Oscar Health expands ACA presence and chronic condition plans

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Healthcare insurtech Oscar Health will be expanding its presence on the Affordable Care Act marketplace in 2025 and is introducing new plans for people with multiple chronic conditions.

The company will expand into 405 markets across 18 states next year, it said.

Oscar is launching a multi-condition plan for members with diabetes, pulmonary and cardiovascular disease – three common conditions impacting ACA members, it said. Internal research showed managing those conditions can lower costs by up to 25%.

Benefits of the plan include no out-of-pocket costs for cardiologists, pulmonologists, endocrinologists, screenings and labs, primary and behavioral care, and medications.

Members can enroll in Oscar's single-condition plans, Diabetes Care and Breathe Easy, in select states.

Meanwhile, employees can now choose from a suit of offerings using their employer contributions. Individuals can select from several plans with high-quality networks that align with their schedules, neighborhoods and health needs, Oscar said, adding that it has a dedicated concierge team for employees that is available 24/7 to help them maximize the new benefits.

Oscar is working with StretchDollar to help businesses with fewer than 50 employees offer pretax contributions that employees can use to buy individual health insurance, it said.

WHAT'S THE IMPACT?

In addition, Oscar is introducing Buena Salud, a Spanish-first offering for Hispanic and Latino members. Individuals engage with Oscar in Spanish and are connected to a care team and primary care provider that shares the language.

Buena Salud builds on the Hola Oscar offering, which has a Spanish-speaking net promoter score (NPS) of 87 and is available across Oscar plans, the company said. The program, developed by native Spanish-speakers at Oscar, accounts for cultural, linguistic and regional differences among Hispanic and Latino communities. These communities make up nearly one-third of Oscar's membership and, according to the Department of Health and Human Services, are the fastest-growing populations in the ACA.

Oscar is also introducing Guided Care HMO, with lower premiums and out-of-pocket costs. Individuals select a primary care provider who manages their care with a network of specialists, and Guided Care HMO delivers urgent and real-time referrals, with benefits including $0 virtual urgent care, $0 medications, and low-cost labs and integrated virtual-first specialty care.

THE LARGER TREND

Oscar named Mark Bertolini as its new chief executive officer in 2023. Bertolini is former chairman and CEO of Aetna. During his tenure at Aetna, Bertolini led the company's transition from a traditional health insurance company to a consumer-oriented healthcare company.

In 2022, Oscar Health and Bright Health said they were pulling back on their Medicare Advantage business to focus more on ACA plans.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.