Understanding today’s healthcare costs: What to know for Open Enrollment | hioscar Blog | Oscar
Understanding today’s healthcare costs: What to know for Open Enrollment
Learn about what’s driving healthcare costs and how Oscar helps you get the most for your money.
Picking a PlanOscar Member Resources
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Whether it's a quick check-up, picking up a refill, or that monthly bill for your plan, you've probably noticed that healthcare costs are climbing. With Open Enrollment right around the corner, you might be asking: Why does healthcare keep getting more expensive?
The truth is, there isn't just one single culprit. Everything from the fact that we're living longer to the rising prices of medicine and hospital stays plays a part. These are big, system-wide challenges that affect every insurance company and every health plan.
While no insurance company can stop prices from rising everywhere, the right plan can help you get the most out of every dollar you spend.
Let’s break down what’s really going on and how Oscar is working to make things easier for you.
1. We’re living longer lives, which means we need more care
Living longer is great news! However, it also means more of us are managing health issues like diabetes or heart disease that require regular care over many years.
It’s not just seniors, either. About 78% of adults aged 35 to 64 (opens in new tab) are also managing at least one chronic health issue. When more people use healthcare more often, it raises the costs for everyone.
How Oscar helps: We don't believe in a one-size-fits-all approach. Oscar offers personalized support to help members manage their health, whether that's staying on top of preventive care, finding the right specialist, or managing a chronic condition like diabetes through Oscar’s Diabetes Care Plan (opens in new tab), or, for members with cardiovascular, kidney, and metabolic (CKM) conditions, accessing Oscar's unique CKM Care Plan (opens in new tab). This condition-specific approach helps members get the personalized care they need, and it aims to prevent more serious and often more expensive health issues down the road.
How Oscar helps: We work hard to negotiate better rates with doctors and hospitals to keep your costs down. And, we build our networks to make sure you have access to high-quality care that won’t break the bank.
3. Prescription drugs are a major factor
New medicines are helping people live healthier lives. But these breakthroughs often come with a very high price tag.
In 2024, Americans spent almost $806 billion on prescriptions (opens in new tab). A lot of that growth comes from popular new treatments, like GLP-1 weight-loss drugs and diabetes medications.
How Oscar helps: Oscar is focused on guiding members to lower-cost, clinically appropriate options – including generics and biosimilars – and helping them take advantage of available savings programs. For specialty medications, we take it a step further by proactively identifying members who may qualify for manufacturer copay assistance and reaching out to help them access those savings. Combined with easy-to-use tools that show what's covered and what different medications cost, Oscar helps members make informed choices while lowering out-of-pocket expenses.
4. It's getting harder to find enough doctors and nurses
When there aren’t enough nurses or doctors, hospitals have to pay more to find and keep staff, which makes care more expensive. It also means it can take longer for you to get an appointment.
How Oscar helps: While no health plan can solve provider shortages, Oscar helps members find in-network care more easily through its provider search tools (opens in new tab), virtual care options (opens in new tab), and Care Team. By making it easier to connect with the right care at the right time, Oscar helps members navigate a healthcare system where access can sometimes be limited.
5. Too much "behind-the-scenes" paperwork
Healthcare involves a massive amount of administrative work: things like billing, processing insurance claims, and getting approvals for treatments. While this work is necessary to make sure everything is paid for correctly, it takes up a lot of time and money.
Researchers estimate that these administrative costs account for 15% to 30% of total U.S. healthcare spending (opens in new tab), which is more than in many other high-income countries. That means billions of dollars each year are spent on paperwork, billing, and other non-clinical activities instead of direct patient care.
How Oscar helps: We use smart technology to cut through the confusion. Our digital tools make it simple to find a doctor, see your claims, and even talk to a provider virtually. We want to spend less time on paperwork and more time helping you stay healthy.
Finding the right partner for your health
Insurance should be about more than just paying bills. It should be a partnership that helps you feel confident and supported. At Oscar, we’re focused on making things simpler. We offer easy-to-use tools and a team that’s here to help you navigate your care, no matter what your health needs are.
You can't change the way the whole healthcare system works, but you can choose a plan that works for you. This Open Enrollment, look for a plan that doesn’t just have a good price, but one that truly supports you on your journey to better health.
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Disclaimer: Oscar Medical coverage is underwritten by Oscar Insurance Company and its affiliates. Administrative Services for all plans provided by Oscar Management Corporation. All insurance policies and group benefit plans contain exclusions and limitations. This advertisement may be broadcast in states where policies and plans are not sold. For availability, costs, and complete details of coverage, contact Oscar at 855-672-2788.
