Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Oscar Health focuses almost exclusively on HMO and EPO plans in the ACA Marketplace, limiting coverage to in-network providers and typically requiring primary care coordination.
• Cigna offers HMO, PPO, EPO, and POS plans, providing more flexibility, especially through employer-sponsored and international plans. Their PPO options allow members to access a broad range of out-of-network providers.

Individual Plans vs. Employer-Sponsored Plans

• Oscar is primarily known for individual and family plans through the ACA Marketplace and does not have a significant presence in the employer insurance market.
• Cigna is strong in employer-sponsored coverage, serving small and large groups globally, while also offering individual ACA plans in select states.

Medicare Advantage vs. Medicare Supplement

• Oscar currently offers Medicare Advantage plans in limited markets with innovative tech-driven experiences but does not offer Medigap (Medicare Supplement) plans.
• Cigna offers both Medicare Advantage and Medicare Supplement plans (Medigap), providing broader choices for seniors.

Medicaid and ACA Marketplace Options

• Oscar has a strong ACA Marketplace presence in states like Texas, Florida, and California, but no Medicaid offerings.
• Cigna participates in both ACA Marketplace and Medicaid programs, depending on the state.

Cost & Affordability

Monthly Premiums Comparison

• Oscar is often recognized for offering lower premiums, especially in ACA Bronze and Silver plans, appealing to cost-conscious individuals.
• Cigna premiums are competitive, especially in employer markets, but may be slightly higher than Oscar in ACA plans due to broader network flexibility.

Deductibles and Copayments

• Oscar ACA plans often feature high deductibles with lower premiums, though Silver plans may have lower out-of-pocket costs with subsidies.
• Cigna offers a variety of deductible options, including low-deductible employer plans and balanced ACA coverage tiers.

Out-of-Pocket Maximums

• Oscar tends to offer lower out-of-pocket maximums in its Silver-tier plans.
• Cigna ranges widely depending on the plan tier and type (employer, individual, Medicare).

Pricing Transparency

• Oscar is highly focused on price transparency, offering user-friendly cost tools in its mobile app and portal.
• Cigna also provides robust transparency features, though the experience can vary by plan type and region.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Oscar operates in fewer states and has limited regional provider networks, usually focused on urban areas.
• Cigna maintains a large national and international provider network, ideal for people who travel or need more provider choices.

Specialist Access and Referrals

• Oscar’s HMO/EPO plans often require referrals and strictly enforce in-network usage.
• Cigna offers direct access to specialists under PPO and POS plans, with flexibility for out-of-network services.

Availability of In-network Hospitals and Doctors

• Oscar partners with select health systems in each region, so hospital access is more limited.
• Cigna contracts with major health systems nationwide, providing broader access to hospitals and primary care doctors.

Out-of-network Coverage and Reimbursement Rates

• Oscar offers little to no out-of-network coverage (except emergencies).
• Cigna provides reimbursement options through PPO and POS plans for out-of-network care.

Member Benefits & Perks

Wellness Incentives (Fitness, Preventive Screenings)

• Oscar offers perks like step tracking rewards, preventive care incentives, and virtual care tools, appealing to tech-savvy users.
• Cigna provides fitness discounts, preventive screenings, smoking cessation support, and other wellness initiatives.

Chronic Disease Management Programs

• Oscar offers digital health coaching and tools for chronic condition monitoring, though more limited than traditional carriers.
• Cigna has robust chronic care management programs, including case management, nurse support, and remote monitoring.

Telehealth and Virtual Care Offerings

• Oscar has one of the best-integrated virtual care platforms, with app-based access to free telehealth and 24/7 virtual urgent care.
• Cigna partners with services like MDLIVE, offering virtual primary and mental health care through employer and individual plans.

Mental Health Coverage and Services

• Oscar offers mental health services through online behavioral health partners.
• Cigna has a comprehensive behavioral health network, including both in-person and virtual therapy options.

Customer Service & Member Experience

Customer Satisfaction Ratings (J.D. Power, NCQA)

• Oscar earns praise for modern, tech-forward member experience, though some regions report limited plan choices.
• Cigna consistently scores well in J.D. Power and NCQA ratings, especially for employer-sponsored and Medicare plans.

Ease of Claims Processing and Disputes

• Oscar has a streamlined claims process, especially within its app-based ecosystem.
• Cigna provides more traditional claims and support, though some users report longer resolution times.

Quality and Usability of Online Portals/Apps

• Oscar excels in mobile usability, offering a seamless app experience with plan management, provider search, and telehealth.
• Cigna has robust but more conventional tools, with mobile access to ID cards, claims, and wellness resources.

Responsiveness of Customer Support

• Oscar provides concierge-style service teams, which receive strong satisfaction scores from younger demographics.
• Cigna has 24/7 support lines, but experience can vary based on employer or plan type.

Reputation & Financial Stability

Financial Strength Ratings (A.M. Best, Moody’s, S&P)

• Oscar is newer and rated slightly lower (e.g., B+ to A- range), reflecting its growth-stage position.
• Cigna has A to A+ ratings, indicating strong long-term financial stability.

Company Reputation and Market History

• Oscar was founded in 2012 and has a modern, tech-focused brand popular among Millennials and ACA shoppers.
• Cigna has over 200 years of history and is globally recognized with long-standing healthcare partnerships.

Consumer Complaints and Regulatory Issues

• Oscar has fewer complaints but operates in a more limited area.
• Cigna has low complaint ratios overall, though experiences vary by state and plan.

Medicare-Specific Criteria

Medicare Star Ratings & Satisfaction

• Oscar’s Medicare Advantage plans are new and region-specific, with early reviews showing average ratings (3.5–4 stars).
• Cigna’s Medicare Advantage plans score 4 stars or higher, with a large footprint and high member satisfaction.

Additional Benefits (Dental, Vision, Hearing)

• Oscar includes basic extras in MA plans, varying by market.
• Cigna offers vision, dental, OTC, hearing, fitness, and transportation in most Advantage plans.

Availability and Quality of Medigap Plans

• Oscar does not offer Medigap (Supplement) plans.
• Cigna offers Medigap plans in most states with competitive rates and a long-standing reputation.

Cost-Sharing Details for Medicare Plans

• Oscar typically provides low or $0 copays in Advantage plans with limited service areas.
• Cigna offers tiered cost-sharing options, often with better pharmacy and out-of-pocket flexibility.

Employer & Small-Business Focus

Small-Business Plan Options

• Oscar does not currently offer small-group or employer-sponsored plans.
• Cigna is a major player in the group insurance market, serving employers of all sizes.

Fully Insured vs. Self-Funded Plans

• Oscar: N/A
• Cigna: Offers fully insured, self-funded, and level-funded plans, including custom designs for SMBs and large enterprises.

Employee Wellness Incentives and Programs

• Oscar lacks robust employer-focused programs.
• Cigna provides employee wellness incentives, including health screenings, flu shots, health coaching, and digital platforms.

Customization & Flexibility of Group Policies

• Oscar: Not available.
• Cigna: Offers highly customizable group health benefits, with tools for plan selection, benefits management, and analytics.