easy is not a term most people associate with health care, but Oscar health insurance is revolutionizing the market by simplifying the process of getting service and using a health plan. They offer excellent customer service and innovative, easy-to-understand and easy-to-use plan designs.
Live support from representatives and medical personnel is easy to access for every member. And, the plan designs make sense even to people who are new to having health insurance coverage.
Oscar is easy to reach. They are open 7 days a week. Over 90% of their callers talk to a person in under 30 seconds. They are aiming to increase this to 95% in the near future.
They aim to not only answer your call quickly, but to the get to the bottom of your issue in a timely manner. The carrier resolves 85% of issues within one day.
Oscar Health Care is committed to return emails within one business day. Each week, they help over 150 members find a doctor.
Also, you can get a call from a doctor twenty-...
by John Hansen
Oscar Health Care offers two categories of medical plans: Market Plans and Simple Plans. The Simple Plans are designed to be super easy to understand. The Market Plans are designed to be offered in the California Health Exchange, through Covered California.
Find out the pros and cons between these two types of health insurance plans. Choose which type of plan will suite you best.
These plans get their name from the fact that they are offered in the California Health Insurance Marketplace. You can purchase Market Plans through Covered California.
Based on your income and household size, if you enroll in a Market Plan, you may qualify for government assistance. That may come in the form of up-front tax credits, Cost Sharing Reduction (CSR) or both.
The Market Plans offer lower prices for Urgent Care on the Silver and Gold. For Simple Plans, the copay is $100 for Urgent Care, but on the Market Plans Urgent Care is $35 or less. None of the Bronze Plans include discounts for U...