Oscar Texas

Our Rating:

★★★★★

Currently serving the areas around Austin and San Antonio, Oscar’s plans offer low premiums in exchange for technology based care 24/7.

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Oscar Texas – Texas Health Plans

Plan Overviews

All of Oscar Texas health plans come with access to great care and the Oscar experience, with free 24/7 calls with doctors and a dedicated health concierge to help manage your care.

A new type of health insurance company, Oscar is focused on using technology to keep costs low. They appear to have the lowest rates available in their coverage area for 2018, and the extraordinary level of service offered makes them the best value in Texas. 

Oscar has partnered with hospitals in Austin and San Antonio to provide the best possible care, but only offers EPOs. Out of network care will not be covered except in the case of an emergency. No referrals needed – ever. Make an appointment with any in-network doctor, including specialists, without a referral. 

Their San Antonio service area includes Bexar and Comal Counties; their new Austin service area includes Travis, Williamson, and Hays Counties.

  2024 Oscar Plan Information

 

  Classic Classic Standard Elite
The Basics PDF PDF PDF
Deductible (Individual / Family) $3,500 / $7,000 $1,500 / $3,000 $750 / $1,500
Pharmacy Deductible (Individual / Family) N/A N/A N/A
Out-of-Pocket Max (Individual / Family) $7,000 / $14,000 $8,700 / $17,400 $5,500 / $11,000
$0 Preventive care ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️
HSA-Compatible? No No No
       
Prices for Benefits
      
Virtual Primary Care (3) $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0
Primary Care Office Visits $40 $30 $25
Specialist Office Visits $40 $60 $50
Urgent Care $75 $45 $50
Emergency Room $650 25% after deductible 30% after deductible
Mental Health Office Visits $40 $30 $50
Labs (Preferred) $10 25% after deductible $10
Labs (Non-preferred) $50 25% after deductible $25
X-rays & Diagnostic Imaging $40 25% after deductible $50
X-rays & Diagnostic Imaging $375 25% after deductible 30% after deductible
MRIs & Advanced Imaging 30% after deductible 25% after deductible 30% after deductible
Inpatient / Outpatient Facility Fee 30% after deductible 25% after deductible 30% after deductible
RX | Generics: Preferred (Tier 1a) $3 $15 $3
RX | Generics: Non-preferred (Tier 1b) $15 $15 $25
RX | Brand: Preferred (Tier 2) $59 $30 $75
RX | Brand: Non-preferred (Tier 3) 30% after deductible $60 30% after deductible
RX | Brand: Specialty (Tier 4) 30% after deductible $250 30% after deductible
  Classic Classic 4700 Classic Standard Elite + PCP Saver Plus Elite + Specialist Saver Plus
The Basics PDF PDF PDF PDF PDF
Deductible (Individual / Family) $7,750 / $15,500 $4,700 / $9,400 $7,500 / $15,000 $0 / $0 $0 / $0
Pharmacy Deductible (Individual / Family) N/A N/A N/A $6,500 / $13,000 $8,000 / $16,000
Out-of-Pocket Max (Individual / Family) $9,100 / $18,200 $9,100 / $18,200 $9,400 / $18,800 $9,450 / $18,900 $9,450 / $18,900
$0 Preventive care ✔️ ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No No
           
Prices for Benefits
          
Virtual Primary Care (3) $80 $70 $50 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0 $0
Primary Care Office Visits $80 $70 $50 $40 $70
Specialist Office Visits $80 $125 $100 $125 $70
Urgent Care $100 $125 $75 $75 $75
Emergency Room 50% after deductible 50% after deductible 50% after deductible $2,000 $2,000
Mental Health Office Visits $80 $70 $50 $125 $70
Labs (Preferred) $10 after deductible $25 50% after deductible $25 $25
Labs (Non-preferred) $50 after deductible $70 50% after deductible $50 $50
X-rays & Diagnostic Imaging 50% after deductible 50% after deductible 50% after deductible $125 $150
MRIs & Advanced Imaging 50% after deductible 50% after deductible 50% after deductible $750 $750
Inpatient Facility Fee 50% after deductible 50% after deductible 50% after deductible $3,000 (copay applies for a
maximum of 2 days per 1 plan
year)		 $3,000 (copay applies for a
maximum of 2 days per 1 plan
year)
Outpatient Facility Fee $1,200 after deductible 50% after deductible 50% after deductible $1,200 $1,200
RX | Generics: Preferred (Tier 1a) $3 $3 $25 $3 $3
RX | Generics: Non-preferred (Tier 1b) $40 $30 $25 $30 $30$30
RX | Brand: Preferred (Tier 2) $250 after deductible 50% after deductible $50 after deductible $100 after deductible $100 after deductible
RX | Brand: Non-preferred (Tier 3) 50% after deductible 50% after deductible $100 after deductible 50% after deductible 50% after deductible
RX | Brand: Specialty (Tier 4) 50% after deductible 50% after deductible $50 after deductible 50% after deductible 50% after deductible

 

  Simple PCP Saver Simple PCP Saver Off Exchange Simple PCP Saver CSR 150 Simple PCP Saver CSR 200 Simple PCP Saver CSR 250
The Basics PDF        
Deductible (Individual / Family) $5,750 / $11,500 $5,750 / $11,500 $0 / $0 $600 / $1,200 $4,750 / $9,500
Pharmacy Deductible (Individual / Family) N/A N/A N/A N/A N/A
Out-of-Pocket Max (Individual / Family) $8,900 / $17,800 $8,900 / $17,800 $1,550 / $3,100 $3,000 / $6,000 $7,200 / $14,400
$0 Preventive care ✔️ ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No No
           
Prices for Benefits
          
Virtual Primary Care (3) $0 $0 $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0 $0
Primary Care Office Visits $20 $20 $5 $10 $20
Specialist Office Visits $80 $80 $10 $40 $80
Urgent Care $75 $75 $30 $50 $75
Emergency Room 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
Mental Health Office Visits $20 $20 $5 $10 $20
Labs (Preferred) $10 $10 $0 $10 $10
Labs (Non-preferred) 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
X-rays & Diagnostic Imaging 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
MRIs & Advanced Imaging 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
Inpatient Facility Fee 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
Outpatient Facility Fee 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
RX | Generics: Preferred (Tier 1a) $3 $3 $0 $3 $3
RX | Generics: Non-preferred (Tier 1b) $25 $25 $5 $10 $20
RX | Brand: Preferred (Tier 2) $100 $100 $30 $40 $80
RX | Brand: Non-preferred (Tier 3) 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible
RX | Brand: Specialty (Tier 4) 40% after deductible 40% after deductible 20% 40% after deductible 40% after deductible

 

  Simple Specialist Saver Simple Specialist Saver CSR 150 Simple Specialist Saver CSR 200 Simple Specialist Saver CSR 250 
The Basics PDF      
Deductible (Individual / Family) $6,500 / $13,000 $0 / $0 $970 / $1,940 $4,500 / $9,000
Pharmacy Deductible (Individual / Family) N/A N/A N/A N/A
Out-of-Pocket Max (Individual / Family) $9,200 / $18,400 $1,375 / $2,750 $2,500 / $5,000 $7,200 / $14,400
$0 Preventive care ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No
         
Prices for Benefits
        
Virtual Primary Care (3) $0 $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0
Primary Care Office Visits $40 $5 $25 $40
Specialist Office Visits $40 $5 $25 $40
Urgent Care $75 $30 $45 $60
Emergency Room 50% after deductible 25% 25% after deductible 50% after deductible
Mental Health Office Visits $40 $5 $25 $40
Labs (Preferred) $10 $0 $10 $10
Labs (Non-preferred) $60 $5 $30 $60
X-rays & Diagnostic Imaging 50% after deductible 25% 25% after deductible 50% after deductible
MRIs & Advanced Imaging 50% after deductible 25% 25% after deductible 50% after deductible
Inpatient Facility Fee 50% after deductible 25% 25% after deductible 50% after deductible
Outpatient Facility Fee 50% after deductible 25% 25% after deductible 50% after deductible
RX | Generics: Preferred (Tier 1a) $3 $0 $3 $3
RX | Generics: Non-preferred (Tier 1b) $25 $5 $6 $25
RX | Brand: Preferred (Tier 2) $75 $20 $40 $75
RX | Brand: Non-preferred (Tier 3)  50% after deductible 50% 50% after deductible 50% after deductible
RX | Brand: Specialty (Tier 4)  50% after deductible 50% 50% after deductible 50% after deductible

 

  Silver Classic Silver Classic CSR 150 Silver Classic CSR 200 Silver Classic CSR 250
The Basics PDF      
Deductible (Individual / Family) $5,400 / $10,800 $0 / $0 $0 / $0 $4,300 / $8,600
Pharmacy Deductible (Individual / Family) N/A N/A N/A N/A
Out-of-Pocket Max (Individual / Family) $8,900 / $17,800 $1,550 / $3,100 $2,900 / $5,800 $7,000 / $14,000
$0 Preventive care ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No
         
Prices for Benefits
        
Virtual Primary Care (3) $0 $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0
Primary Care Office Visits $35 $0 $10 $35
Specialist Office Visits $95 $5 $40 $80
Urgent Care $100 $15 $50 $100
Emergency Room $750 after deductible $500 $750 $750 after deductible
Mental Health Office Visits $80 $0 $40 $80
Labs (Preferred) $10 $0 $10 $10
Labs (Non-preferred) $50 $10 $25 $50
X-rays & Diagnostic Imaging $70 $15 $50 $70
MRIs & Advanced Imaging 50% after deductible 20% 30% 40% after deductible
Inpatient Facility Fee 50% after deductible 20% 30% 40% after deductible
Outpatient Facility Fee 50% after deductible 20% 30% 40% after deductible
RX | Generics: Preferred (Tier 1a) $3 $0 $3 $3
RX | Generics: Non-preferred (Tier 1b) $25 $5 $20 $25
RX | Brand: Preferred (Tier 2) $75 $15 $75 $75
RX | Brand: Non-preferred (Tier 3) 50% after deductible 50% 50% 50% after deductible
RX | Brand: Specialty (Tier 4) 50% after deductible 50% 50% 50% after deductible

 

   Classic Standard Classic Standard CSR 150 Classic Standard CSR 200 Classic Standard CSR 250
The Basics PDF      
Deductible (Individual / Family) $5,900 / $11,800 $0 / $0 $700 / $1,400 $5,700 / $11,400
Pharmacy Deductible (Individual / Family) N/A N/A N/A N/A
Out-of-Pocket Max (Individual / Family) $9,100 / $18,200 $1,800 / $3,600 $3,000 / $6,000 $7,200 / $14,400
$0 Preventive care ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No
         
Prices for Benefits
        
Virtual Primary Care (3) $0 $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0
Primary Care Office Visits $40 $0 $20 $40
Specialist Office Visits $80 $10 $40 $80
Urgent Care $60 $5 $30 $60
Emergency Room 40% after deductible 25% 30% after deductible 40% after deductible
Mental Health Office Visits $40 $0 $20 $40
Labs (Preferred) 40% after deductible 25% 30% after deductible 40% after deductible
Labs (Non-preferred) 40% after deductible 25% 30% after deductible 40% after deductible
X-rays & Diagnostic Imaging 40% after deductible 25% 30% after deductible 40% after deductible
MRIs & Advanced Imaging 40% after deductible 25% 30% after deductible 40% after deductible
Inpatient Facility Fee 40% after deductible 25% 30% after deductible 40% after deductible
Outpatient Facility Fee 40% after deductible 25% 30% after deductible 40% after deductible
RX | Generics: Preferred (Tier 1a) $20 $0 $10 $20
RX | Generics: Non-preferred (Tier 1b) $20 $0 $10 $20
RX | Brand: Preferred (Tier 2) $40 $15 $20 $40
RX | Brand: Non-preferred (Tier 3) $80 after deductible $50 $60 after deductible $80 after deductible
RX | Brand: Specialty (Tier 4) $350 after deductible $150 $250 after deductible $350 after deductible

 

  Elite Saver Plus Elite Saver Plus CSR 150 Elite Saver Plus CSR 200 Elite Saver Plus CSR 250
The Basics PDF      
Deductible (Individual / Family) $0 / $0 $0 / $0 $0 / $0 $0 / $0
Pharmacy Deductible (Individual / Family) $200 / $400 $50 / $100 $100 / $200 $200 / $400
Out-of-Pocket Max (Individual / Family) $9,100 / $18,200 $1,500 / $3,000 $2,500 / $5,000 $7,250 / $14,500
$0 Preventive care ✔️ ✔️ ✔️ ✔️
Dedicated Care Team ✔️ ✔️ ✔️ ✔️
HSA-Compatible? No No No No
         
Prices for Benefits
        
Virtual Primary Care (3) $0 $0 $0 $0
Virtual Urgent Care (4) $0 $0 $0 $0
Primary Care Office Visits $60 $0 $15 $60
Specialist Office Visits $100 $10 $30 $100
Urgent Care $50 $15 $15 $50
Emergency Room 50% 20% 30% 50%
Mental Health Office Visits $60 $0 $15 $60
Labs (Preferred) $10 $0 $10 $10
Labs (Non-preferred) $50 $10 $20 $50
X-rays & Diagnostic Imaging $100 $10 $50 $100
MRIs & Advanced Imaging 50% 20% 30% 50%
Inpatient Facility Fee 5-% 20% 30% 50%
Outpatient Facility Fee 50% 20% 30% 50%
RX | Generics: Preferred (Tier 1a) $3 $0 $3 $3
RX | Generics: Non-preferred (Tier 1b) $30 $5 $25 $30
RX | Brand: Preferred (Tier 2) $125 $30 $75 $125
RX | Brand: Non-preferred (Tier 3) 50% after deductible 50% after deductible 50% after deductible 50% after deductible
RX | Brand: Specialty (Tier 4) 50% after deductible 50% after deductible 50% after deductible 50% after deductible

 

Coverage Map

Austin

San Antonio

2021/2022 Participating Hospital List

 

 

Check the Provider Finder to see if it’s in-network!

Oscar Announces Partnerships with HCA Healthcare to offer seamlessly connected health insurance and care across El Paso, San Antonio, Austin, Houston, and Dallas-Fort Worth, Texas. HCA Healthcare’s facilities in those markets are referred to locally as:

  • St. David’s HealthCare – Austin
  • Medical City Healthcare – Dallas-Fort Worth
  • Las Palmas Del Sol Healthcare – El Paso
  • HCA Houston Healthcare – Houston
  • Methodist Healthcare System – San Antonio

Other Hospitals below by county. Don’t see your preferred hospital? Check the Provider Finder to see if it’s in-network!

 

Bexar County

  • Baptist Medical Center
  • Mission Trail Baptist Hospital
  • North Central Baptist Hospital
  • Northeast Baptist Hospital
  • St. Luke’s Baptist Hospital Comal
  • Resolute Health Hospital

Comal County

  • Resolute Health Hospital

Travis

  • St. David’s South Austin Medical Center
  • Dell Seton Medical Center at The University of Texas
  • St. David’s Medical Center
  • Ascension Seton Medical Center Austin
  • Ascension Seton Northwest
  • St. David’s North Austin Medical Center

Williamson

  • Cedar Park Regional Medical Center
  • Seton Medical Center Williamson
  • St. David’s Round Rock Medical Center
  • Medical Center – Cedar Park

Hays

    • Seton Medical Center Hays

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Online Application

Oscar Texas Perks

Dedicated Health Concierge Team

 With Oscar, you get your own Concierge team – three care guides and a nurse. You talk to the same people every time you call or message. And you get personalized care from people who know you as more than just a member ID number.

Innovative Mobile App

“Simple, useful, and actually gives me money!” – App Store review

Simple. Smart. Snazzy. It’s a health insurance app that doesn’t look or act like one. The Oscar app makes it easy to manage your health, find great care, and see everything in one place. And it’s easy on the eyes. Here’s what members love most about it.

Reach your Concierge team in one tap.

Don’t go through an annoying automated phone system to get help. Ask your dedicated Concierge team about bills, benefits, prescriptions, and doctors right from the Oscar app. You’ll talk to one of the same four people every time you message or call.

Get a diagnosis and prescription in two taps.

The average Doctor on Call user saves $600-$900 by using the free service instead of visiting the ER or urgent care. Send a request 24/7, and a board-certified Doctor will call you within 15 minutes. No booking ahead, no waiting rooms, no off-hours.

See all of your stuff in one place.

You shouldn’t have to navigate a clunky website just to find your own health info. Your plan details, labs, prescriptions, health history, bills, and ID card are on the app.

Get Money For Walking.

Earn $1 toward an Amazon® Gift Card for every day that you hit your step goal. It’s hassle-free – the app automatically syncs your steps from Apple Health or Google Fit.

Step Tracking Rewards

Earn up to $75* a year in Amazon® Gift Cards for tracking your steps or sleep.
The Oscar app syncs with Google Fit or Apple Health, and you earn $1 for every
day you hit your step or sleep goals.

DOWNLOAD THE OSCAR APP
Then tap “Sync your steps” to connect your Apple Health app or Google
Fitapp to your Oscar profile. Then start walking and earning rewards! Visit
hioscar.com/ app to learn more. Sleep tracking is also available.

 

If you’re unable to participate in this program, you may qualify to earn the same reward in a
different way. Contact 1-855-672-2755 and we’ll work with you (and, if you’d like, with your doctor)
to find a wellness program that’s right for you.

Dual Networks

In 2022, Oscar is proud to offer individuals and families even more options for new and renewing members by offering two comprehensive net works in select Texas markets.* Why dual net work options? Oscar offers two network options with high- quality health systems and providers so you can choose the network with the right doctors for you and your family.

If you live in Harris, Fort Bend, Montgomery, Galvest on or Brazoria counties, you can choose between two provider networks:

Oscar Choice Network

The Choice network is broad and offers an expansive network of quality doctors, specialists, clinical facilities and hospitals. This network is in partnership with Hermann, HCA Gulf Coast and St. Joseph?s.**

Oscar Select Network

The Select network provides a locally curated net work of doctors, specialists, hospitals and clinical facilities that offer cost-effective medical care without sacrificing the quality our members expect. This net work is in partnership with HCA and St. Joseph’s.**

 

 

*In Texas, the Choice network and the Select network are available in Harris, Fort Bend, Montgomery, Galvest on and Brazoria counties.
** Provider listings are not all-inclusive and are as of Sept ember 2021; subject to change. For a list ing of doctors and facilities that participate in the Select and Choice networks, contact your local broker or visit hioscar.com.

For Diabetic Members

People often pay too much for plans that aren’t right for them. That’s why Oscar has plans custom designed for the kind of care you really need. If you have Type 1 or Type 2 diabetes, Oscar has plans that can save you money and help you manage your condition.

Once your plan is active, it includes:

Plan Benefits:*

  • $0 HbA1c, urinalysis, metabolic, lipid panel
  • $0 Tier 1a drugs
  • $0 PCP visits
  • $0 behavioral health visits
  • $0 diabetic foot care and diabetic retinal exams
  • $100 per month maximum on insulin****

Rewards and Incentives: 

  • Earn cash rewards for healthy groceries – up to $100 a year**
  • Get access to a national network of gyms and fitness classes through ASH Fitness***

Reach out to one of our licensed experts to see which plan is best for you!

 

* Plans are available to all eligible persons, regardless of disease status. If you don’t have type 1or type 2 diabetes, or you have pre- diabetes or gestational diabetes, these plans may offer you certain reduced costs, but you are not eligible for all Rewards and Incentives program offerings t hat offer even more savings. Coverage for benefits is limited per clinical guidelines. These plans are not available in MI, TN, VA, CA, NY & NJ.
** To be eligible for healthy groceries rewards, members must have a type 1or type 2 diabetes diagnosis, be active in Oscar’s diabetic management program within 3 months of plan activation date, and complete either their annual physical or a wellness visit . Cash rewards are distributed through healthy groceries debit cards? up t o $100 per year. *** Fitness class access is available after a member completes 2 recommended services (labs, eye exam)**** Maximum out- of- pocket insulin cost depends on applicable state rules. Review your plan document s to confirm costs. Oscar will apply the lower of the maximum state- mandated out- of- pocket insulin cost , or $100.

Oscar $3 Prescriptions

Youread that right. Oscar is always looking for ways to help members save, so Oscar is reducing t he cost of many of the most commonly prescribed drugs to $3.

How to make $3 prescriptions work for you:

  • Check this PDF to see if any of your prescriptions are on it. The next time you fill that prescription, it will only cost you $3!
  • Don’t see your prescription? Show this list to your doctor and see if there’s an equivalent $3 option that could work for you instead.
  • Questions? Your Concierge team is here to help you better understand. Call 855-672-2755 or visit this link.

Primary and Urgent Care

Oscar Primary Care helps you put your health first with virtual visits right from home!

Staying on top of your routine care with regularly primary care provider visits helps you stay well. Oscar makes it easy for you to get it on your terms. With Oscar Primary Care, you’ll have a virtual care team dedicated to you and your health for the long haul. AND virtual visits for $0* – Just log into the Oscar app and our virtual doctor’s office will come to you through video, phone, or secure messaging. It’s up to you.

A whole team is by your side
Your Oscar Primary Care team includes a licensed provider, a nurse, and a medical assist ant . When something comes up, simply message your medical team right through the app and they’ll be in touch.

Ongoing support for chronic conditions
Your team can also help you develop a tailored care plan and coordinate your care so you never miss anything. From ongoing diabetes management and resources to mental health support, and more.

Get in-person care whenever you need it
Sometimes to get a full picture of your health you’ll need in-person care. When that time comes, Oscar will direct you to the right specialist , lab, or imaging facility in their network. Some screenings and tests may be available t o be done in the comfort of your home too.

Get care 24/7 without copays, appointments, or hassles

When a minor health issue comes up, stay put and get the help you need right from home with Virtual Urgent Care.

Here’s how it works
Log into t he Oscar app or site and look for Virtual Urgent Care to book a visit . Tell us a few details and we’ll reach out in as little as 15 minutes over the phone. Then, a provider will help you determine next steps and even provide a prescript ion or refill, if needed. It ?s really simple.

Think of it as your first step for things like:

  • Sinus infections
  • Sore throat , cough
  • Allergies
  • Skin conditions
  • Nausea or vomiting
  Virtual Urgent Care Urgent Care Center Emergency Room
Cost $0 $$ $$$
Wait Time In as little as 15 minutes to get care An hour or more Over an hour
When to use it Minor health issues that need immediate care and prescriptions Urgent but not life-threatening issues that may require stitches or x-rays Life threatening situations like broken bones, severe chest pain, heavy bleeding, etc

Contact Us

Phone: (312) 726-6565 Email: [email protected]

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