Oscar is a private insurance company, not a government program

Oscar is a private health insurance company that sells plans to individuals and families. It is not Medicaid or Medicare — it is a for-profit business that competes with other private insurers like Aetna, Cigna, and UnitedHealthcare.

Oscar does sell plans that work with Medicare and Medicaid, but the company itself is not either program. Understanding the difference matters because it changes how you pay, what you are covered for, and who handles your claims.

Key Takeaways

  • Oscar is a private insurance company, not a government program like Medicare or Medicaid.
  • Oscar sells Medicare Advantage plans (Part C) to people 65 and older, which are private alternatives to Original Medicare.
  • Oscar also sells Medicaid plans in some states, meaning it administers Medicaid benefits on behalf of the state.
  • You pay Oscar directly for private plans, but Medicare Advantage and Medicaid plans are subsidized by the government.
  • Your coverage, costs, and which doctors you can see depend on which type of Oscar plan you have.

Oscar Medicare Advantage plans (Part C)

Oscar sells Medicare Advantage plans, also called Part C. These are private insurance plans that cover the same benefits as Original Medicare (Parts A and B) but through a private company instead of the federal government. If you are 65 or older and enrolled in Medicare, you can choose an Oscar Medicare Advantage plan instead of staying with Original Medicare.

With an Oscar Medicare Advantage plan, you still pay your Medicare Part B premium to the government, but Oscar becomes your main insurer. Oscar collects a payment from Medicare for each person enrolled, then manages your coverage. Many Oscar Medicare Advantage plans include prescription drug coverage (Part D) and dental or vision benefits that Original Medicare does not cover.

The trade-off is that Oscar Medicare Advantage plans usually have a network — you may pay more or nothing at all if you see doctors in the network, but you pay more if you go out of network. Original Medicare has no network, so you can see any doctor who accepts Medicare.

Oscar Medicaid plans

Oscar also sells Medicaid plans in some states. Medicaid is a joint federal and state program for people with low income. When Oscar offers a Medicaid plan, it means the state has hired Oscar to manage Medicaid benefits for its members. You do not pay Oscar directly — the state pays Oscar, and you receive Medicaid coverage through Oscar.

Which states Oscar serves changes over time, and not all states use private insurers for Medicaid. If you are on Medicaid and live in a state where Oscar operates, you may be assigned to an Oscar plan or given the choice to pick one. Your coverage, costs, and network depend on your state's Medicaid program and the specific plan Oscar offers there.

How Oscar differs from government programs

Medicare and Medicaid are government programs run by the federal government (Medicare) or jointly by federal and state governments (Medicaid). Oscar is a private company that profits from selling insurance. The government sets the rules for what Medicare Advantage and Medicaid plans must cover, but Oscar decides how to run its plans within those rules.

This means Oscar can change which doctors are in its network, which drugs it covers, and how much you pay out of pocket — as long as it meets government standards. If you disagree with an Oscar decision about coverage, you have the right to appeal, but Oscar makes the initial decision, not the government.

Oscar also has customer service representatives who work for Oscar, not for Medicare or Medicaid. If you have questions about your Oscar plan, you call Oscar, not Medicare or your state Medicaid office (though those offices can also help).

What to check before choosing an Oscar plan

If you are considering an Oscar plan, confirm which type it is — Medicare Advantage, Medicaid, or a private plan for people under 65. Then check whether Oscar serves your area. Oscar does not operate in every state or every county within a state.

For Medicare Advantage, review the plan's network to see if your current doctors participate. Check the formulary (the list of covered drugs) if you take prescription medications. For Medicaid plans, ask your state Medicaid office which plans are available to you and what the differences are.

You can also call Oscar directly to ask questions about coverage, costs, and network doctors. Oscar's customer service can tell you whether a specific doctor or hospital is in network and what you would pay for a specific service.

When to contact Medicare, Medicaid, or Oscar

Contact Medicare (1-800-MEDICARE) if you have questions about whether you are enrolled in Medicare, how Medicare works, or whether you are may be able to access for it. Contact your state Medicaid office if you have questions about Medicaid may be able to access or which Medicaid plans are available in your area.

Contact Oscar directly if you have questions about your Oscar plan's coverage, costs, network, or claims. Oscar's phone number is on your insurance card. You can also contact Oscar if you want to switch plans or if you have a complaint about your coverage.

If you are unsure whether you have an Oscar plan, check your insurance card or the paperwork you received when your coverage started. It will say "Oscar" or the name of the plan, and it will say whether it is a Medicare Advantage plan, a Medicaid plan, or a private plan.

Frequently Asked Questions

Can I have both an Oscar plan and Original Medicare at the same time?

No. If you choose an Oscar Medicare Advantage plan, you are leaving Original Medicare. You can switch back to Original Medicare during the annual enrollment period (October 15 to December 7), but you cannot have both at once. If you have an Oscar Medicaid plan, you cannot also have Medicare Advantage unless you are may be able to access for both Medicare and Medicaid (called "dual may be able to access"), in which case you would have separate plans for each.

Does Oscar insurance cost money?

It depends on the plan. Oscar Medicare Advantage plans are subsidized by Medicare, so you pay a premium (usually $0 to $50 per month, but it varies by plan and location) plus out-of-pocket costs when you use care. Oscar Medicaid plans are free or very low cost because Medicaid is a government program for people with low income. Oscar private plans for people under 65 cost more and vary widely by plan and age.

What happens if Oscar stops offering plans in my area?

If you have a Medicare Advantage plan and Oscar leaves your area, Medicare will notify you and give you a window to switch to a different plan. If you have a Medicaid plan and Oscar stops serving your state or county, your state Medicaid office will tell you which plans are available and help you switch. You will not lose coverage during the transition.

Is Oscar insurance accepted everywhere?

No. Oscar Medicare Advantage plans have a network, so you pay less or nothing when you see doctors in the network. Out-of-network care costs more. Oscar Medicaid plans also have a network that varies by state. If you travel or move, check whether Oscar's network covers doctors in that location before you go.

How do I know if my doctor accepts Oscar?

Call Oscar's customer service number on your insurance card and ask whether a specific doctor is in network. You can also ask your doctor's office directly whether they accept your Oscar plan. Do not assume a doctor accepts Oscar just because they accept Medicare or Medicaid — network participation is specific to each plan.