When Oscar’s CEO Mario Schlosser came to Los Angeles to go over the 2020 Open Enrollment Period with insurance brokers, many brokers were simultaneously excited and confused about changes to Oscar’s EPO plans.
The biggest change for 2020 Oscar individual and family plans is that there will be two different EPO networks, the Oscar Circle EPO & and the Oscar Select EPO. The Oscar Circle EPO is much the same network as the standard EPO plans offered in 2019 with major hospital systems such as UCLA, Hoag, Providence, USC & more in-network. The Oscar Select EPO will exclude UCLA & Hoag hospital systems but will offer lower prices compared to the Oscar Circle EPO. Furthermore, Oscar Circle EPO will not be available through Covered California which also means that you cannot enroll in a subsidized Oscar EPO with access to UCLA.
Oscar Circle EPO only comes in the Bronze & Silver metal tiered plans and only off-exchange. Oscar Select EPO is available both on and off-exchange and for all 4 metal tiers (bronze, silver, gold & platinum) with the ability to apply for subsidies on Covered California. CEO Mario Schlosser articulated that their data showed only a small percentage of their Covered CA members went to UCLA facilities so they decided to offer two different EPOs to keep prices down and please two different demographics based on income.
With that being said, current Oscar members on Covered California who qualify for little or no subsidy and would like to go to UCLA should consider enrolling in Oscar Circle off-exchange (not through Covered California). For UCLA patients that qualify for significant premium assistance, they may want to consider Blue Shield’s PPO, the only other carrier to have UCLA in-network for individual/family plans.
For those that are not familiar with Oscar, Oscar is a newer health insurance carrier that started out with CEO Mario Schlosser confused with his personal health insurance claims with his wife’s pregnancy. He and his partners came up with Oscar to provide a more personalized, simplified & technology-driven experience to consumers. Backed by Alphabet (Google), Goldman Sachs and other major companies, Oscar has built their claims department from the ground up. Each Oscar member receives free doctors on call, a personalized concierge team of 4 care guides and one nurse to navigate members through their care, and even rewards members with Amazon gift cards for each day they reach a step goal.
If you are interested in learning more about the changes to Oscar in 2020, please do not hesitate to contact us. At Solid Health Insurance Services, we strive to keep clients up-to-date on the insurance market which is constantly changing. To get more information or a quote for you, your family or business, please contact us at info@solidhealthinsurance.com or call us at 310-909-6135.