Oscar’s 2 Types of Plans: Market and Simple Plans
Posted: September 23, 2016
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 Urgent Care.
If you need non-preferred brand drugs or specialty drugs, you will want to get a Gold or Platinum Market Plan. The Simple Oscar health plans do not include discounts for these high priced medications.
Market Plans come in Bronze, Silver, Gold and Platinum. Currently, there is no Minimum Essential Coverage Plan. Market Plans are available off-exchange as well.
We love the Simple Plans because they are so easy to understand. The deductible and the out-of-pocket maximum are the same amount. So, when you reach one, you have reached the other.
Most plans have three confusing stages:
- Before you’ve reached the deductible
- After you’ve reached the deductible, but before you’ve reached the out-of-pocket maximum
- After you’ve reached the out-of-pocket maximum
Consumers have a hard time understanding and keeping track of each of these three stages. So, Oscar Health Insurance created the Simple Plan, which only has two stages:
- Stage 1 – Before the Deductible/OOP Max: During this stage some covered benefits are free or only require a small copay. Other benefits are subject to the deductible.
- Stage 2 – After the Deductible/OOP Max: During this stage, all covered benefits are free because you have reached the out-of-pocket maximum.
You don’t have to worry about keeping track of two separate numbers. On the Gold Plan, once you’ve reached $3,000, you have reached your deductible and your out-of-pocket maximum.
There is no Simple Platinum Plan available. However, the Gold Plan offers excellent coverage. It has a lower out-of-pocket maximum than even the Platinum Market Plan. And, most standard benefits are covered with a low copay up front.
Not including the Secure Plan, the Simple Plans offer very low costs for generic drugs. Generic medications are only $5 on the Bronze plan and they are free for the Silver and Gold Plans.
These plans are only available off-exchange. If you qualify for a government subsidy, you would want to enroll on a Market Plan.
The “Secure” Simple Plan: This Simple Plan caught our attention. It is the perfect plan for someone looking for cheap, major medical coverage.
This plan has low monthly premiums and a high deductible/out-of-pocket maximum. It’s a Simple Plan, so once you’ve reached the deductible, you have reached the OOP Max.
But what if I need to see the doctor? The Secure Plan includes three primary care doctor visits for free. Also, keep in mind that with Oscar you can always talk to a doctor over the phone at no charge.