Oscar is a private insurance company, not Medicaid itself — but it does sell Medicaid plans in some states

Oscar Health is a for-profit insurance company that sells health plans directly to individuals and families. In certain states, Oscar also contracts with state Medicaid programs to offer Medicaid managed care plans. This means Oscar can be your insurer whether you buy private coverage or enroll in Medicaid, but the two are legally separate programs with different rules, costs, and coverage.

The confusion arises because Oscar's name appears on Medicaid insurance cards in states where it operates a Medicaid plan. If you see "Oscar" on a Medicaid card, Oscar is administering your Medicaid benefits — but you are still enrolled in Medicaid, not in Oscar's private business. The distinction matters for how you pay, what you can change, and what happens if Oscar stops offering plans in your state.

Key Takeaways

  • Oscar Health is a private insurance company that sells both individual health plans and Medicaid managed care plans, depending on the state and your income.
  • If your Medicaid card says Oscar, Oscar is managing your Medicaid coverage, but you are still a Medicaid member — not a private insurance customer.
  • Oscar's private plans and Oscar's Medicaid plans have different premiums, deductibles, and rules because they are governed by different laws.
  • Oscar operates Medicaid plans in only some states; availability and plan details vary by location and change year to year.
  • If Oscar stops offering Medicaid plans in your state, you will be moved to another Medicaid plan automatically — you do not lose Medicaid itself.

How Oscar's private insurance and Medicaid plans differ

Oscar's individual and family health plans are private insurance sold on the open market. You pay a monthly premium, choose your deductible and coverage level, and can switch plans during the annual open enrollment period (usually November through January). These plans follow federal health insurance rules but are not Medicaid.

Oscar's Medicaid plans are different. Medicaid is a joint federal and state program that covers people with low income. When Oscar offers a Medicaid plan, it is contracted by your state to manage Medicaid benefits for enrolled members. You do not pay a premium to Oscar for Medicaid coverage (though your state may charge a small copay for some services). You cannot straightforward switch to a different Medicaid plan mid-year unless you have a may have access to life event, and the plan's rules are set by your state, not by Oscar alone.

The key difference: with Oscar's private plan, you are buying insurance from a company. With Oscar's Medicaid plan, you are receiving a government benefit that Oscar administers on the state's behalf.

Which states offer Oscar Medicaid plans

Oscar does not operate Medicaid plans in every state. As of early 2024, Oscar offered Medicaid managed care plans in a limited number of states, including California, Florida, New York, and Texas, though this list changes. Some states have dropped Oscar's Medicaid plans, and Oscar has exited others due to financial or operational reasons.

To find out whether Oscar offers Medicaid in your state, contact your state's Medicaid agency directly or visit its website. Your state Medicaid office can tell you which managed care plans are available in your area and whether Oscar is one of them. Do not rely on Oscar's website alone, because it may not reflect current state-by-state availability.

How to tell whether you have Oscar private insurance or Oscar Medicaid

Check your insurance card. If the card says "Medicaid" anywhere on it, you are enrolled in Medicaid through Oscar. If it does not mention Medicaid, you have Oscar's private insurance. You can also call the customer service number on your card and ask directly.

Your enrollment letter or welcome packet will also make this clear. Medicaid plans come with a letter from your state's Medicaid agency or a notice that says "Medicaid managed care plan." Private plans come with a letter from Oscar Health as a company, not from a state agency.

If you are unsure, call your state's Medicaid hotline. They can confirm whether you are enrolled in Medicaid and, if so, which plan you are in.

What happens if Oscar stops offering Medicaid in your state

If Oscar exits the Medicaid market in your state, you will not lose Medicaid. Your state will automatically move you to another Medicaid managed care plan that is still operating in your area. You will receive a notice in the mail explaining the change and which plan you are being moved to. Your coverage will continue without a gap.

You may have a short window (usually 30 to 60 days after receiving the notice) to choose a different Medicaid plan instead of the one your state assigned you. Read the notice carefully to see whether you have this choice and what the important date is. If you do nothing, the state's default plan will take effect.

This is different from Oscar's private insurance. If Oscar stops selling private plans in your state, you would need to find and enroll in a different private plan yourself — you would not be automatically moved.

How Oscar Medicaid plans are paid for

Medicaid itself is funded by federal and state taxes. When Oscar operates a Medicaid plan, the state pays Oscar a fixed monthly amount per member to cover the cost of care. You do not pay Oscar a premium for Medicaid coverage. Your state may charge you small copays (usually $1 to $5) for doctor visits or prescriptions, depending on your income and the service, but these go to the provider, not to Oscar.

Oscar's private plans work differently. You pay Oscar a monthly premium, and that premium covers your insurance. The premium amount depends on your age, health status (in some cases), and the plan you choose.

How to enroll in Oscar Medicaid if it is available in your state

You do not enroll in Oscar Medicaid directly through Oscar. You enroll in Medicaid through your state's Medicaid agency. Once you are approved for Medicaid, your state will show you which managed care plans are available in your area — Oscar may be one of them. You then choose Oscar (or another plan) as your managed care plan.

To start, contact your state's Medicaid office or visit its website. You will need to provide information about your income, household size, and citizenship status. If you are found to be income-may be able to access for Medicaid, you will be given a list of available plans and can choose Oscar if it is offered in your area.

The process and timeline vary by state. Some states process Medicaid applications in a few days; others take several weeks. Your state Medicaid office can tell you how long to expect.

Frequently Asked Questions

Can I have both Oscar private insurance and Oscar Medicaid at the same time?

No. If you are enrolled in Medicaid, you cannot also have private insurance as your primary coverage. Medicaid is your primary insurance. In rare cases, you might have Medicaid and a limited supplemental plan, but this is uncommon and depends on your state's rules. Contact your state Medicaid office to ask whether supplemental coverage is an option.

If I have Oscar Medicaid, can I switch to Oscar's private insurance?

You can switch to Oscar's private insurance only if you no longer may have access to for Medicaid (for example, if your income rises above your state's Medicaid limit). Once you lose Medicaid, you can enroll in Oscar's private plan during the annual open enrollment period or if you have a may have access to life event. You cannot hold both at the same time.

Does Oscar Medicaid cover the same doctors and hospitals as Oscar private insurance?

No. Oscar's Medicaid plans and private plans have different networks of doctors and hospitals. The network for a Medicaid plan is determined by your state and Oscar's contract with the state. The network for a private plan is determined by Oscar's business decisions. Always check the plan's provider directory before enrolling to make sure your doctor is included.

What if I move to a state where Oscar does not offer Medicaid?

If you move and Oscar does not operate Medicaid plans in your new state, your Medicaid coverage will transfer to your new state's program. Your new state will assign you to a Medicaid managed care plan or allow you to choose one. You will not lose Medicaid, but you will be in a different plan, possibly with a different insurer.

How do I know if I may have access to for Medicaid in the first place?

Medicaid income limits vary by state. Most states cover adults with income up to 138% of the federal poverty level, but some states have lower limits. Contact your state's Medicaid office or visit its website to learn the income limit in your state and to start the enrollment process. You can also call 211 for a referral to your local Medicaid office.