Loading...
Loading...
Oscar Health Gold Elite is a 2026 Texas individual and family marketplace health insurance plan. The official plan grid lists a $1,200 individual / $2,400 family medical deductible and a $7,800 individual / $15,600 family out-of-pocket maximum. The pharmacy deductible is integrated with the medical deductible. The plan is identified as an EPO, and the published prescription schedule lists $3 for preferred generic Tier 1a, $30 for non-preferred generic Tier 1b and $75 for preferred brand Tier 2 drugs. Non-preferred brand and specialty drugs are listed at 50% coinsurance after the deductible. Premium and exact benefit availability depend on the applicant and service area.
$1,200 individual deductible; $7,800 individual out-of-pocket maximum
Gold Elite has a lower listed deductible than several other Oscar Gold options in the 2026 Texas grid, but members should compare the premium, provider network and service-level cost sharing before enrolling. The official grid lists a $1,200 individual deductible and $7,800 individual out-of-pocket maximum. Medical and pharmacy deductibles are integrated. The grid lists 30% coinsurance after the deductible for inpatient and outpatient facility fees, and 50% after the deductible for non-preferred brand and specialty prescriptions. The plan is an EPO, so checking in-network doctors, hospitals and laboratories is important. Review the official Summary of Benefits and Coverage and current formulary for complete details.
Oscar Health
Key Insights
Founded
2012
Oscar Health was established 14 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
0% CSR, calculated as a 3-year average
Oscar Health settles 0% of all claims it receives.
Network Hospitals
60,000+ Providers
Oscar Health has a network of 60,000+ Providers hospitals, ensuring wide accessibility and convenience for policyholders.
The official 2026 Texas plan grid lists a $1,200 individual and $2,400 family medical deductible.
The deductible applies to services according to the official benefit schedule.
The official grid lists a $7,800 individual and $15,600 family out-of-pocket maximum.
Refer to the policy for eligible expenses counted toward this limit.
The published plan grid indicates that the pharmacy deductible is integrated with the medical deductible.
Prescription costs depend on drug tier and applicable benefit rules.
The official 2026 grid lists a $3 member cost for preferred generic Tier 1a drugs.
Check the current formulary and pharmacy requirements.
The published grid lists a $30 member cost for non-preferred generic Tier 1b drugs.
The formulary determines the tier assigned to each medicine.
Oscar-related supplemental-plan information lists dental options, including options with vision coverage, and a dental, vision and hearing option for eligible members.
Separate supplemental coverage; confirm current Texas availability, eligibility, benefits, exclusions and price before purchase.
A separately offered accident plan may provide additional financial benefits for covered accidental injuries, subject to its own policy terms.
Covered services may be subject to deductibles, copays, coinsurance, network rules, prior authorization and medical-necessity requirements. Check the official policy and Summary of Benefits and Coverage.
Conditions or treatments that the policy clearly says it will not cover.
Insurer
Oscar Health plans and claim process
It is a 2026 Texas individual and family Gold-tier health insurance plan identified as an EPO.
The official 2026 plan grid lists a $1,200 individual medical deductible.
The official plan grid lists a $2,400 family medical deductible.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Ratings and figures are based on publicly available company disclosures and state insurance department filings. Finzony is not an insurance broker or agent. Verify all details on the official Oscar Health website before purchasing.
Contact Details
1-855-672-2788
Headquarters: 75 Varick Street, 5th Floor, New York, NY 10013, United States
Official Website
hioscar.com
Visit the official Oscar Health website for plan brochures, premium quotes and policy services.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Not a benefit automatically included in this Oscar medical plan. Confirm availability and the exact benefit schedule.
A separately offered supplemental product is listed for additional financial support related to specified serious conditions.
Separate policy and eligibility requirements apply. Do not assume it pays every medical bill or covers every diagnosis.
Supplemental life insurance is listed among the optional products offered through Oscar-related supplemental-plan information.
Separate life insurance product; verify current availability, underwriting and policy terms.
The official grid lists $7,800 for an individual. Check the policy for expenses counted toward the limit.
The official grid lists $15,600 for a family.
No. The published grid indicates that the pharmacy deductible is integrated with the medical deductible.
The official grid lists $3 for preferred generic Tier 1a prescriptions.
The published grid lists $30 for non-preferred generic Tier 1b prescriptions.
The official grid lists $75 for preferred brand Tier 2 prescriptions.
The published grid lists 50% coinsurance after the deductible for non-preferred brand Tier 3 prescriptions.
The official grid lists 50% coinsurance after the deductible for specialty Tier 4 prescriptions.
The premium depends on applicant details, location and applicable financial assistance. Review Oscar’s official 2026 plan documents, provider directory, formulary and Summary of Benefits and Coverage for the plan available in your area.