VIDEO Instructions on how to
ENROLL ONLINE direct,
Quotes & Enroll Covered CA
Oscar’s Health Insurance focuses centers around the Internet and mobile applications. Another click and appointment options — a free doctor’s call or a visit to a primary care physician or specialist — are splashed on the screen with estimated costs. A consumer could expect to shell out a total of $200 in co-pays and typical prescriptions or tests for a visit to a specialist. Oscar offers an Exclusive Provider Organization plan, or EPO — a hybrid of the HMO and PPO models. Consumers, for example, receive no coverage out of network, but unlike an HMO they don’t need a primary care physician or a referral to see a specialist. Providence Health & Services, UCLA Health, St Joseph, HOAG, Huntington Memorial and USC Keck have signed on to Oscar’s network, giving it 19 hospitals and 11,000 MD’s in Los Angeles. Orange County has 9 hospitals and 5,000 providers.
All plans are EPOs with Doctor on Call, Concierge, and Step Rewards for staying active. Even better, Oscar never requires referrals to see a specialist. This means you don’t need to book an appointment with a primary care provider just to get a permission slip, saving you time and money.
Classic plans
Classic plans have higher monthly premiums and lower annual deductibles than Simple plans. Most plans provide pre-deductible copays for routine care and drugs. All plans have either coinsurance or affordable copays after you hit your deductible.
Saver plans
(Non Standard)
Saver plans are low premium, high deductible plans. In California, these are plans that work alongside a Health Savings Account (HSA). With HSA compatible Saver plans, you pay the full negotiated rate for care out of your HSA until your reach your deductible. After that, Oscar pays 100% for any covered care.
Oscar’s Simple Plans
(Non Standard)
offer something different, they combine the deductible and Out of Pocket Maximum as one number. The kicker, you still get pre-deductible benefits. For example, you have a $4,500 deductible and MOOP on the Gold Simple plan, however you can go to the doctor, get your labs and x-rays all at a flat co-pay prior to meeting your deductible. Simple!
Jump to:
VIDEO Instructions on how to
ENROLL ONLINE direct,
Quotes & Enroll Covered CA
Pharmacy Rx Benefits
Oscar Explanation of Coverage for #Rx
Holistic alternative for erectile dysfunction to Viagra?
See our FAQ section for more details on how Rx Coverage works.
#EPO vs HMO vs PPO?
EPO
All plans are EPOs Exclusive Provider Organization with Doctor on Call, Concierge, and Step Rewards for staying active. Even better, Oscar never requires referrals to see a specialist. This means you don’t need to book an appointment with a primary care provider just to get a permission slip, saving you time and money. See Page 5 of EOC Evidence of Coverage for more details.
Choice of Physicians and Providers
This is an Exclusive Provider Organization (“EPO”) plan.
Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable. Typically, there are no Benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are:
● Services received by an Out-of-Network Provider as a result of a medical Emergency, Urgent Care Visit, or an Authorized Referral as defined in the
DEFINITIONS section; and
● Covered Services received at an In-Network Facility, at which, or as a result of which, the Member receives Covered Services from and Out-of-Network Provider. Authorized Referrals and Covered Services received under the second exception are provided at In-Network Cost Sharing.
To maximize Your benefits, be sure to confirm that the Provider (e.g. a Physician or Hospital) You wish to see is an In-Network Hospital or an In-Network Provider (for Providers other than Hospitals) under Your Plan. Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable, unless one of the exceptions listed above apply. 2020 EOC *
OSCAR #TeleMed
This is our “Main Page” on Telemed. Not just Oscar but Telemed for ALL companies, in general.
Oscar covers Medically Necessary Covered Services offered through Telehealth by an In Network Provider subject to the terms and conditions of the their contracts with In Network Providers. Telehealth Visits from certain Oscar-designated Telehealth Providers are covered in full.
Telehealth Visits can be requested through Oscar’s website, mobile application, and their customer service line 1-855-672-2755.
hioscar.com/need-medical-advice-call-a-doctor-instead-of-your-mom
OSCAR Tele Med
1 page flyer
My CPA’s thoughts & research on Telehealth
Further clarification from Oscar:
- Our Doctor on Call benefit is on all Oscar plans and include Oscar physicians that are board certified in your state.
- These physicians are not specialists, they generally are listed as Internal Medicine, Primary Care, etc.
- These doctors are not found on our website because there is no way to visit/select which doctor you speak to.
- The physicians often service multiple states, as they are generally certified in multiple.
- Personally, when I used the Doctor on Call benefit (at 11 pm) the doctor called me within 10 minutes.
- If I called again today I would likely be speaking to a different physician.
- I checked with Oscar circa 4.4.2019 and their Tel Med is just for an initial visit. Check our Coronavirus page for updates on that.
- doctor on demand.com
AB 744 will require contracts issued, amended or renewed after January 1, 2021 between a health care service plan and a health care provider to specify that the provider who delivers services appropriately through telehealth be reimbursed on the same basis and to the same extent that the plan would have had the same service been provided in-person. The health plan cannot require the use of telehealth if the health care provider has determined that it is not appropriate nor does it limit the ability of the health plan and provider to negotiate the rate of reimbursement for a service. TeleHealth Resources.org *
Oscar #Member Portal Login
Links & Videos to help you get the most from Oscar
Concierge – reinventing customer service with a personalized team of 3 care guides and a nurse – for every member.
- Oscar App Demo Video
- Two page summary of setting up an Oscar Account
- See why Oscar’s mobile app is the industry leader for member engagement.
- Doctor on Call Demo Video
- Concierge – We can help you get care VIDEO
- Making Health Care more human VIDEO
- How to find MD’s in Oscar App VIDEO
- Oscar Playlist 19 videos, about 15 seconds each VIDEO
- Modern Technology for Modern Care VIDEO
Every Oscar member gets a dedicated team of care guides and a nurse. See how it works.
Our VIDEO explaining all the webpages below.
You can use the Oscar Provider Finder without logging in.
Oscar Video Instructions to use provider finder
Other links mentioned in our mini webinar:
- Oscar Change of Broker
- How to set up Oscar Account?
- https://steveshorr.com/intro/15-reasons/covered-ca-agent-appointment-instructions/
- https://life.healthreformquotes.com/estate-planning/term-life-quotes/
- Oscar Create an account
- https://www.take-a-screenshot.org/
- Oscar Log In
- https://www.hioscar.com/app
- https://www.hioscar.com/care-team
- https://steveshorr.com/intro/set-a-meeting/
Steve Shorr
Website Video #Introduction
Our webpages on our qualifications, reviews, testimonials, etc.
Our Webpage on Insurance Coverage for
COVID 19
OSCAR
Forms, Evidence of Coverage, Grievances & Summary of benefits
2021 Rate Sheet - but it's easier to get a quote - see links above
OSCAR Rx & Doctor #Provider Finder
Oscar Network Options
Circle & Select
Los Angeles * San Francisco
Our web pages on UCLA & Cedars
Oscar Network Search Instructions
Child Pages
6 comments on “Pharmacy, Doctor & Provider Finder”
Is shop rite pharmacy a participating pharmacy of oscar
https://www.shopriterx.com/ on South St in Lakewood?
I used the search provider above and found John’s Shop Rite Pharmacy here:
https://www.hioscar.com/
Here’s instructions to appoint us as your Covered CA broker, no extra charge, so that we can get paid for helping you.
https://steveshorr.com/intro/15-reasons/covered-ca-agent-appointment-instructions/
What pharmacies accept Oscar?
Here’s the reply from the Oscar Regional Sales Manager:
We do not have that list of participating pharmacies. I can tell you that our pharmacy benefit manager is CVS Caremark.
So, go to the Caremark website and set up an account.
Did you want to appoint us as your agent, no extra charge.
Is rite aid pharmacy an in network pharmacy
The best way to know would be to follow the instructions above and set up a CVS Caremark Account.
Looks like a YES, but double check this. The citation is for New York…
Get prescriptions flled (or re-flled) at any one of Oscar’s national pharmacy partners including CVS, Walgreens, Rite-Aid, WalMart, and many more
Oscar Rx FAQ’s Pharmacy Explanation
Rite Aids Insurance Webpage
If you are with Covered CA – click here for instructions to appoint us as your agent. Where else can you get answers?
More on Rx
https://www.hioscar.com/faq/prescription-drugs
Scroll down & Search Rx & Doctors
https://www.hioscar.com/care-options
I just noticed the Select plans don’t cover Cedars or UCLA.
Is there a Circle plan hsa?
How much more?
Sorry, Oscar doesn’t have an HSA for the Circle Network to include UCLA & Cedars.
You can get a Circle Bronze or Blue Shield HSA PPO. See links below about calculating estimated future claims and what is the best guest to predict the future. We can do a Zoom meeting to go over the plans & calculations. https://steveshorr.com/intro/set-a-meeting/
Here’s our research.
Cedar’s Sinai Website https://www.cedars-sinai.org/billing-insurance/insurance.html and UCLA https://www.uclahealth.org/health-plans#individual-family-small-business
Take these individual plans
Blue Shield PPO in and out of Covered CA
Oscar Circle Network ONLY
Circle vs Select

HDHP Plans

Circle Plans

Here’s our webpage on Metal Levels and comparisons https://individuals.healthreformquotes.com/aca/metal-levels/
Our webpage on Health Savings Accounts https://individuals.healthreformquotes.com/misc-coverages/hsa/
Website visitors can get quotes for their situation with Oscar here https://www.hioscar.com/get-quote/?broker_npn=2710578
All companies here http://www.quotit.net/eproIFP/webPages/infoEntry/InfoEntryZip.asp?license_no=0596610
Hi Steve,
Does Oscar cover anything while I’m in Portugal? Please let me know as I moved here in January and don’t think I’ll be going anywhere else anytime soon.
I may need to cancel Oscar and sign up for a local plan here.
1st there is TeleHealth – TeleDoc
https://youtu.be/DTkVIINQumk
Uh-oh Falling in Love Gloria Estefan May not cover Tele Health Doc internationally – see footnote in flyer
Just got this bulletin
COVID-19 has disrupted all of our lives in many different ways. We understand that even people who do not have symptoms may be experiencing mental and emotional hardship.
Here’s how we’re helping Oscar members cope with the stress and emotional impact of the pandemic:
We’ve created a dedicated webpage at hioscar.com/covid19/mental-health-resources that contains full details about all the mental health resources Oscar members have access to. Feel free to share this URL with your clients or learn more below.
2nd – There is the CA mandate penalty and it doesn’t sound like you’ll qualify for an exemption. Special enrollment when you get back?
Here’s the evidence of coverage for the Oscar EPO Exclusive Provider Plans.
Page 4
Choice of Physicians and Providers
This is an Exclusive Provider Organization (“EPO”) plan.
Services must be performed or supplies furnished by an In-Network Provider (Search) in order for benefits to be payable. Typically, there are no Benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are:
[you can use] ● Services received by an Out-of-Network Provider as a result of a medical Emergency , Urgent Care Visit, or an Authorized Referral as defined in the DEFINITIONS section; and …
Yes, I know these terms are confusing. Agents are not allowed to interpret or modify contracts… That’s why I have links to the actual policy. See that, it’s mandated to be written in plain English. Here’s my webpage on reading statutes, laws, Insurance Contracts, etc.
What exactly do they cover for emergency?
I think I’m best off looking into a global health plan, or something just in lisbon for now since no one is moving anytime soon.
Emergency Services means, with respect to an Emergency Medical Condition or a
Psychiatric Emergency Medical Condition:
Emergency Services and Care will not be covered if You did not require emergency services and care and You reasonably should have known that an emergency did not exist. EOC Page 16
Note also, the State of CA mandate for Corona Virus testing at no deductible or co-pay.
Many Insurance Companies will pay 100% of COVID 19 costs, even if you have Bronze Plan! I’m not sure if Oscar has joined them. Check here https://www.hioscar.com/covid19
I’ll agree, the President & CEO doesn’t look like one…
https://www.linkedin.com/in/mario-schlosser/
https://www.cnbc.com/2018/12/21/success-tips-from-oscar-ceo-mario-schlosser.html
You Tube Video Oscar and Covid 19 https://youtu.be/FcDac7e9_uE
See our link below about Travel Quotes.
I’m not sure how much coverage one can get now, with a crisis going on. While Covered CA opened up enrollment, Health Care.gov hasn’t!
Where is your residency?
We can get you travel policies
1 I am looking at Oscar EPO and L.A. Care 60 HMO plans.
2 Oscar plan just says 40% after deductible.
3 The visit fee is not given.
4 Do you know the fee that is charged up to the 6000 deductible.
5 Monthly cost is 90.42 per month.
6 L.A. Care has $75 office visit for 1st 3 visits.
7 No mention of how much after that.
8 Been noticing fees are increasing (big surprise).
9 I need the best plan available.
10 Not sure of what my income will be next year.
1, 6 & 7 Check this webpage for more details on LA Care plans.
2 When using our proposal feature Quotit, please note that it’s all summaries. Come to our page for each company for more details. On Quotit, click on Plan details for more information.
Here’s more detail of the Bronze 60 EPO from Oscar.
Please review this brochure and if you have more questions, let us know.
5 & 10 Subsidies IMHO are all “hocus – pocus.” The true premium cost is a lot more. It’s just that you are getting subsidies on your taxes to pay the premium. Subsidies get reconciled when you file taxes and form 8962.
Please just report any changes of income within 30 days. If you drop below 138% of Federal Poverty Level, Covered CA will put you into Medi Cal. When your income increases, then you can come back into Covered CA even if it’s not Open Enrollment.
8 See our page on why premiums are increasing.
9 What do you mean by “best?” There are severe laws about agents saying “best” unless they can back it up.
Los Angeles times on telehealth
http://www.latimes.com/business/lazarus/la-fi-lazarus-cvs-video-medicine-telehealth-20180817-story.html
I’m not happy with Oscar.
What are my other options again?
The first problem is, are you within 60 days of a qualifying event? https://individuals.healthreformquotes.com/open-enrollment-for-individuals-families/ccr-code-regulations-ca-§6504-special-enrollment-periods/
If not, there is probably nothing we can do till Open Enrollment which starts 10.15.2018 for a 1.1.2019 effective date. https://individuals.healthreformquotes.com/open-enrollment-for-individuals-families/
Click here to see your options with other companies http://www.quotit.net/eproIFP/webPages/infoEntry/InfoEntryZip.asp?license_no=0596610
I will resend you privately your options from our quote engine.
What is it you are not happy about with Oscar? They have a concierge team. Maybe I can fix it?
Please send over:
1. tele-med (sp?) info (I’m open to more shrinkage solutions, maybe I’ll use it, esp if the price is right!)
2. Link so I can look up doctors and which plans they are officially part of.
3. And my lingering question: I see from my taxes Form 8962 I’m paying back subsidies from last year.
Can you help me get my brain around the math for what’s happening with each month/doctor visit appointment that passes while I’m still on the Blue Shied Silver 94 subsidized plan?
4. When I decide on a plan, what happens next, do I go to that quotit link and Add to Cart and pay directly, or…?
1. Oscar Tele Med? Here’s the video that explains it. One page pdf I’ll check if they have therapists on Tele Med
https://youtu.be/DTkVIINQumk
I checked with Oscar and their Tel Med is just for an initial visit.
Here’s what I googled for online therapists. Check with them and ask what Insurance Plans they take. Then double check on the official Insurance Company provider list.
http://www.apa.org/helpcenter/online-therapy.aspx
https://www.talkspace.com/
https://amwell.com/cm/services/online-therapy/
https://www.breakthrough.com/
https://www.livehealthonline.com/psychology
2. Doctor List for Oscar https://www.hioscar.com/search/?planType=INDIVIDUAL&year=2018
3. We’ve answer your tax, perjury and enhanced silver questions in the Enhanced Silver Q & A
4. If you choose Oscar, click on the link at the very top of this page. If you choose another plan, you can use quotit – our quote engine and do add to cart, but it works faster and better to use the direct links on our website. Find them here or email [email protected]
Hi, Steve.
Thanks, I’m all set with Oscar. I received a welcome letter and found instructions on making a web payment for my EPO 87 plan for Jan 1, 2018.
I also set up the auto-pay recurring payments as well.
Thanks for your help with the ACA insurance stuff here. Bye bye to Blue Shield of Calif. Their rates for the same PPO enhanced silver insurance were ridiculous.
Oscar is a newer, startup company, so the competition for business is exactly what President Obama and Congress intended when they set up the ACA, among many other patient protections for those of us with pre-existing conditions.
Thank you again,
Whose provider – doctor finder is more accurate and to be trusted?
Oscar’s
https://www.hioscar.com/search/?planType=INDIVIDUAL&year=2018
or
Covered CA Shop & Compare?
https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage#
Covered CA right on their website – provider finder tells you that Oscar’s is better.
The Covered California provider directory can help you select a health plan. The directory is updated monthly and may not be a current or complete list of the health plan’s providers.
The health plan you select will have the most current provider directory. You may not have coverage or may have higher costs if you visit a provider who is not in your plan’s network. To avoid this, you must verify with your health plan if the provider is in-network before you seek care.
Is Oscar my best option?
I know my choices are limited unless I want to pay more.
I read some reviews and comments on Oscar, and they weren’t good. BBB rated F.
How are you defining “best?”
I guess Oscar doesn’t know how to play the game with the BBB. I made a report to BBB a few years back on a property management company who I think had no rating or a very low one. I recollect they got an “F” after my review. The Property Manager then joined BBB and their rating was upgraded to A. Here’s the report I made to Rip Off Report.com
Oscar is resolving complaints where it counts. They had 6 with DMHC and resolved them all.
To sell insurance in CA Oscar has complied with vetting from the CA Department of Insurance, Department of Managed Health Care and Covered CA.
Oscar is new. Oscar is even newer in CA. There website looks good. I can’t say I always find what I’m looking for.
Obamacare mandates that Insurance Companies pay 80% of what they take in, out in claims. Thus, rates are going to be high everywhere.
IMHO the best way to compare plans is to start with our quote engine. Use the menu above to go to the webpage we have for each company if you want more detail.
Hey Steve,
I think you hit the nail on the head here. You’ll see that Aetna, Cigna and many other carriers have more unresolved complaints than we do and more negative complaints! However, they have an A+, even with, in certain cases, ZERO positive mentions. In my opinion, the BBB is losing it’s status and prestige with social media players such as TripAdviser and Yelp providing independent reviews that aren’t manipulated in a pay for play system. While Yelp will allow people who pay to list higher in searches, they’re reviews are what genuinely influence the rating. So one can pay and list higher under a review category, but if they have a 3/5 star, that’s how it will show.
We do very much appreciate your response and how you handled it. I wish there were more sales people fighting the good fight such like you are!
Cheers,
—
Jesse Hendon
Oscar Health
CA Sales Executive
Oscar now has a BBB rating of A-
https://www.bbb.org/new-york-city/business-reviews/health-insurance/oscar-in-new-york-ny-152584
We just created a new page about Oscar’s financials https://individuals.healthreformquotes.com/companies/oscar-insurance/member-portal/financials-oscar/
I see that Oscar offers plans where the deductible is the same as the max out of pocket (MOOP?). Is that unique? I thought the max out of pocket was always higher than the deductible.
Yes, having the same out of pocket maximum and deductible is unique, although a lot of people get confused and think they are the same. That’s why we created this webpage to explain deductibles, co-insurance, OOP – MOOP Out of Pocket maximum, etc. Be sure to check out the screen shot above and note the coverages that have very low co-pays regardless of the deductible.