Your Guide to Oscar for Texas Individuals and Families
It's not easy in Texas competing with BCBS but Oscar has managed to do it.
They're clearly #2 on the market for Obamcare (on-exchange with subsidy) and off-exchange.
Almost all enrollment these days is on-exchange as we'll explain below and Oscar is front and center here.
So... why is Oscar gaining in Texas for individuals and families?
Pricing and Network!
We'll compare them below but first our credentials:
This is what we'll cover:
- Quick intro to Oscar for Texas Obamacare plans
- The EPO network for Oscar in Texas
- Oscar's pricing in the Texas market
- How Oscar compares with BCBS of Texas
- How to quote and enroll in Oscar for Individuals and Families
Let's get started!
Quick intro to Oscar for Texas Obamacare plans
Oscar actually originated out of New York but they are the first post-internet insurance carrier to really compete in the health market.
The theory was that by leveraging technology, they could make health insurance less of a 21st century endeavor with its triplicate forms and frustrating customer service.
It's winning so far! They expanded into California (a brutal market with Shield, Cross, Kaiser, and more) and then finally, came to Texas.
2019 is when they entered and it's been a steady climb since then. They are a clear #2 in the market now which is tough with the footprint that BCBS enjoys after decades.
A few notes before we jump into the differences. There's so much that's the same!
First, all major carriers can allow you to take advantage of the subsidies available based on income.
This means that your Oscar monthly premium may come down significantly based on income from Bronze to Platinum level plans. We can only get the subgsides on-exchange AND it's just easier to enroll versus off-exchange (same plans, networks, and benefits!).
You may also be eligible for much richer versions of Oscar silver plans based on income.
Here's the income chart and we cover it in more detail here.
Speaking of plans, those are also pretty comparable these days with the 4 metallic levels:
- Bronze: high deductible
- Silver: mid-deductible and copays for office and RX
- Gold: low deductible and richer copays
- Platinum: low/no deductible and richest copays; out-of-pocket max may be lower.
Here's the secret...
A given metallic plan can't differ by other plans at the same level by 2 +/- %.
This means that a Gold plan has to be pretty similar to another Gold plan across the market!
Learn more how to compare the metallic plans to understand this better.
Next up, the benchmark plans.
This gets confusing so reach out to us at help@texasplans.com or 800-320-6269.
There's zero cost for our assistance and we can compare the options for you.
The net net is this... it makes it easier to compare Oscar plans with other carriers or even within Oscar itself since they're all tethered to the benchmark plans.
So... if the subsidy piece and what's covered are comparable, what's really different?
Let's go to why Oscar is gaining in Texas. A big part is the network.
The EPO network for Oscar in Texas
Since 2014 (ACA law went into effect), there's been a steady move away from flexibility and control (PPO) to HMO's.
This makes sense as the carrier panicked with rising healthcare costs.
The individual family market is almost entirely HMO these days.
Then there's Oscar!
They have an EPO available on the market which is right between a PPO and an HMO.
Let's explain this in practical terms:
- PPO: you can see any doctor in the network; less benefits out-of-network; more control
- HMO: you must stay in local network; more "management" of care = less control
- EPO: works like a PPO but with no benefit out of network other than true emergency
The big difference is that you and your doctor make more decisions without the HMO (carrier) approval.
You're not locked into an area either. No primary care doctor for referrals.
I've been on both PPOs and EPOs. They feel very similar.
In fact, in today's world, you really don't want to be out of network in a PPO. They pay horribly and that will only get worse (medical expense above).
This EPO is a welcomed blast of what people use to have on the individual/family market before 2014.
People are finding their doctors in the network and that's a huge deal. In the quotes below, you'll be able to check the directory or ask your doctor "what Texas Obamacare plans do you participate with?".
More on comparing the Texas exchange networks.
That just leaves pricing!
Oscar's pricing in the Texas market
A few notes here.
If you qualify for the enhanced silver plans (87 or 94) based on income, there's no reason to go higher.
Where Oscar surprises on the pricing front is with the Gold plans. For some reason, their Gold pricing is better than the Silver plan in some cases!
If you need richer coverage and don't qualify for the Silver 87 or 94, Oscar becomes a very attractive offering.
Otherwise, they're just above BCBS for bronze and silver plans which makes sense since that's comparing HMO and EPO.
So... it's probably a network decision first (HMO versus EPO) and a pricing follow-up to seal the deal.
This gets complicated and we're happy to run the comparison for you. Just let us know what you're looking for.
Email is help@texasplans.com or call 800-320-6269. There's zero cost for our assistance!
Pricing can really swing from area to area, plan level to plan level, and by age!
You can run your specific quotes here:
So... what about #1 versus #2?
How Oscar compares with BCBS of Texas
BCBS is probably over 1/2 the Texas individual/family Obamacare market these days.
Oscar is arguably around 1/4 above that.
Oscar only came on the market in 2019 so that's a pretty big gain!
How do we really compare these two?
Again, so much is similar since 2014:
- Subsidy through Obamacare will apply equally to both
- Benefits are standardized in terms of what's covered
- Plan levels are comparable +/- 2% by law now
So... the first question:
"What Obamacare plans do your doctors participate with?"
Literally, that's the question to ask the office. The quote tool below will also have provider lookups by plan as well.
That may give you the answer right there if these doctors are very important to you.
Let's assume they both participate.
How do you feel about HMO versus EPO? This is control and flexibility in terms of how care is managed.
If you're coming off an employer PPO plan and you're used to lots of control, HMO's might feel restrictive.
Finally, once you've narrowed down a plan level (Silver is the most popular - check out silver plan guide), look at pricing between the two.
BCBS's HMOs tend to be cheaper than Oscar's EPO but how much depends on your area, age, and family make-up.
Full comparison of BCBS of Texas and Oscar if you want to go deeper.
We're happy to quote and compare these for you but if you want to see the rates yourself, here you go!
How to quote and enroll in Oscar for Individuals and Families
We make this fast, free, and easy here:
A few notes to get the best quote.
- Your best estimate for this year's income (AGI on the 1040 next April)
- Household is everyone that files on that 1040 tax form even if not enrolling
The income piece is tricky and we help people with this all day! Reach out to us if your income is varied, changing, or in flux.
There's zero cost for our assistance.
As for enrollment, we have a simplified Obamacare application which we scrub to make sure there's nothing that will cause you any issues.
How can we help you out!