Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences:

• Oscar Health: Primarily offers EPO plans that combine cost-effectiveness of HMOs with direct specialist access without referrals. Oscar doesn’t generally offer PPO plans, focusing instead on simplicity and affordability within EPO structures.

• Molina Healthcare: Specializes predominantly in Medicaid and marketplace HMO plans, typically requiring members to select a Primary Care Provider (PCP) and referrals for specialist care. Limited or no PPO or POS options available.

Individual Plans vs. Employer-Sponsored Plans:

• Oscar Health: Strong focus on individual ACA marketplace plans in select states. Provides small group employer plans in certain urban markets but primarily targets individuals and young adults seeking simplicity and digital-first approaches.

• Molina Healthcare: Primarily offers individual marketplace plans and Medicaid coverage with minimal employer-sponsored options. Molina targets affordability and comprehensive Medicaid coverage rather than employer groups.

Medicare Advantage vs. Medicare Supplement:

• Oscar Health: Recently entered the Medicare Advantage market with limited availability, focusing on digital tools and preventive care. Currently, no Medigap (Supplement) plans are offered.

• Molina Healthcare: Offers Medicare Advantage plans in select states, emphasizing affordability, integrated Medicaid-Medicare dual eligibility (DSNP), and community-based health solutions. Medigap options generally unavailable.

Medicaid and ACA Marketplace Options:

• Oscar Health: No direct Medicaid involvement, but robust ACA marketplace presence in selected states like New York, California, Florida, and Texas.

• Molina Healthcare: Strong presence in Medicaid programs nationwide, with significant ACA marketplace coverage aimed at low-to-moderate income individuals.

Cost & Affordability

Monthly Premiums Comparison:

• Oscar Health: Moderate premiums generally competitive within ACA marketplace, particularly attractive to younger adults due to simplicity and digital tools.

• Molina Healthcare: Typically offers lower premiums, especially in ACA marketplace and Medicaid, designed explicitly for affordability and cost-sensitive consumers.

Deductibles and Copayments:

• Oscar Health: Clear, predictable deductibles and copay structures, offering transparency but often slightly higher than Molina due to network flexibility.

• Molina Healthcare: Usually lower deductibles and copays, targeting affordability, especially beneficial for lower-income members utilizing Medicaid and ACA subsidies.

Out-of-pocket Maximums:

• Oscar Health: Moderate out-of-pocket maximums, clearly outlined in policy terms; typically higher than Molina’s due to provider choice flexibility.

• Molina Healthcare: Lower out-of-pocket maximums reflecting its affordability-focused strategy, advantageous for Medicaid recipients or low-income marketplace members.

Pricing Transparency:

• Oscar Health: Exceptional transparency with easy-to-use digital tools providing clear breakdowns of costs, copays, and deductibles.

• Molina Healthcare: Good pricing transparency, but slightly less digital clarity compared to Oscar, primarily relying on traditional documentation.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks:

• Oscar Health: Medium-sized networks primarily in urban and suburban areas in states such as CA, NY, TX, FL. Limited rural availability.

• Molina Healthcare: Robust Medicaid-focused networks, predominantly in urban and underserved areas nationwide, though limited in rural locations.

Specialist Access and Referrals:

• Oscar Health: No referrals required for specialists with EPO plans, offering greater convenience and flexibility.

• Molina Healthcare: Typically requires PCP referrals for specialist visits, aligning with its HMO-centric model to control costs and manage care.

Availability of In-network Hospitals and Doctors:

• Oscar Health: Growing but focused networks with reputable urban hospitals and medical providers. Some restrictions in rural or suburban areas.

• Molina Healthcare: Adequate network in urban markets, extensive coverage of community clinics and Medicaid-friendly hospitals, though fewer prestigious private providers compared to Oscar.

Out-of-network Coverage and Reimbursement Rates:

• Oscar Health: Minimal or no out-of-network coverage within standard EPO plans, except emergencies.

• Molina Healthcare: Very limited or no out-of-network coverage, typical of Medicaid or marketplace HMO plans, emphasizing cost containment.

Member Benefits & Perks

Wellness Incentives (Fitness Memberships, Preventive Screenings):

• Oscar Health: Provides excellent wellness incentives, including discounted fitness programs, preventive screenings, wellness coaching, and health trackers integrated through its app.

• Molina Healthcare: Wellness incentives primarily focused on preventive screenings, vaccination programs, and healthy-lifestyle education, fewer perks like gym memberships.

Chronic Disease Management Programs:

• Oscar Health: Strong chronic disease management with personalized coaching through digital platforms, especially effective for tech-savvy members.

• Molina Healthcare: Robust, community-focused chronic disease management programs particularly strong in diabetes, asthma, and cardiovascular conditions, targeted at Medicaid population.

Telehealth and Virtual Care Offerings:

• Oscar Health: Exceptional digital-first approach with 24/7 telehealth access via Oscar app at no extra charge for many plans.

• Molina Healthcare: Provides telehealth services, though less extensive and digitally sophisticated compared to Oscar. Available through third-party partnerships.

Mental Health Coverage and Services:

• Oscar Health: Comprehensive mental health coverage with easy access to virtual therapy, psychiatry services, and integrated behavioral health care.

• Molina Healthcare: Strong behavioral health coverage, particularly community-focused mental health and substance abuse support. More traditional provider-based rather than digital.

Customer Service & Member Experience

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

• Oscar Health: Generally high satisfaction ratings due to digital convenience, transparent pricing, and responsive customer care, though newer in the market.

• Molina Healthcare: Average satisfaction scores; some complaints related to provider network limitations or customer service responsiveness.

Ease of Claims Processing and Disputes:

• Oscar Health: Streamlined digital claim processing with minimal disputes, straightforward billing clarity.

• Molina Healthcare: Average claims processing speed with occasional delays or disputes, especially with specialized care or out-of-network issues.

Quality and Usability of Online Portals/Apps:

• Oscar Health: Industry-leading, user-friendly mobile app and portal, highly praised for ease of use, digital ID cards, telehealth integration, and claim tracking.

• Molina Healthcare: Functional but less intuitive online portals/apps, primarily informational rather than interactive or comprehensive.

Reputation & Financial Stability

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

• Oscar Health: Moderate financial stability ratings; relatively new insurer with evolving ratings, rated “B” by A.M. Best as they establish market presence.

• Molina Healthcare: Solid financial ratings (typically “BBB” to “A-“) reflecting long-established Medicaid market presence and financial stability.

Company Reputation and Market History:

• Oscar Health: Newer insurer founded in 2012, recognized for innovation, customer-focused digital approach, appealing to younger, digitally savvy demographic.

• Molina Healthcare: Established Medicaid-focused insurer founded in 1980, longstanding reputation for affordability, stability, and community-based coverage.

Medicare-specific Criteria

• Oscar Health: New to Medicare Advantage, limited market presence and moderate supplemental benefits (dental, vision, hearing). No Medigap offerings currently.

• Molina Healthcare: Strong in Medicare Advantage, especially Dual Special Needs Plans (D-SNP) for Medicare-Medicaid members. Generally solid ratings, moderate supplemental benefits; limited Medigap availability.

Employer & Small-Business Focus

• Oscar Health: Offers attractive small-business plans, fully insured with digital engagement tools and flexible wellness benefits, ideal for tech-oriented businesses.

• Molina Healthcare: Minimal or no small-business group coverage, primarily focused on Medicaid, Medicare, and ACA marketplace individual plans.