OSCAR is a health insurance company that sells plans through the federal marketplace

OSCAR is a private health insurance company that offers medical coverage to individuals and families. You can purchase OSCAR plans through the federal health insurance marketplace (Healthcare.gov) during the annual open enrollment period, or if you experience a may have access to life event like losing employer coverage or moving to a new state.

OSCAR was founded in 2013 and operates in multiple states, though not all states. The company focuses on offering plans with digital tools — like a mobile app and telemedicine options — alongside traditional insurance coverage. Like all marketplace plans, OSCAR policies must cover the ten essential health benefits required by federal law, including hospitalization, prescription drugs, and preventive care.

OSCAR plans come in four metal levels: Bronze, Silver, Gold, and Platinum. These levels determine how much you pay upfront (your premium) versus how much you pay when you use care (your deductible, copays, and coinsurance). You may also receive a tax credit or cost-sharing reduction to lower your monthly premium or out-of-pocket costs, depending on your household income.

Key Takeaways

  • OSCAR is a private insurance company that sells plans only through Healthcare.gov, not directly to consumers outside the marketplace.
  • You can purchase an OSCAR plan during the annual open enrollment period (usually November through January) or if you have a may have access to life event.
  • OSCAR plans are available in select states, so you must check whether OSCAR operates in your state before shopping.
  • All OSCAR plans cover the same ten essential health benefits, but the metal level you choose affects your monthly premium and what you pay when you receive care.
  • Your income may make you may be able to access for a federal tax credit that reduces your monthly premium or a cost-sharing reduction that lowers your out-of-pocket costs.

How to find OSCAR plans in your state

OSCAR does not sell insurance outside the federal marketplace, so you cannot purchase a plan directly from the company's website. Instead, go to Healthcare.gov, enter your zip code, and see which insurers offer plans in your area. OSCAR may or may not appear as an option depending on your state and county.

OSCAR currently operates in a limited number of states. Before you spend time comparing plans, check the OSCAR website or call their customer service line to confirm they sell plans where you live. If OSCAR does not operate in your state, you will see other insurers' plans on Healthcare.gov instead.

If OSCAR is available in your area, you can compare their Bronze, Silver, Gold, and Platinum plans side by side on Healthcare.gov. The site shows you the monthly premium, annual deductible, and typical out-of-pocket costs for each plan so you can see the real cost difference between metal levels.

Understanding the four metal levels

The metal level you choose determines the split between what you pay monthly (premium) and what you pay when you use care. Bronze plans have the lowest monthly premium but the highest deductible and out-of-pocket costs. Platinum plans have the highest monthly premium but the lowest deductible and out-of-pocket costs. Silver and Gold fall in between.

For example, a Bronze plan might cost $150 per month with a $6,000 annual deductible, while a Silver plan might cost $250 per month with a $3,500 deductible. The choice depends on whether you expect to use a lot of medical care this year. If you rarely see a doctor, Bronze may save you money overall. If you take regular medications or have ongoing treatment, Silver or Gold might cost less when you add up the premium plus what you actually spend on care.

All metal levels cover preventive services like annual checkups and vaccines at no cost to you, even before you meet your deductible. The metal level only affects how much you pay for other services like office visits, specialist appointments, and hospital stays.

Tax credits and cost-sharing reductions

If your household income falls between 100 and 400 percent of the federal poverty level, you may receive a premium tax credit that lowers your monthly bill. The credit is based on your expected income for the year, so you estimate your income when you shop on Healthcare.gov. If your actual income turns out to be different, you may owe money back or receive a refund when you file your taxes the following year.

If your household income is below 250 percent of the federal poverty level and you choose a Silver plan, you may also receive a cost-sharing reduction. This benefit lowers your deductible, copays, and coinsurance — meaning you pay less when you actually use care. Cost-sharing reductions are only available with Silver plans, not with Bronze, Gold, or Platinum.

To see whether you may have access to for either benefit, enter your household size and expected income on Healthcare.gov. The site will show you the estimated tax credit and cost-sharing reduction you may receive before you choose a plan.

What happens after you purchase an OSCAR plan

Once you enroll in an OSCAR plan on Healthcare.gov, your coverage begins on the first day of the following month (or the first day of the month after you experience a may have access to life event). OSCAR will send you a member ID card by mail, though you can often view your card number in the OSCAR mobile app or member portal before the physical card arrives.

You can use your OSCAR plan at any doctor, hospital, or pharmacy that accepts your plan's network. OSCAR plans typically use a broad network, but you should check whether your current doctors are in-network before you enroll. You can search the OSCAR provider directory on their website or call their customer service number to confirm.

OSCAR offers a mobile app and online member portal where you can view your claims, find in-network providers, request prescription refills, and schedule virtual doctor visits. You can also call OSCAR's customer service line if you have questions about your coverage or need help finding a provider.

When you can enroll in an OSCAR plan

The main enrollment period for marketplace plans runs from November through January each year. During this time, anyone can shop for and enroll in an OSCAR plan (or any marketplace plan) without a specific reason.

Outside the main enrollment period, you can only enroll in an OSCAR plan if you experience a may have access to life event. These events include losing employer health coverage, moving to a new state, getting married, having a baby, or experiencing a significant drop in income. When you have a may have access to event, you typically have 60 days to enroll in a new plan.

If you miss the enrollment period and do not have a may have access to event, you cannot enroll in an OSCAR plan until the next annual enrollment period begins. There is no way to enroll outside these windows, so mark your calendar for November if you think you may need coverage.

OSCAR plans versus other marketplace insurers

OSCAR is one of many private insurers that sell plans through Healthcare.gov. Other large marketplace insurers include Anthem, Aetna, Cigna, Humana, and regional Blue Cross plans. All marketplace plans — whether from OSCAR or another company — must cover the same ten essential health benefits and follow the same rules about deductibles, copays, and out-of-pocket limits.

The main differences between OSCAR and other insurers are the specific doctors and hospitals in their network, the customer service experience, and the digital tools they offer. OSCAR emphasizes its mobile app and telemedicine options, while other insurers may focus on different strengths. The best plan for you depends on which doctors you want to see, which metal level fits your budget, and which company's tools and customer service you prefer.

When you shop on Healthcare.gov, compare plans from all available insurers in your area, not just OSCAR. The site makes it straightforward to see the premium, deductible, and out-of-pocket costs side by side so you can choose the plan that works best for your situation.

Frequently Asked Questions

Can I buy an OSCAR plan directly from OSCAR's website?

No. OSCAR only sells plans through Healthcare.gov. You cannot purchase coverage directly from OSCAR outside the federal marketplace. Go to Healthcare.gov during the enrollment period to shop for and enroll in an OSCAR plan.

Do all OSCAR plans cover the same doctors and hospitals?

All OSCAR plans in a given state typically use the same network of doctors and hospitals, regardless of which metal level you choose. However, the network may vary by state or county. Check the OSCAR provider directory before you enroll to confirm your doctors are in-network.

What is the difference between a premium tax credit and a cost-sharing reduction?

A premium tax credit lowers your monthly bill. A cost-sharing reduction lowers your deductible, copays, and coinsurance when you use care. You may receive one, both, or neither depending on your household income. Cost-sharing reductions are only available if you choose a Silver plan.

Can I switch from an OSCAR plan to a different insurer mid-year?

No, not unless you experience a may have access to life event like losing coverage or moving. If you enrolled in an OSCAR plan during open enrollment and want to switch to a different insurer, you must wait until the next annual enrollment period in November.

Does OSCAR offer plans in every state?

No. OSCAR operates in select states and counties. Check the OSCAR website or Healthcare.gov to see whether OSCAR plans are available in your area. If not, you can shop for plans from other insurers that do operate in your state.