Covered vs. covered-in-full vs. not covered

Just because something is a covered benefit on a health insurance plan doesn't mean it's free. Here's the difference between care that's covered-in-full, covered, or not covered.

Covered-in-full

Covered-in-full, or full coverage, means a benefit is paid entirely by your health insurance plan. In other words, it’s free for you! Some examples include your annual physical, some kinds of primary care depending on your health history, your annual well-woman (opens in new tab) (OB-GYN) exam, an annual flu shot, many immunizations (opens in new tab), and certain types of birth control.

Covered

Covered benefits are paid for according to your health insurance plan’s rules for cost-sharing. If you have a deductible (opens in new tab), you’ll pay the bill at Oscar's negotiated rate (opens in new tab) and it will count toward your deductible and out-of-pocket max (opens in new tab). If you met your deductible but not your max, you might owe a copay (opens in new tab) or coinsurance (opens in new tab). How much you’ll pay depends on your plan and the services you received.

Not covered

Services that are not covered 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 our network (opens in new tab), services that aren't medically necessary (opens in new tab), or drugs that aren't in the formulary (opens in new tab). Keep in mind that any money you pay for services that are not covered will not count toward your deductible or your out-of-pocket max.