Where to Get Health Insurance: 4-1-1 on Coverage Options | Blog | Oscar | hioscar Blog | Oscar
Where to Get Health Insurance: 4-1-1 on Coverage Options
If you’re shopping for an individual health insurance plan, consider the pros and cons of each option.
Picking a Plan Oscar Health Insurance
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If you’re shopping for an individual health insurance plan, make sure to consider the pros and cons of each option.
Shopping for health insurance options is hard. Whether you’re coming off a parent’s plan, or you’re no longer covered by an employer, buying your own health plan can feel like an impossible task. But choosing a plan doesn’t have to be as intimidating as it sounds—let us break it down for you.
ACA plans are highly protective of members: you’re accepted regardless of pre-existing conditions (opens in new tab), you are guaranteed to get (like prescription drugs, mental health, and maternity benefits), and there are strict limits to what you’re expected to pay .
Some ACA plans (like Oscar) come with extra perks for their members. Oscar has free 24/7 Virtual Urgent Care (opens in new tab), where you can talk to a health care provider in as little as 15 minutes, for common health issues or prescription refills. Oscar members also get a dedicated Care Team (opens in new tab) team who can answer questions and solve billing issues. There’s even an app with Step Tracking rewards (opens in new tab) where you can earn $ just for walking.
Cons: Because ACA plans have such strong member protections and tend to offer better coverage, their premiums may be higher than other forms of insurance. If you don’t think you can afford it, make sure you check if you qualify for financial assistance (opens in new tab) and you may be surprised to find that you are eligible for a subsidy.
Where to buy an ACA plan:
You can find all available ACA plans for your area through a Marketplace (opens in new tab). You can buy a plan through your state’s health insurance marketplace (like New York State of Health or Covered California), or through HealthCare.gov (opens in new tab), the federal marketplace.
You can also buy your plan directly from a health insurance company. With Oscar, you can get a quote for individual or family health insurance (opens in new tab), and sign up online in minutes. You can also talk to one of our experienced plan guides at 1-855-672-2788. They can help you decide on a plan and enroll you over the phone.
Short-Term Health Plans (STHPs)
Short-Term health plans provide coverage in case of illness and accidents for a defined period of time. They are flexible solutions designed to fill in gaps during periods of transition;for example, if you leave your current job and are waiting to get insurance from your next employer.
Pros:
Short-Term Health Plans often have low monthly premiums—as little as $160 a month.
You can sign up for a Short-Term Health Plan at any time of year; they do not have Open Enrollment restrictions.
Cons: While STHPs can be less expensive than ACA-compliant plans, there are a few things you should consider before going all in.
STHPs tend to cover fewer medical services than comprehensive insurance. STHPs are not required to provide coverage for the "10 essential health benefits" that other insurers must cover under the Affordable Care Act. For instance, not all STHPs cover hospitalization, prenatal and maternity care, mental health care, drug treatment, or prescription drugs.
Other STHPs may limit coverage even more by putting a dollar cap on some covered benefits. Let’s say the STHP covers hospitalization, for example. The plan may still only pay $100 worth of hospitalization costs per day for 10 days, which is far less than an actual hospitalization would likely cost.
Pre-existing health conditions, or a history of health problems, could prevent you from qualifying for a STHP.
Some STHPs issue waiting periods for coverage. Meaning, they don’t cover treatments for an illness within the first five days of coverage. Cancer treatment, for example, may not be covered in certain plans during the first month a person is enrolled in a plan, and no treatment for illness is covered in the first five days.
You cannot apply government subsidies to a STHP, because it does not meet the minimum standards established by the ACA.
So, is a STHP for you? If you don’t qualify for a subsidy and you are looking to fill in a temporary gap in coverage due to a life transition, then a STHP might be a good option. Just make sure you read and understand the fine print.
Health Care-Sharing Ministries (HCSM)
A health care-sharing ministry is another low-cost health coverage option that groups together people with a common set of religious beliefs to help them pay for care. Members of the HCSM make monthly payments to cover the expenses for themselves and other members.
A common misconception is that HCSMs are comparable to health insurance. Here are a few things that make them different:
HCSMs don't guarantee a full reimbursement of care. So if you get a procedure, it may cover less than you expected—and you'll be responsible for paying the difference.
Many HCSMs don’t work directly with doctors and hospitals. Without payer-negotiated provider networks the patients are stuck negotiating their own health care costs.
HCSMs don’t have limits to how much patients can have to spend out-of-pocket, and they don’t have free essential health benefits or regulations for pre-existing health conditions.
HCSMs also usually expect their members to adopt their religious lifestyle, and they tend to decline payment for treatments that go against their faith, which can include birth control pills.
While HCSMs offer more affordable coverage, they don’t have the safety net that ACA plans offer, leaving members at risk of substantial out-of-pocket costs (and making HCSMs a real leap of faith).
How to pick health insurance coverage that is right for you
Next steps for buying your own health plan
Now that you’ve learned a bit about some of the different kinds of plans available, hopefully you’ll be able to choose the type of health coverage that’s right for you. If you’re still not sure, you should check and see if you qualify for a subsidy. If you do, an ACA plan is a great way to keep your costs lower and still get the benefits of a more protective plan. It’s also a good idea to review your health costs from the past few years—if you’ve spent money on a recurring issue or a chronic condition, you should also consider getting ACA-compliant coverage. It may cost more on a monthly basis, but if you take advantage of all your plan has to offer, it can save you money in the long run.
Ready to learn more about Oscar’s ACA-compliant health care plans? You can sign up online (opens in new tab) in minutes, or you can talk to one of our experienced Enrollment Guides at 1-855-672-2788.
