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Oscar Health Silver Simple Guided Care is a 2026 Texas individual and family health insurance plan with an HMO network. The plan summary lists a $6,300 individual deductible and a $12,600 family deductible, with an out-of-pocket maximum of $9,300 individual and $18,600 family. Eligible in-network preventive care is covered at no charge. Primary care visits have a $10 copay, specialist visits have a $70 copay, and Tier 1 generic prescriptions have a $3 copay. Many hospital and emergency services have 50% coinsurance after the deductible. Premium information is provided separately and depends on applicant and location details.
$6,300 individual deductible; $10 primary care; $70 specialist; $3 Tier 1 generic prescription
The plan offers comparatively low copays for primary care and Tier 1 generic medicines, which may help members who regularly use these services. However, the deductible remains substantial, and many inpatient, emergency and other major services have 50% coinsurance after the deductible. As an HMO, the plan generally requires members to use its provider network and follow its referral and authorization rules. Confirm whether referrals are required for particular services, and verify doctors, hospitals and medicines in the current plan documents before enrolling.
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 plan summary lists a $6,300 individual deductible and $12,600 family deductible. The out-of-pocket maximum is $9,300 individual and $18,600 family.
Premiums and non-covered services do not count toward the out-of-pocket maximum.
Eligible in-network preventive care and screenings are covered at no charge under plan terms.
Additional diagnostic or non-preventive services may have cost sharing.
In-network primary care office visits have a $10 copay.
Check the policy for the applicable visit and provider rules.
The plan summary lists a $70 copay for an in-network specialist visit.
HMO referral and authorization requirements may apply; confirm them with Oscar Health.
Tier 1 generic prescriptions have a $3 copay. Preferred brand medicines have a $125 copay after the deductible; non-preferred brand and specialty medicines may have 50% coinsurance after the deductible.
Check the current formulary, pharmacy network and drug-specific restrictions.
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.
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 health insurance plan with an HMO network. Confirm the current service area and enrollment availability with Oscar Health.
The plan summary lists a $6,300 individual deductible.
The plan summary lists a $12,600 family 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 listed maximum is $9,300 for an individual and $18,600 for a family. Premiums and non-covered services are excluded.
The plan summary lists a $10 copay for an in-network primary care visit.
The plan summary lists a $70 copay for an in-network specialist visit. Confirm whether a referral is required for your service.
Eligible in-network preventive care is covered at no charge under plan terms. Non-preventive services may have cost sharing.
The plan summary lists a $100 copay for urgent care. Check network and service rules before treatment.
Tier 1 generic prescriptions have a stated $3 copay. Other drug tiers have different cost-sharing rules.
Many hospital and inpatient services have 50% coinsurance after the deductible. Consult the official SBC for the specific service.
Routine out-of-network care is generally not covered under this HMO plan, except as provided by emergency-care rules and other plan exceptions.
The plan summary provides premium information separately. The actual premium depends on location, age, household details and any financial assistance.