Oscar Plans Beat Anthem/Blue Shield in Some CA Regions

by John Hansen

Lower Prices, Great Networks, Better Technology, Better Service, and Other Perks

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.

Provider Networks and Hospitals

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:

• UCSF

• One Medical

In 2016, participating hospitals included:

• Providence St. Joseph Medical Center

• Providence Holy Cross Medical Center

• Providence Little Company of Mary Medical Center – Torrence

• Providence Little Company of Mary Medical Center – San Pedro

• Providence Tarzana Medical Center

• Providence St. John’s Health Center

• Good Samaritan Hospital

• St. Joseph Hospital of Orange

• St. Jude Medical Center

• Hoag Memorial Hospital Presbyterian

• Mission Hospital Regional Medical Center – Main

• Mission Hospital Regional Medical Center – Laguna Beach

• Huntington Memorial Hospital

• UCLA Medical Center – Santa Monica

• UCLA Medical Center – Ronald Reagan

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 California Counties and Regions

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 counties.

That puts Oscar in Covered California regions 4, 7, 8, 16, and 18. However, they only partially cover the Los Angeles 16 region.

In every region they exist, they offer the lowest-priced non-HMO plan on or off the California Health Exchange. Off-exchange, they will have the cheapest plan period in Orange County and San Francisco in 2017.

EPO Plans with No Out-of-Network Coverage

Oscar Health Plans offer only EPO coverage, not PPO. So there is no out-of-network coverage. Similarly, in many regions Anthem Blue Cross of California has stopped offering PPO and gone solely with EPO in order to compete better.

If you’re wanting PPO out-of-network coverage, you’ll likely need to go with Blue Shield, Anthem or Health Net.

Carriers like Oscar negotiate rates and coverage with doctors, hospitals and provider networks. By limiting their coverage to in-network, they can keep their costs down and pass the savings on to their members. Also, this helps them compete in the Health Insurance Marketplace.

With EPO’s, just like with a PPO, members never need a referral to see in-network providers. Members can see any doctor or specialist they wish without a referral from their Primary Care Physician (PCP).

Due to new mandates in California, all enrollees including Oscar Health Insurance members will be assigned a PCP within six months of enrollment. However, for those on EPO’s and PPO’s, this is just an added convenience to make healthcare more accessible.

Oscar plan members do not ever have to see their assigned Primary Care Physician. They can choose any other in-network doctor, and they can see a specialist without approval from their doctor.

Out of town with an emergency? 

Emergencies and urgent care are covered worldwide. Also, members can call a “Doctor on Call” at anytime from anywhere in the world at no charge. The Oscar pharmacy network is also nationwide.

Health Care Made Easy

Oscar was not started by doctors, providers or insurance companies. It was started by techies and venture capitalists who wanted to simplify health care. They wanted to make it easy for the average Joe.

Whether on the web, the mobile app, their promotions, or even their membership card, they offer a simple look that is easy to understand and helpful.

On one side of the membership card, you will see a list of covered members in the household along with their official website URL and customer service phone number. This makes it very clear who is enrolled on the Oscar plans and where you need to go to access health care services.

On the other side of the card, you’ll find your member number and the benefit highlights for your plan. Quickly and easily, you’ll see what the costs are for doctor visits, specialist care, emergency, and hospitalization. There are also helpful codes and the address where you can submit claims.

It seems that the Oscar Health Plan has modeled themselves after Google and Apple. In all electronic interactions with Oscar as well as with their mail-outs, you can expect simple, sleek, streamlined, easy-to-understand communication.