Health insurance that works for individuals and families

Frequently asked questions

• What are my covered essential benefits?
  • All qualified health plans offered on the ACA marketplace offer coverage for basic benefits, or essential health benefits. When you choose Oscar, you’re covered with these 10 essential benefits:

    1. Ambulatory (or “outpatient”) services: Any medical care you receive where you aren’t admitted to a hospital.
    2. Emergency services: Medical care that you receive when visiting an emergency room, whether for a broken arm or a heart attack.
    3. Hospitalization: Any reason you’re admitted into a hospital, including for surgery or overnight observation.
    4. Pregnancy, maternity, and newborn care: All of your practitioner provider visits during your pregnancy, as well as your birth and doctor visits for your newborn baby.
    5. Mental health and substance use services: Psychiatrist or counselor care as well as treatment at a mental health clinic.
    6. Prescription drugs: Antibiotics, blood pressure drugs, antidepressants, and all other medications prescribed by your doctor.
    7. Rehabilitative services and devices: All medical care you get for an injury, disability, or chronic condition (like physical and occupational therapy, speech therapy, psychiatric rehabilitation, etc.)
    8. Laboratory services: Any time a practitioner takes a sample (blood, urine, skin, etc.) and sends it to a lab for testing.
    9. Preventative care, wellness services, and chronic disease management: Visits to your doctor for your annual checkup, vaccines, or screenings (such as blood pressure, cholesterol, or colon cancer), along with medical care for chronic diseases (like diabetes, heart disease, cancer, or arthritis).
    10. Pediatric services: All healthcare for kids, including dental and vision.

    Additional benefits include:

    1. Contraceptives: Many forms of birth control including the pill, implants, IUDs, emergency contraception, sterilization procedures for women, and more, as well as counseling from your doctor.
    2. Breastfeeding coverage: Breastfeeding support, counseling, and education, as well as breastfeeding equipment and supplies for the duration of breastfeeding.

    These aren’t necessarily the only benefits your plan offers. Certain benefits are only covered with some plans, while others are only required in select states. Not sure what else your plan includes? Check online or find a plan to see what other benefits you get as an Oscar member.
• How can I find out which doctors are in your network?
  • You can search our provider network by doctor name, specialty, symptoms, and more by visiting hioscar.com/care-options.
• How can I see if my prescriptions are covered by Oscar?
  • You can find out if your drugs are covered by Oscar and how much they will cost by visiting hioscar.com/care-options, or you can find a list of drugs covered by Oscar in Oscar’s drug formulary here.