6 questions to ask when buying health insurance | Blog | Oscar | hioscar Blog | Oscar
Buying health insurance? Here are 6 questions you should ask.
If you're shopping for an individual health plan, ask these questions before buying.
Picking a Plan Oscar Health Insurance
5 min read
Share article
Buying a health insurance plan is a big investment, so make sure you ask your broker, employer or Enrollment Guide the right questions before spending any $$$.
How much will it cost?
Let’s go straight to the hardest question! How much your health insurance will cost you depends on your premium (opens in new tab), deductible (opens in new tab), and out-of-pocket max (opens in new tab). When you’re shopping for a plan, it’s important to know what these 3 costs will be up front, because they vary across health plans and will definitely impact what you owe.
Premium: The first bill you’ll get is your premium, which is the amount you pay monthly to stay covered. If you have a $200 premium, that adds up to $2,400 annually.
: If you have a deductible of $3,000, that means you’ll pay for the first $3,000 of care before your insurance plan starts paying for certain benefits. You are perhaps asking, “Well, why do I even need to have insurance if I’m just paying doctor bills anyway?” The benefit of insurance is that you pay a , which is usually below the full price. Plus, all the money you spend is tracked, and when you do hit your deductible, you’ll pay much less.
Out-of-pocket max: If you have an out-of-pocket max of $5,000 and you end up needing a procedure that costs $55,000, you’re only responsible for $5,000. If you already hit your $3,000 deductible, then you’re only responsible for $2,000. In summary: $3,000 is a big chunk of change, but it’s much better than owing the 55K you’d be on the hook for if you weren’t insured. The out-of-pocket max is there to protect you from huge bills, but you still need to make sure you’re getting your procedure done at an in-network hospital. More about that here. More about that here (opens in new tab).
Remember, there is free preventive care (opens in new tab) included with every Oscar plan! Annual physicals with a primary care doctor, OB-GYN or pediatrician, flu shots, and many types of disease screenings are available at no cost.
Which plan is right for me?
To answer this question, you’ll need to pick your metal tier (opens in new tab), which will determine how much you’ll pay per month and how high your deductible will be. This chart explains the differences between each tier—which one is right for you depends on the amount of care you anticipate you’ll need in the next year.
When it comes to choosing a tier, everybody’s different. If you’re a fitness nut who wants to make sure you’re covered in case of an emergency and keep your monthly premium bill to a minimum, Bronze or Silver is a good choice. But if you’re dealing with a more complicated medical issue that requires tests, surgery, and prescriptions, Gold or Platinum plans with a low deductible are a better way to save you money throughout the year.
Another important thing you should consider when picking a plan is if your doctor, therapist, clinic, hospital, etc. will be covered. If you want to stick with your current doctor, be sure to check that they are in your health insurance company’s network of providers. If there are prescriptions or medical equipment you rely on, check the formulary (opens in new tab) to make sure they are also covered. If you want to find out if your doctor or prescription is in the Oscar network, you can check our provider directory.
Hot tip: Oscar doesn’t require referrals on any of our plans. If you have a specialist you like, and they are in our network, you can make an appointment with them directly—no need to get permission from a primary care provider first.
Is there someone I can call when I have questions?
Does your prospective insurance carrier have a customer service team you can contact when you have questions about bills, claims, or copays? Is there somebody you can call when you need help finding a doctor? When you call, will you get an automated phone system, or an actual human being?
With Oscar, you’ll get paired with a Care Team (opens in new tab) - a team of Care Guides (and a nurse, if you’ve recently been hospitalized). Their only job is to help you navigate your plan and answer any of your questions. They can help you find a doctor, coordinate care for complex conditions and procedures, and of course, answer your questions.
What happens if there is an emergency?
Sometimes emergencies occur and you need to see a doctor right away. When this happens you should go to the closest ER, or call 911. For regular care (opens in new tab), it’s important that you make sure that your doctor is in-network, but in an emergency situation this may not be possible. In a true emergency, the hospital will work with your health insurer on any authorizations you need. You can receive as many emergency services as you need and they will be covered by your plan until you’re considered “stable,” meaning you will be okay on your own without immediate medical attention. However, if you are stable but still need follow-up care, this care may not be covered if the provider is out-of-network (opens in new tab). Be sure to follow up with an in-network provider in order to take advantage of your plan’s benefits. Read more about how emergency care is covered with Oscar plans. (opens in new tab)
What are the perks?
Finally, the good stuff! Be sure to ask if there are any sweet perks that come with your plan, things like telemedicine (calling a doctor), rewards, and free classes may be included.
Oscar has an excellent app (opens in new tab) that you can use to easily find doctors, see your labs and prescriptions, track your deductible and access your ID card. You can message your Concierge team directly when you need assistance.
With Virtual Urgent Care (opens in new tab), you can talk to or message a provider - and get a diagnosis, new prescription, or a refill in as little as just 15 minutes for $0, anytime 24/7. It's especially helpful for rashes, common prescription refills, and could-be-a-cold-but-maybe-it’s-the-flu symptoms.
You can also track your steps and earn AmazonⓇ Gift Rewards for every day that you hit your step goal. To make it hassle-free for you to get rewarded for staying active, the app automatically syncs your steps from Apple Health or Google Health.
