Oscar is not a Medicaid plan — it's a private insurance company that sells plans on the individual market

Oscar Insurance sells health coverage directly to individuals and families, not through Medicaid. You buy an Oscar plan on the open market, usually through the federal health insurance marketplace (Healthcare.gov) or your state's marketplace, and you pay the premium yourself. Medicaid, by contrast, is a government program run by your state that covers people who meet income and other requirements — you don't buy into it the way you buy into Oscar.

That said, Oscar does sell plans that work alongside Medicaid in some states. If you have Medicaid, you cannot also have an Oscar individual plan at the same time. But some states allow people to use Medicaid funds to buy into a private plan through a program called a Medicaid Advantage plan or managed long-term care plan. Oscar may or may not participate in those programs in your state.

Key Takeaways

  • Oscar Insurance is a private company selling individual health plans, not a Medicaid program run by the government.
  • You cannot hold both an Oscar individual plan and Medicaid coverage at the same time.
  • Some states allow Medicaid funds to be used to purchase private plans through managed care programs, and Oscar may participate in your state's program.
  • If you think you may may have access to for Medicaid, contact your state Medicaid office directly rather than purchasing an Oscar plan first.

How Oscar plans differ from Medicaid coverage

Oscar plans are sold to anyone who wants to buy them and can afford the monthly premium. There is no income test, no asset limit, and no waiting period. You choose your plan, pay the premium, and coverage begins on the date you select. Medicaid, on the other hand, is only available to people whose income and household size fall below your state's threshold, and may be able to access rules vary widely by state.

Oscar plans also tend to have higher out-of-pocket costs than Medicaid. You pay a monthly premium, a deductible, copays, and coinsurance. Medicaid typically has no or very low premiums and minimal copays, especially for low-income enrollees. If you are considering Oscar because you don't think you may have access to for Medicaid, it's worth checking with your state Medicaid office first — the income limits are often higher than people expect.

When Oscar might work with your Medicaid status

In some states, Medicaid beneficiaries can enroll in a Medicaid Advantage plan (also called a Medicaid managed care plan). These are private insurance plans that contract with your state to deliver Medicaid benefits. Oscar operates Medicaid Advantage plans in several states, though not all. If Oscar offers a Medicaid Advantage plan in your state, you would use your Medicaid coverage to enroll in it — you would not pay a separate premium to Oscar.

To find out whether Oscar offers a Medicaid Advantage plan where you live, contact your state Medicaid office or visit your state's Medicaid website. They maintain a list of all private plans available to Medicaid members in your area. You cannot enroll in a Medicaid Advantage plan through Oscar's website or by calling Oscar directly; enrollment happens through your state Medicaid program.

What happens if you buy an Oscar plan and then may have access to for Medicaid

If you purchase an Oscar individual plan and later find out you may have access to for Medicaid, you will need to drop the Oscar plan. You cannot hold both at the same time. When you enroll in Medicaid, your state will ask you to cancel any other health coverage. If you don't, your state may cancel it for you.

Dropping an Oscar plan mid-year is usually allowed without penalty if you have a may have access to life event — such as losing other coverage, moving to a new state, or having a significant change in income. Gaining Medicaid may be able to access counts as a may have access to event. Contact Oscar to cancel your plan, and keep documentation of your Medicaid approval letter in case there are questions about the timing.

How to tell if you may have access to for Medicaid instead

Medicaid income limits vary by state and family size. Some states cover people earning up to 138% of the federal poverty level; others have lower thresholds. The only way to know whether you may have access to is to contact your state Medicaid office or use your state's online screening tool. Many state Medicaid websites have a simple form where you enter your income and household size and get an answer within minutes.

If you do not may have access to for Medicaid but cannot afford an Oscar plan, you may be able to lower your costs through tax credits and cost-sharing reductions on the federal marketplace. These are separate from Medicaid and are based on your income. You can explore marketplace plans and see what subsidies you might receive at Healthcare.gov or your state marketplace.

Oscar plans on the marketplace versus Medicaid Advantage

Oscar sells two different types of plans. One is individual coverage sold on the marketplace — these are not Medicaid plans and require you to pay the full premium (though you may get a tax credit to help). The other is Medicaid Advantage plans sold to people who already have Medicaid. Do not confuse the two. If you are shopping on Healthcare.gov or your state marketplace, you are looking at individual plans, not Medicaid.

When you shop on the marketplace, the system will ask whether you have other coverage. If you already have Medicaid, you should answer yes and not purchase a marketplace plan. If you do not have Medicaid and want to explore whether you may have access to, pause your marketplace shopping and contact your state Medicaid office first. It takes only a few minutes to find out, and it could save you money.

Frequently Asked Questions

Can I use Oscar insurance if I have Medicaid?

No, you cannot hold both an Oscar individual plan and Medicaid at the same time. However, if Oscar offers a Medicaid Advantage plan in your state, you can use your Medicaid coverage to enroll in it through your state Medicaid program.

If I buy Oscar now and get Medicaid later, do I lose my money?

You will need to cancel your Oscar plan when you enroll in Medicaid. Gaining Medicaid is a may have access to event that allows you to cancel mid-year without penalty. You will not receive a refund for premiums already paid, but you will not owe anything for the months after you cancel.

How do I know if Oscar offers Medicaid plans in my state?

Contact your state Medicaid office or visit your state's Medicaid website. They list all private plans available to Medicaid members. You can also call your state's Medicaid hotline — the number is on your state's Medicaid website.

What if I cannot afford Oscar but do not may have access to for Medicaid?

You may be able to lower your costs through tax credits on the federal marketplace or your state marketplace. These are based on your income and are separate from Medicaid. Visit Healthcare.gov to see what subsidies you might receive on an Oscar plan or other marketplace plans.