Commonly asked questions about health insurance | hioscar Blog | Oscar
Commonly asked questions about health insurance
Oscar is here to answer your top health insurance questions.
How Insurance Works Oscar Health Insurance
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Now that Open Enrollment—aka the annual signup period for health insurance—is underway, this is the best time to pick a plan that works for you. Because health insurance is you know, super complicated, we’ve put together some FAQs we get a lot here at Oscar. These are also good things to ask your insurance company, broker, or Enrollment Guide when signing up for a plan!
What do the metal tiers mean?
Some individual health plans have a metal tier (opens in new tab) in their name to make it easier for you to compare options across different insurance companies. The difference between the tiers is how much you'll pay for care versus how much your plan will cover.
Bronze and Silver plans have lower monthly premiums (opens in new tab), but they have higher deductibles (opens in new tab), so you pay more when you need care. Gold and Platinum plans cost more every month, but they have lower deductibles, so the plan pays for more of your care if you get sick. People who rarely see a doctor tend to choose Bronze or Silver plans to save money every month, while people who need more care during the year or have regular prescriptions usually opt for Gold or Platinum plans to save money on their medical bills.
It’s the dollar amount you pay out-of-pocket for covered services before your plan begins paying. Let's say your plan has a $1,500 deductible. Each month, you'll pay your premium to maintain your health coverage. When you go to the doctor, hospital, therapist, etc., you'll pay for the first $1,500 of care you need. Once your spending reaches your deductible, you'll start paying much less. If your spending reaches your out-of-pocket-max (opens in new tab), you won't spend anything more on covered health care as long as you get care with doctors in our network. In general, the higher your deductible, the lower your premium. Information on your deductible can be found in your plan’s schedule of benefits (opens in new tab).
Can I save money on health care by staying in-network?
That’s a big yes!Getting care in-network is the best way to save money (opens in new tab) and avoid big medical bills. When you use a doctor, hospital, or lab that takes Oscar insurance, these providers are in our network, which means they have already agreed to our negotiated rates (opens in new tab). These rates are 10%-60% lower than full price, depending on the service. When we built our network, we chose high-quality doctors near you and negotiated lower prices than you could get on your own. This gives you access to great doctors at lower prices.
There are few ways to save money on prescription drugs:
Mail-order your long-term prescriptions. You can often get discounts on your prescriptions by having them shipped directly to you. Oscar’s Concierge (opens in new tab) team can set this up for you.
Switch to a generic formula. In most cases, generic drugs (opens in new tab) are identical to brand-name, so they’ll work exactly the same way in your body. If you’re doctor approves, make the switch!
Choose a plan with prescription copays (opens in new tab) you can afford. Before signing up for a new plan, search for the names of any prescriptions you take to be sure they're covered and find out if they require a copay. This information can be found in your plan’s schedule of benefits.
Ask your doctor about other resources. Some drug manufacturers offer coupons, samples, or rebates that can help you get the medicine you need. Because doctor's offices deal directly with drug reps, they’re often the first to hear of or have access to resources that can help.
What’s the difference between “Covered,” “Covered-in-full,” and “Not covered?”
Covered: These benefits are paid for according to your plan’s rules for cost-sharing. If you have a deductible, you’ll pay the bill at Oscar's negotiated rate and it will count toward your deductible and out-of-pocket max. If you met your deductible but not your max, you might owe a copay or coinsurance (opens in new tab). How much you’ll pay depends on your plan and the services you received.
Not covered: These services are not paid for at all by your health insurance plan. Examples of services that aren't typically covered are services with providers who aren't in your insurance plan’s network, services that aren't medically necessary (opens in new tab), or drugs that aren't in the formulary (opens in new tab).
