Open Enrollment: Choosing a Health Plan That Works for You | Blog | Oscar | hioscar Blog | Oscar
Open Enrollment: Choosing a 2025 Health Plan That Works for You
As you look forward to the new year and think about your health coverage, we want to make sure you feel informed.
How Insurance Works Oscar Health Insurance
7 min read
Share article
As you look forward to next year and start thinking about your health coverage, we’d like to make your life just a little bit less complicated. The period known as Open Enrollment (opens in new tab) is here, so we want to make sure you feel confident and informed as you seek out the health insurance plan that works best for you.
What is Open Enrollment?
Open Enrollment is the window of time where you and your family can sign up for a health insurance plan for 2025 coverage. It begins on November 1st, 2024 and ends on January 15th, 2025 for most states. Be sure to check both healthcare.gov (opens in new tab), as well as your state’s marketplace for important dates and updates.
How do you sign up for health insurance during Open Enrollment?
You can also work with a health insurance broker (opens in new tab). These are licensed professionals who are experts in health insurance. They can guide you through the enrollment process on the exchange, or through an insurer directly.
Lastly, you might be able to get insurance through your employer. If so, your employer can provide the necessary information, usually through a human resources department. If you’ve had employer-based insurance and recently lost your job, you might qualify for a , which means you can sign up for new insurance even if it’s outside of the Open Enrollment window.
Covered services: These are the health care services that your insurance plan will help you pay for. This can change based on the plan, but usually plans with a higher monthly premium will cover more of the cost of your care.
Copayments (opens in new tab): Often shortened to copays, this is the cost that you’re responsible for paying for a covered appointment, service, or prescription. For instance, if you have a $10 copay for a visit to a doctor, you will pay a maximum of $10 and your insurer will pay the rest, regardless of the actual total cost.
Coinsurance (opens in new tab): This is similar to a copayment, but instead of being a fixed cost ($10), it’s a fixed percentage of the total cost of the appointment, service or prescription. So if you see a specialist that requires a 20% coinsurance and the total cost of that appointment is $100, you’ll owe $20, and your insurer will pay the remaining $80.
Deductible (opens in new tab): If your insurance plan has a deductible, this is the total cost that you’ll need to pay out-of-pocket before your insurer begins paying for services. Once you hit that number, you’ll only owe copays, coinsurance, or maybe nothing at all. Related to this is the out-of-pocket max (opens in new tab), the maximum amount of money that you would ever be expected to pay in a single calendar year. Once you hit that—through copays, coinsurance, or payments towards your deductible—you should owe nothing again beyond your monthly premium.
All about networks
Do you have a doctor you see regularly and want to keep seeing? If so, you’ll want to make sure they’re in an insurer’s network (opens in new tab).
Every health insurance company maintains a network of hospitals and doctors that it works with, and your coverage will differ if your doctor is in-network rather than out-of-network.
You might want to stick to in-network healthcare for two reasons: it will almost certainly save you money, no matter what insurance plan you have, because in-network providers negotiate lower rates with your insurance provider. Also, the money spent on out-of-network bills does not count toward your deductible or your out-of-pocket max (except for emergency services).
Before committing to a new insurance provider, you should call your existing doctors and ask which networks they’re part of. If you’re an Oscar member, we have a helpful search tool to find in-network doctors, hospitals, and urgent care centers—or you can call or message your Care Team anytime to help you find the in-network doctor that’s right for you.
An HMO (Health Maintenance Organization) will require you to choose a primary care doctor. This doctor will be your main health care contact—and in most cases, will need to refer you to any specialists, labs, or other medical facilities. The exceptions to this are emergencies and, for women, a referral is not required for an OB-GYN visit. Also, HMOs generally do not cover out-of-network providers.
A PPO (Preferred Provider Organization) plan is more flexible; you can usually get some level of coverage for out-of-network providers, and you don’t need a primary care doctor to refer you if you want to see a specialist. But keep in mind that even covered out-of-network care can be more expensive.
An EPO (Exclusive Provider Organization) such as Oscar combines features of the HMO and PPO model: you get the flexibility of a PPO with the cost savings of an HMO. With an EPO, the networks tend to be smaller, and you must stay within them for care to be covered in most circumstances.
POS (Point of Service) plans are another hybrid of HMO and PPO plans. You’ll get the benefit of lower costs when you use in-network doctors, but you can be covered out-of-network with a referral from your selected primary care doctor. In fact, you’ll need to get a referral from your primary care doctor for any specialist, even if they’re in-network.
How do you know which insurance plan is best for you?
Are you someone who is generally healthy and sees a doctor only a few times per year? If so, you might be a great fit for a low-premium, high-deductible plan, where you’ll pay a lower monthly rate but would pay more out-of-pocket in an emergency or for any unexpected health needs.
If you have an existing health issue or chronic illness, or if you tend to see specialists regularly, it might make sense to pay a higher monthly premium but have fewer out-of-pocket expenses—because doctor visits and diagnostic tests are more likely to be covered by your insurer.
On the insurance exchanges, you’ll see health plans divided into tiers: Bronze, Silver, Gold, and Platinum. Bronze plans will have the lowest monthly premiums, but the highest deductibles, whereas Platinum will have the highest premiums but the lowest deductibles; and Silver and Gold are in the middle.
If you’re under the age of 30, catastrophic plans might be available if you qualify for a hardship or affordability exemption. These plans have low premiums, but you can’t use a tax credit for these plans. If you qualify for a tax credit, a Bronze or Silver plan might be the better value.
Advanced premium tax credits are similar to premium tax credits, however instead of receiving the credit at the end of the year on your taxes, the credit is calculated and sent directly to your health insurance company who uses it to lower your monthly premiums.
In this case, when you apply through the health insurance Marketplace, you can choose to have a credit paid directly to your insurance company, which will lower your premium. If you choose this option, you’ll need to reconcile what was paid the insurance company with what was allowed as a credit. This is done using Form 8962, Premium Tax Credit (PTC) when you file your tax returns for the year.
So what makes Oscar different?
Now that you’ve learned the basics, there’s one more thing you should consider before making a decision—the perks that an insurer offers its members. At Oscar, we’ve got some great features and benefits, including:
The easy-to-use Oscar App (opens in new tab) for iPhone and Android helps you make the most of your plan. You can search for doctors near you, get prescriptions refilled, review your plan information, manage payments (or set up autopay), and more. You can even track your steps on the app to earn step tracking rewards—$1 toward an Amazon gift card for each day that you hit your step goal (up to $25 in CA and NY, $50 in FL, and $75 in all other Oscar states).
A Care Team (opens in new tab) of your very own—they can answer your plan questions, help you navigate your care, find a great doctor in your area, and more.
With Oscar’s Virtual Urgent Care (opens in new tab), you can talk with a provider 24/7 over the phone or via messaging. Get a diagnosis, a new prescription or refill if needed, and more, in as little as 15 minutes. No appointment needed, and no copays, ever.*
Got questions?
Call our Enrollment Guides at 1-855-672-2788, or visit hioscar.com/individuals for a free quote.
*Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits. Prescriptions, visits and services may be limited per provider discretion.
