In Los Angeles & Orange County, we have 6 different insurance carriers for the individual & family market. Many of our clients are considering choosing between Oscar’s EPO vs Blue Shield’s PPO as they both offer top hospital systems in the region. We will go over some of the major differences between the two health insurance options.
Both Blue Shield’s PPO & Oscar’s EPO include great hospital systems such as Providence, USC, Kindred, Children’s, Torrance Memorial, and more. Oscar’s Circle EPO & Blue Shield’s PPO both include UCLA & Hoag. Cedars-Sinai is exclusively in-network with Blue Shield for the individual & family plans. Besides the hospital systems, Blue Shield’s PPO offers the largest provider network of private practice doctors. Although Oscar does offer an extensive list of hospital systems, Oscar does have a limited private practice network and limited urgent care services and does not pay for out-of-network services.
PPO vs EPO vs HMO
Both PPO & EPO plans allow you to see any in-network specialist without a referral from your primary care doctor. EPO allows self-referral to a specialist but will not pay for out-of-network doctors. PPO will pay for out-of-network doctors however you have to meet first a high deductible of $ 5000 of Blue SHield’s contracted rates. HMO plans such as Blue Shield’s Trio HMO require a referral from your primary care doctor to see a specialist but your PCP will only refer within their own Independent Physician’s Association or IPA to control cost and medical data flow. PPO plans also cover out-of-network providers but only after the member meets a $5,000+ annual out-of-network medical deductibles before the insurer will pay up to 50% coinsurance (50% of the maximum allowable amount for an in-network provider).
Both Blue Shield & Oscar offer doctors on call. Oscar’s telemedicine is provided for free to all members while Blue Shield has partnered with Teladoc to offer doctors on call for just a $5 copay. During the Covid-19 the telemedicine is free of charge. Doctors are available 24/7/365 to treat conditions such as colds and flu, ear and eye infections, skin conditions, mental health and more. This can be a very valuable service that saves you time and money on your healthcare and is especially valuable during self-quarantine with the coronavirus. During Covid-19 time both carriers are offering free tele mental help. Oscar is using Optum Blue Shield is using Teladoc services.
Both Oscar and Blue Shield have in-network urgent care providers but the number of available urgent care facilities in Oscar’s network is rather limited. For example, only Exer Urgent Care Beverly Hills is in-network with Oscar in West LA and none are available in Downtown LA. Urgent care is one area where Oscar is lacking but we are hoping Oscar will continue to grow its provider network. Oscar believes that their excellent telemedicine features will reduce the need to use urgent care service.
Both Oscar & Blue Shield offer great customer service. This is one area where we think Oscar has an edge because they assign each member a concierge team of 4 care guides and one nurse to navigate them through their care, answer any questions they may have about their insurance, and provide a personalized touch to customer service. Although Blue Shield also offers great customer service, as a large insurer here in California, they do not provide the same level of personal touch by having a different person answer the call each time. Overall, Blue Shield still has great customer service although we wish they would provide a similar concierge team model that Oscar does to its members. On the Blue Shield HMO Trio system, there is a Concierge system however the network is rather limited on the Westside of Los Angeles
Blue Shield’s PPO offers a much larger provider network compared to Oscar’s Circle & Select EPOs which makes the premiums higher. By offering a provider network more focused on large hospital systems, Oscar is able to offer premiums roughly 30-34% lower than Blue Shield’s (example based on Silver 70 PPO vs Silver 70 Circle/Select EPO for a 40 year old in West LA). If you want to have Cedars-Sinai or an extensive private practice network, paying the extra premium for Blue Shield’s PPO is understandable. If you are someone who is less particular or happy to find in-network providers at your local hospital system, Oscar may be better for your budget and needs.
Overall, choosing the right insurance carrier depends on your personal medical needs and budget. Please contact us at Solid Health Insurance Agency or at firstname.lastname@example.org to go over your health insurance options, either through Covered California or directly to Blue Shield, Oscar, or another insurance carrier. At Solid Health Insurance Services, we are always happy to assist you with all of your health, dental, vision, life, and long-term care needs.