Oscar Cuts UCLA, Hoag from Covered California Health Plans

Oscar will cut UCLA and Hoag hospitals from its network of providers for Covered California health plans in 2020. In addition to the loss of 5 hospitals, Primary Care Physicians will be reduced by 700 and specialists will drop by 2,000. Oscar will make their full original network of providers available to individuals and families who purchase health insurance directly from them outside of Covered California.

For 2020, Oscar will introduce two provider networks for their Los Angeles and Orange County markets. The Oscar Circle Network will be comprised of all the providers they have contracted with including UCLA and Hoag hospitals and affiliated doctors. The Oscar Select Network will be a smaller offering of in-network providers that does not include UCLA or Hoag. Oscar health plans purchased through Covered California will only have access to the smaller Select network of providers.

UCLA & Hoag Out To Reduce Rates

For consumers who enroll in Oscar health plans off-exchange, outside of Covered California direct from Oscar with no access to subsidies for reducing the health insurance premiums, both the Circle and the Select networks will be offered. Oscar estimates the rates for their health plans with the small Select network are approximately 10% less expensive. They also note that there is 78% overlap of providers between the Circle and Select networks.

Only 3 Plans To Offer UCLA & Hoag From Oscar

If you want to keep either UCLA or Hoag in your Oscar health plan, you will have to enroll in an off-exchange Oscar plan that is designated with the Circle network. The Circle network that includes UCLA and Hoag will only be available in the metal tier plans of

• Bronze 60 Circle
• Silver 70 Circle (not to be confused with the Silver 70 Off-Exchange plan or the Silver Simple plan)
• Silver Classic Circle

If you can’t afford to leave Covered California because of the subsidies offered to reduce the monthly health insurance premium, the Blue Shield PPO plans have both UCLA and Hoag, and the Blue Shield Trio HMO plans also include Hoag. However, always double check both the health plan and the provider to make sure they are still contracted and in-network for these plans.

Covered California is expanding subsidies to households whose incomes are higher and previously not eligible for subsidies. This is great for individuals and families whose income is between 400% and 600% of the federal poverty level. But if current off-exchange Oscar members go into Covered California to receive the subsidies, they must enroll in an Oscar Select Network plan that will not include either UCLA or Hoag.

Oscar 2020 Plan Closures

Another change Oscar is making for 2020 is the elimination of their Bronze High Deductible Health Plan that is Health Savings Account compatible. The rational for removing the Bronze HDHP plans was that Oscar wanted to keep their Doctor on Call benefit through their mobile application at no cost. The Doctor on Call is available 24/7 and you can make unlimited calls to doctors for a variety of non-emergency health care issues such as flu, skin conditions, joint pain, infections and receive prescriptions for birth control, antibiotics and allergy medications.

We are discontinuing select plans in California because a new plan regulation requires that we remove HSA-compatibility in order to continue offering free Doctor on Call in 2020. We believe that the ability to offer free Doctor on Call is an important benefit that can save your clients both time and money. Last year, Oscar members saved an average of $129 each time they used Doctor on Call and saved over 106,000 hours in total travel time.

Each of your clients has been mapped to a renewing plan that is nearly identical to their 2019 plan, except for HSA-compatibility. Please note that while your clients can no longer contribute funds to an HSA in 2020, they can still use any previously accumulated funds towards qualified medical expenses. 

The following California individual market plans will be discontinued for 2020:
Oscar Bronze 60 HDHP EPO
Oscar Bronze 60 HDHP EPO
Oscar $0 Cost Share EPO AI-AN
Oscar Bronze 60 HDHP EPO AI-AN
Oscar Saver Silver HSA HDHP EPO

– From Oscar agent correspondence

Initially, when Oscar expanded into California, part of their marketing was health care made simple. Unfortunately, someone in the marketing department had to make things confusing. Their off-exchange plans have always had names such as Simple, Saver, or Classic. There is nothing simple, classic or saving about health insurance. Now we are given network names such as Circle and Select, which imparts very little information to the consumer.

In reality, Circle equals full network including UCLA and Hoag. Select represents a narrow network which excludes UCLA, Hoag, and a variety of physicians. But you won’t have access to the full Circle network if you enroll through Covered California and they won’t be available even if you have an off-exchange plan in metal tiers Gold or Platinum. So much for Oscar being the simple choice for health insurance.