Kaiser Permanente HMO stands out with its high customer satisfaction ratings and integrated telehealth system, but it requires using Kaiser Permanente facilities. Oscar Health Simple Plan emphasizes ease of access through technology and a dedicated care team, but lacks specific customer satisfaction data. The best choice depends on individual priorities, such as provider network flexibility versus customer satisfaction and integrated care.
| Attribute | Kaiser Permanente HMO | Oscar Health Simple Plan |
|---|---|---|
| Monthly premium cost | Varies based on location, age, income, and plan. In California, premiums for faculty/staff range from $39.77 to $205.85 for an individual, depending on salary. Average monthly cost for an ACA marketplace plan is $501. Costs for ACA plans range from $386 for a 21-year-old to $1,049 for a 60-year-old. | Varies depending on the specific plan, location, and individual circumstances. It is recommended to get a quote for a specific plan. |
| Deductible amount (individual/family) | Many plans have no deductible. Some plans have deductibles such as $5,800 individual / $11,600 family, $2,100 individual / $4,200 family. A silver plan has an average annual deductible of $4,115. | Individual: Deductibles can vary. For example, one "Oscar Simple Silver" plan has a $7,900 individual deductible. Another "Oscar Simple Bronze" plan has a $7,150 individual deductible. A "Silver Simple PCP Saver" plan has a $5,750 individual deductible. Family: Family deductibles also vary. One "Oscar Simple Silver" plan lists a $15,800 family deductible. Another "Oscar Simple Bronze" plan has a $14,300 family deductible. A "Silver Simple PCP Saver" plan has a $11,500 family deductible. |
| Copay for primary care physician visit | Varies; some plans offer $30 copays, others $20 copays. One plan has a $60 copay per visit. Some plans may waive the copay for children under age 5. | Copays vary depending on the specific plan. Some plans offer primary care visits with a copay. For instance, the "Silver Simple PCP Saver" plan may have a $10 or $20 copay. Some plans may have $0 copay for the first few visits. |
| Copay for specialist visit | Varies; some plans have a $40 copay, others a $50 copay. One plan has a $95 copay per visit, but the deductible is waived for the first three visits for non-preventive specialty care. | Specialist copays also depend on the plan. Some plans have a copay for specialist visits. For example, a "Silver Simple PCP Saver" plan may have a $70 copay. |
| Out-of-pocket maximum (individual/family) | Varies by plan. Examples include $1,500 individual / $3,000 family, $3,500 individual / $7,000 family, $6,600 individual / $13,200 family, $7,550 individual / $15,100 family, $8,850 individual / $17,700 family. | Individual: Out-of-pocket maximums vary. For example, one "Oscar Simple Silver" plan has a $7,900 individual out-of-pocket max. Another plan has a $9,050 individual out-of-pocket maximum. Family: Family out-of-pocket maximums also vary. For example, one "Oscar Simple Silver" plan has a $15,800 family out-of-pocket max. Another plan has a $18,100 family out-of-pocket maximum. |
| Coverage for prescription drugs (formulary details) | Uses a formulary, a list of covered drugs developed and updated regularly. Generic drugs are generally preferred and cost less than brand-name drugs. Some plans may have a separate prescription drug deductible, such as $450 individual / $900 family or $200 individual / $400 family. Copays vary; one plan offers generic drugs for $10 and brand-name drugs for $30. Another plan offers generic drugs for $10 and brand-name drugs for $40 for up to a 30-day supply. | Coverage and costs vary by plan and drug tier. Some plans offer generic drugs with a low copay. Some plans may have a separate drug deductible. Certain "Simple" plans may not include discounts for non-preferred or specialty drugs. |
| Availability of telehealth services | Offers 24/7 virtual care, video visits, phone appointments, e-visits, and email communication with care team. Telehealth is integrated with the electronic health record system. | Oscar Health plans generally offer telehealth services. Some plans include free 24/7 telemedicine. Some plans may have a copay for telehealth visits, while others, particularly with Oscar-designated providers, may be covered in full. |
| In-network hospitals and providers | Typically requires members to use Kaiser Permanente doctors and facilities, except in emergencies. Has a large network of providers. | Oscar Health plans use a network of providers. You can find a list of in-network providers on the Oscar website or by calling their customer service. |
| Coverage for mental health services | Offers coverage for mental health services, including therapy (individual, group, and family), medication management, mental health screenings, and coverage for a wide range of mental health conditions. Some plans offer access to mental health services without requiring a referral. | Oscar Health plans generally cover mental health services, including therapy. Coverage details (copays, deductibles) vary by plan. |
| Coverage for emergency room visits | Emergency room visit costs vary, e.g., $150, $250, or $350 copay per visit (deductible may not apply). The copay is often waived if the member is admitted to the hospital. Members are covered for emergency and urgent care anywhere in the world. | Emergency room coverage often involves a copay or coinsurance after the deductible has been met. Some plans may have a higher cost share for emergency room services. |
| Preventive care services covered | Generally covers many preventive services at no extra cost, including routine physical exams, vaccines and immunizations, cancer tests and screenings, mental health screenings, and screenings related to cardiac care, diabetes, osteoporosis, and domestic violence. | Oscar Health plans cover preventive care services as required by the Affordable Care Act (ACA). This includes routine check-ups, screenings, and immunizations. |
| Customer satisfaction ratings | Generally receives high customer satisfaction ratings. Tied for No. 1 overall in Insure.com's list of the Best Health Insurance Companies for 2025. Ranked first in a recent JD Power survey for health insurance customer satisfaction. | Customer satisfaction ratings specific to the "Simple Plan" were not found in the search results. |