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Oscar, the first tech-driven health insurance company, today announced plans to launch its new $0 Virtual Primary Care product and expand to a total of 19 states and 47 markets in 2021. The company will offer health insurance to individuals and families in four new states and 19 new markets during the upcoming Open Enrollment period, pending regulatory approvals.

  • Plans to expand individual and family plans to 19 states and 47 markets, including 19 new markets, pending regulatory approvals.(1)
  • Announces Virtual Primary Care, bringing longitudinal telehealth and a suite of additional incentives to members for just $0.(2)
  • Virtual Urgent Care offering expanded to include $0 drugs and labs.

Virtual Primary Care is the latest addition to the suite of Oscar Care features that provide a personalized experience for Oscar members. Oscar Care, which includes access to Oscar designated virtual primary and urgent providers, offers our members with Individual and Family Plans:

Virtual Primary Care: $0, unlimited virtual visits with a dedicated team of Oscar primary care providers.(3) Tier 1 prescriptions, DME, labs, diagnostic imaging orders(4) and initial specialist referrals prescribed by an Oscar Primary Care provider are also $0.(5) Oscar Primary Care also will bring some care directly to members in their homes, by offering $0 vitals monitoring kits and in-home lab draws,(6) when ordered by an Oscar Primary Care provider.

Virtual Urgent Care: 24/7 access to Oscar Virtual Urgent Care Providers at $0 for whenever a member needs to see a doctor quickly.(7) Tier 1 prescriptions and labs are $0 when prescribed by our virtual urgent care providers, too.(8)

Care Teams: Dedicated Care Guides, including a nurse, who know the member’s medical history, help them navigate their plan, and connect them with in-network providers.

“With the launch of Oscar Primary Care, Oscar is making even more unprecedented, cost- effective plans available,” said Oscar Co-Founder and CEO Mario Schlosser. “Americans consistently cite cost, quality and convenience as their biggest struggles with the healthcare system – our new offering solves for all of them.”

Oscar Expansion Markets

2021 will mark the fourth consecutive year Oscar expands its footprint to offer affordable care designed around members’ health, budget, family, and community needs.

As a part of the 2021 expansion, Oscar will offer Individual and Family Plans for the first time in: Arkansas (Little Rock and Fayetteville), North Carolina (Asheville), Oklahoma (Oklahoma City), and four markets in Iowa, including Des Moines and Sioux City.

We also will expand our existing state footprints to Boulder, Colorado, three markets in Northeast Pennsylvania, multiple markets across Florida, including Jacksonville, Sarasota, and Tallahassee, and across new counties in Phoenix, AZ, San Francisco, CA, and Columbus, OH.

Oscar Virtual Primary Care Markets

The COVID-19 pandemic is transforming how Americans access health care and accelerating demand for virtual services. While just 11% of U.S. consumers used telemedicine in 2019, 76% are interested in using virtual care following the outbreak, according to McKinsey.

Oscar will offer Virtual Primary Care in 10 markets in 2021: Miami, FL, Fort Lauderdale, FL, Palm Beach, FL, Houston, TX, Dallas, TX, Austin, TX, Los Angeles, CA, Orange County, CA, Denver, CO, and New York, NY, pending regulatory approval.

The specifics of Oscar’s 2021 insurance plan portfolio are still being reviewed by regulators. Details regarding pricing, network partners, and added benefits will be available closer to the open enrollment period this fall. In the meantime, more information can be found at www.hioscar.com.

About Oscar

Oscar is the first health insurance company built to make health care easy. Headquartered in New York City, Oscar has been challenging the health care system’s status quo since our founding in 2012, developing seamless technology and providing personalized support to help our members navigate their health care. Oscar was the first insurer to offer $0, 24/7 telemedicine to members and to integrate direct scheduling with providers through our app.

Oscar plans also include access to a network of first-rate physicians and hospitals, as well as a personalized Care Team that supports members every step of the way, from finding a doctor to navigating costs. Oscar is known for its easy-to-use digital tools, including a website and mobile app that let members view their health history, speak directly with their Care Teams and virtual providers, and access their account information.

All products and services are provided exclusively by or through operating subsidiaries of Mulberry Health Inc., including Oscar Insurance Company and its affiliates. Say hi or learn more at https://www.hioscar.com or follow us at https://twitter.com/OscarHealth.

Media Contact: Jackie Kahn, Head of Communications; jkahn@hioscar.com; 202-538-0128

Footnotes

  1. (1) Market numbers are based on Metropolitan Statistical Areas (MSAs); Oscar entrance into and disclosure of all specific cities and counties within each MSA are pending regulatory approvals.
  2. (2) Not available in CA.
  3. (3) Oscar Virtual Primary Care providers are employed by Oscar Medical Group and are not employed by Oscar Insurance.
  4. (4) Some prescriptions and orders are unavailable via virtual visits. Other exclusions apply.
  5. (5) Not available in CA. Some exclusions apply.
  6. (6) Not available in all markets, including Los Angeles, CA or Denver, CO.
  7. (7) Available on most Oscar plans.
  8. (8) Some Tier 1 prescriptions are unavailable via virtual visits. Other exclusions apply.

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It withdrew from the market at the end of 2016, after two other insurers dropped out of the individual marketplace.

Health care startup Oscar Health sold insurance in Dallas-Fort Worth for 2016, only to lose money and drop out of the market a year later.

Now, the New York-based insurer is returning to North Texas to sell individual and family health plans on the exchange created by the Affordable Care Act.

In an interview, Oscar CEO Mario Schlosser said the company negotiated more cost-competitive contracts with local providers, so it can attract customers and keep the company on the path to profitability.

Oscar’s return to the Dallas area signals that it has the confidence to grow, even as lawmakers and presidential candidates debate changes that could shake up the health care market. It also indicates the startup is serious about competing in Texas, which has the highest uninsured rate in the country. The company has 260,000 members across the U.S., with about 1 in 4 living in Texas. It sells insurance in Austin, San Antonio and El Paso. It’ll tack on two extra Texas metro areas in 2020: Dallas-Fort Worth and Houston.

Oscar is expanding to 12 new markets and six states in 2020, its largest expansion since it was founded in 2012. It will be in 15 states and 26 markets, and will start selling Medicare Advantage in Houston and New York City.

It isn’t the only insurer in growth mode. Thirteen companies that compete in the individual marketplace are entering at least one new state in 2020 and none have announced they’re exiting a state, said Rachel Fehr, a research assistant who studies health reform and private insurance for the Kaiser Family Foundation. She said the companies have remained profitable despite policy changes — such as the repeal of a mandate that required most Americans to buy insurance or pay a fine.

“It’s definitely a stable market, despite uncertainty,” Fehr said.

In Dallas-Fort Worth, Oscar will offer about a dozen different insurance plans on the exchange for 2020. Oscar has signed contracts with Methodist Dallas and Medical City. It has deals with HCA Healthcare, the country’s largest hospital system and Medical City’s parent company, in other markets.

The last time Oscar was in the Dallas market, it partnered with Tenet Healthcare and Baylor Scott & White Healthcare System.

Oscar dropped out of the individual marketplace in the Dallas area at the end of 2016, after Aetna and Scott & White Health (a plan offered through the Dallas-based health care system) announced plans to withdraw from the marketplace. Oscar had between 7,000 and 8,000 members in the Dallas area in 2016.

Schlosser said the company had to make tough choices. At the time, he said, the company’s medical claims were about 20undefined of Oscar members’ visits to a new doctor, the company has been the source that has recommended that doctor, he said.

It has a feature that aims to get ahead of a common complaint, too. If customers are going to be billed more than $200 out-of-pocket for a claim, they get a message ahead of time that offers to answer questions.

Schlosser said Oscar and insurers on the exchange must pay attention to something that’s overlooked by many “sleepy incumbents”: customer service.

“If you hate your insurance company and you get it through your employer, you’re out of luck,” he said. “You can’t go to your employer and say, ‘Please, for the thousand people who are at this company with me, can you please change companies? I had a bad experience.’ That’s not going to happen. But in our market, you can vote with your feet.”

“In my view, that’s how all of health care should work and how all of health insurance companies should work,” he added.

BACK WITH A SPLASH

Oscar grew to $1.2 billion in annual revenue in 2018. Two years ago, it began offering Oscar for Business in select markets. The employer-based health coverage is available to companies with up to 100 employees in New York, New Jersey, Nashville and Los Angeles. It has 17,000 members covered through the plan.

Oscar will compete with other companies on Healthcare.gov in Dallas, Collin and Tarrant counties. Three companies — Blue Cross Blue Shield of Texas, Celtic Insurance and Molina Healthcare — participated in the exchange in Dallas and Collin counties in 2019. Two companies, Blue Cross and Celtic, competed on the exchange in Tarrant County in 2019. Open enrollment on Healthcare.gov begins Nov. 1.

Texas is a significant business opportunity for health insurance companies, but it’s a challenging one. Nearly 18 percent — or 5 million — of Texans did not have health insurance in 2018, according to U.S. Census Bureau data. That’s higher than any other state and double the national average of about 9%.

While some states have encouraged signups with outreach campaigns and other approaches, Texas has taken the other tack. It is one of 14 states that have not accepted funding to expand Medicaid. It set strict rules and required additional training for navigators, people who help in the community with health plan sign-ups. And Texas Attorney General Ken Paxton is leading a challenge of the ACA in court.

That means companies like Oscar have had to field their own ground game to persuade Texans to sign up for health insurance — especially those who are young, healthy and feel they can go without it.

Oscar has a Texas office in Dallas with about a dozen employees who work in sales, growth and clinical review, said Kyle Estep, market director for Oscar’s central region. It opened in 2015.

Estep said the company, originally known for catering to hipsters and freelancers, has a diverse customer base that includes lower-income families, middle-age professionals and grandparents.

In recent weeks, Schlosser visited with insurance brokers in Dallas. And Dallas residents will soon see the Oscar brand on billboards and ads on streaming services, such as Netflix.

“We’re going to really try to make a splash in Dallas and reintroduce ourselves to the market in a very convincing way,” he said.

Oscar Health will roll out its biggest expansion of health insurance yet, expanding to 12 new markets and six new states to sell coverage for individuals and families in 2020.

Calling the expansion its “biggest market expansion ever,” Oscar’s effort comes as health insurance companies across the country make more money and better manage the care of sick patients signing up for individual Obamacare coverage sold under the Affordable Care Act.

“This is the third consecutive year Oscar has significantly expanded its footprint, and this expansion brings Oscar’s total geographic footprint to 15 states and 26 markets,” Oscar said Thursday. The company said its “2020 insurance plan portfolio” is still being reviewed by regulators so executives didn’t release pricing or provider network partners on Thursday.

The announcement comes after Oscar announced another quarterly underwriting profit and signed an agreement with a new reinsurance partner, Berkshire Hathaway’s National Indemnity reinsurance subsidiary. Such reinsurance partnerships typically mean a health plan like Oscar will have more capital to expand and invest in new technology.

Oscar currently sells individual Obamacare coverage in 14 markets in 9 states: New York, New Jersey, California, Tennessee, Ohio, Texas, Florida, Michigan and Arizona. Oscar now has 260,000 health plan enrollees across the country.

On Thursday, Oscar said it will expand in Florida to Miami, Tampa, Ocala and Daytona. In addition, Oscar said it will sell plans for the first time in Philadelphia; Denver; Richmond, Va.; Atlanta and the Kansas City market that includes both Kansas and Missouri. And in Texas, where Oscar has offered coverage for several years, company executives said they will “enter Houston and expand the plan options we offer in Dallas-Fort Worth.” The company is also expanding to “serve several counties in Western Michigan,” Oscar said.

“Oscar’s expansion proves that our commitment to making health care easy — by developing seamless technology and providing personalized support — is working,” Oscar CEO and Co-founder Mario Schlosser said. Schlosser founded Oscar with Joshua Kushner, brother of Donald Trump’s son-in-law Jared.

Oscar, which made its name as a startup focused on providing Obamacare coverage, earlier this month reported second-quarter “underwriting profit of $128 million.” Earlier this year, Oscar announced plans to enter the business of selling private Medicare Advantage plans for seniors.

Source Link: https://www.forbes.com/sites/brucejapsen/2019/08/22/oscar-health-to-launch-biggest-obamacare-expansion-yet/

We also created a Guide to Oscar Medicare Certification for your convenience. If you have any issues or questions about getting certified, please contact our Enrollment Support Team at 1-866-590-9771 or support@enrollinsurance.com

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