As an insurance agent I am always eager to learn about new health insurance options,  such as California’s 2016 Oscar Health Insurance for 2016 in California and Covered California.  I make a point in trying each of the systems myself so I can share my experiences with my clients and potential clients .

In 2014 I signed up my personal insurance with Covered California and although I did not receive subsidies, I wanted to see what my clients were experiencing. Two years later, I can tell you there is no difference being on the exchange or off the exchange with Anthem, Kaiser and Blue Shield . The individual networks are the same and the doctors are treating you the same way. Although you will hear sometimes complains from doctors and office staff as most likely the negotiated rates for providers are lower.

In 2016 a new health insurance provider named Oscar entered the insurance market.  I became very interested in Oscar when I learned that one of the financial backer are  Google and Goldman Sachs. While attending an Oscar  sales meeting,  I learned that Oscar offers outside the exchange a Gold Plus and Platinum Plus plan, which has a lower out-of-pocket maximum than the traditional ACA plans.  These two plans reduce the subscriber’s overall financial exposure to  $ 3000 (Gold Plus Plan +) and $ 1000 ( Platinum Plus + Plan ), plus the cost of Oscar’s reasonably priced premiums.  Additional benefits are that  primary care visits, generic medication and labwork performed  by Quest are all free of charge; and you  are able to talk to a doctor via the Oscar app anytime,free of charge.  

However, the Oscar health plans have their draw backs. First they are EPO’s, which means that you must stay inside the Oscar network, which is much smaller than the networks of Anthem and Blue Shield . In 2016 Anthem and Blue Shield are both true PPO’s and have all major hospitals in their networks.  Oscar uses many of the UCLA and Providence hospitals and doctors, which makes it an attractive alternative for residents on the West Side of Los Angeles.  Oscar does not cover Cedars Sinai Medical Center and Hospital or any of their doctors. If a subscriber to Oscar uses and out-of- network doctor, those expenses  are not covered and would not be applied to the out-of-pocket maximum.

Since I am, thankfully, healthy, I personally decided to sign up for Oscar’s Gold Plus plan outside the exchange, as the premium is very attractive and I like knowing that $ 3000 is my out-of-pocket maximum. Due the very limited open enrollment period, I made a point of scheduling as many as possible, of my preventive exams in January, so that if I do not have a clean health bill or if I have a bad experience, I am able to  switch to the traditional plans of Blue Shield or Anthem, which offer a wider network.

This is my Oscar experience thus far:

  1. I have not yet received my welcome kit,which is supposed to include a fit bit band yet. Apparently there has been a delay in sending them out. However,  this is not a problem as I could easily print out my temporary ID-card online and was able to schedule my appointments with my  primary care doctor as visiting him will be free of charge. I chose a primary doctor who is with  UCLA Bay Physicians and I was lucky to get an appointment in the same week. For many of the UCLA patients the preventive services will be moved to February as the facilities are swamped with so many patients wanting to get their free preventive care visits done.
  2. My Primary Doctor was not familiar with Oscar! When she said she wanted to draw my blood, I asked her whether  she would be sending  it to Quest.  She said “no” that she would use their UCLA facility. I asked her to provide me a referral to Quest . Quest was able to draw my blood on the same day, without my having set up an appointment in advance.   Any Oscar Member – Please make sure to alert your doctor that you need a referral to Quest for any labwork, as Quest is the only  facility that allows you to get your labwork done for free. 
  3. My Primary Doctor referred me to a UCLA dermatologist. After checking into the Oscar network, I made an appointment  for 2 days later. I saw the doctor and paid $ 50 for seeing a specialist. I received a complete check up and was provided with a prescription. The next day I went on my membership account on the Oscar website and saw that one prescription is completely free of charge (wow) and the other one is not covered. I was very much impressed that Oscar sent me a message, gave me  an alternative suggestion which I will discuss with my doctor.I really appreciated getting this information at home rather than at the pharmacy.
  4. My Preventive Visit to get my free mammogram is scheduled. However, as Oscar does not show very clearly where I can get a free preventive screening, I am still researching this area. I have contacted my Oscar my sales representative for help as Oscar’s website does not clearly show mammography centers. I am confident that this will be resolved quickly.
  5. My Oscar App is very easy to navigate and with one click I can find my health history and find a doctor to talk to. Just perfect!

After having experienced this much with Oscar, it is my opinion that the optimal policyholder for Oscar is:

computer savvy individual, who is in good health, concerned about staying healthy by doing preventive check-ups and fitness (see free Fitbit Band) ,  flexible enough to switch to different doctors, and is okay with navigating through a new system, which is still working out some of its start-up problems.

I would not recommend  Oscar to individuals who want complete freedom of choice to use any doctors they want to. Anthem and Blue Shield will be more appropriate carriers for these Individuals.  In 2016 both Anthem and Blue Shield offer more doctors and more choices. In addition these carriers are already established with many doctors’ offices, so the doctors and their office personnel know how to navigate their systems.

If you are the computer savvy Individual living in Los Angeles , who is flexible and is attracted to good insurance premiums  and overall good health coverage, then start to apply to Oscar with this link.

Remember the Open Enrollment Period for coverage beginning February 1,2016,  is 1/15/16.  The last day to make a change in your insurance choice for 2016 is 1/31/2016, which than reflect an effective date of March 1,2016.

Please feel free to contact us at Solid Health Insurance Services to get your free quote.