Oscar Classic Gold Plan Details for 2020- HealthPocket

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Zip Code63129
Applicant1/24/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOscar Classic Gold
Plan IDqhp-69512MO0010013
Plan Year2020
Insurance ProviderOscar Insurance Company
Metal LevelGold
Plan TypeEPO
Deductible$1,700
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$50 Copay
Laboratory Outpatient and Professional ServicesNot Applicable
X-rays and Diagnostic Imaging20.00% Coinsurance after deductible
Deductible - Family$3400
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$3 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs20% Coinsurance after deductible
Specialty Drugs20% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.hioscar.com/search/?networkId=029&year=2020

Hospital services

Emergency Room Services20% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)20% Coinsurance after deductible
Inpatient Physician and Surgical Services20% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient Services20.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for Children20.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsDurable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Dental Check-Up for Children
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsAcupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
PremiumPlan NameDeductible
from $335
Select by Medica Bronze Share Plus
$1,600.00Select
from $362
WellFirst Gold Copay Plus 1500X
$1,500.00Select
from $409
Select by Medica Bronze Share Plus
$1,600.00Select
from $442
WellFirst Gold Copay Plus 1550
$1,550.00Select
from $443
WellFirst Gold Copay Plus 1500X
$1,500.00Select
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  • Phone Number
    (314) 487-8724
  • Office Locations
    4530 Lemay Ferry Rd
    Saint Louis, MO 63129
4530 Lemay Ferry Rd Saint Louis MO, 63129
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).