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How Oscar is Revolutionizing Plan Design
Oscar’s condition-specific plans are designed to make managing chronic illness easier.
General HealthOur Culture
4 min read
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Healthcare isn’t one size fits all: individuals have different needs based on factors like age, gender identity, health history, and whether or not they live with a chronic illness. Annually, individuals with chronic illness spend approximately five times more on medical expenses than people without chronic illnesses. Chronic conditions such as heart disease, cancer, diabetes and lung disease are leading drivers of the nation’s $4.1 trillion in annual healthcare expenditures (opens in new tab). That figure doesn’t include the time it takes to navigate the complexities of chronic illness and indirect costs like interference with education, job prospects, and social interactions.
Individuals managing chronic illness deserve healthcare that's built to address their unique needs. That’s why we created health insurance plans specifically for them. Oscar is introducing tailored plan designs with high-frequency care routing and engagement for members who suffer from chronic illness. Our first two condition-specific plans address the needs of diabetes and respiratory illness patients. Both conditions are common in the US, and among Oscar members. Our condition-specific plans are designed to make managing chronic illness easier.
We first launched Diabetes Care plans in 2022 and will continue to offer these plans in 2024. Diabetes is one of the most prevalent chronic illnesses in the US, affecting 37.3 million adults (opens in new tab) in the US, and growing.
Managing Diabetes is expensive: the total direct and indirect estimated costs of diagnosed diabetes in the US was $327 billion. Members who enroll in Oscar’s plan enjoy benefits like $0 PCP visits, diabetic foot and retinal eye exams, diabetic labs and wellness programs, and health coaching*. In addition to cost savings, members enrolled in this plan have seen notable results: 9% better adherence to diabetes medications, 16% higher rates of eye exam screenings, and 12% higher rates of kidney disease screenings**.
Next year, we are launching a new personalized plan to build on the success of Diabetes Care and meet the needs of our members. Breathe Easy addresses the needs of individuals with COPD and asthma, two leading respiratory diseases in the US. COPD affects 6.4% of adults in the US (opens in new tab), and asthma affects nearly 26 million (opens in new tab) (1 in 13 people). According to a study published in 2022, the total direct and indirect cost of respiratory diseases was $170 billion (opens in new tab).
Breathe Easy is a plan that puts respiratory care at the forefront to lower healthcare spend and improve patient experience. When members enroll in Breathe Easy, they can enjoy $0 benefits such as pulmonologist and PCP visits, pulmonary rehabilitation, oxygen services, Tier 1 preferred generics, nicotine replacement, and behavioral health office visits***. These benefits were carefully selected to ensure that patients with COPD and asthma can access quality care they need.
We believe in making the individual market the market for everyone. When people have healthcare that works for them, at a price they can afford, they can experience improved access to the medications, services, and treatment that can help them feel their best. Our members’ needs are always at the forefront of our work. We believe offering personalized, member-focused plans and a high-touch, seamless member experience are the first step in meeting the needs of our member base – and making healthcare more accessible.
*Plans are available only to all eligible persons, regardless of disease status, in GA, IA, IL, KS, MO, NC, NE, OH, OK, TN. If you don’t have type 1 or type 2 diabetes, or you have pre- diabetes or gestational diabetes, these plans may offer you certain reduced costs, but you would not be eligible for all Rewards and Incentives program offerings that may offer additional savings. Coverage for benefits is limited per clinical guidelines.
** Data from plan year 2022, comparing diabetic members in Oscar’s Diabetes Care plan to diabetic members not enrolled in Oscar’s Diabetes Care plan.
*** Plans are only available to eligible persons in AZ, TN and OK, regardless of disease status. If you don’t have asthma or COPD, these plans may offer you certain reduced costs, but you would not be eligible for all Rewards and Incentives program offerings that may offer additional savings.
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. For availability, costs, and complete details of coverage, contact Oscar at 1-855-672-2788.
