Michigan health plan · 2026

Gold Elite Saver Plus · 77739MI0070035

Oscar Insurance Company offers this marketplace health insurance plan (Plan ID 77739MI0070035) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: EPO CSR: Standard Gold On Exchange Plan Issuer: Oscar Insurance Company
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 79.99% (20.01% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$320 – $1254

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$8,600

$17200 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $30.00
HSA Not eligible

Drug tiers

Generic $3.00
Preferred brand $75.00 Copay after deductible

View formulary tiers

$438 / mo before subsidies

≈ $5257 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1388 / mo before subsidies

≈ $16659 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1681 / mo before subsidies

≈ $20176 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1068 / mo before subsidies

≈ $12822 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$500.00

Durable Medical Equipment

20.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$500.00

Durable Medical Equipment

20.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 77739MI0070035
Coverage year 2026
State Michigan
Issuer Oscar Insurance Company
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 77739MI0070035-01
Available variants

Standard Off Exchange Plan · 77739MI0070035-00

Standard On Exchange Plan · 77739MI0070035-01

Open to Indians below 300% FPL · 77739MI0070035-02

Open to Indians above 300% FPL · 77739MI0070035-03
Last plan update Tue, 28 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Michigan 16636
PCPs in Michigan 419
Telehealth support Data pending
Nationwide providers 78354
16,636 doctors statewide 419 PCPs 6 OB/GYN

Provider network(s)

Providers Michigan All US states
All 16636 78354
PCP 419 1035
Allergy 1 4
OB/GYN 6 19
Dentists N/A 2

Drug coverage overview

4,026 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,209
NON-PREFERRED-BRAND 614
SPECIALTY-DRUGS 590
PREFERRED-GENERIC 320
ZERO-COST-SHARE-PREVENTIVE-DRUGS 214
NONPREFERRED-SPECIALTY-DRUGS 79
Prior authorization Drugs
Required 880
Not Required 3,146
Step therapy Drugs
Required 19
Not Required 4,007
Quantity limits Drugs
Has Limit 1,455
No Limit 2,571

Customer highlights

What stands out for members

  • Issuer: Oscar Insurance Company · Plan ID 77739MI0070035 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 77739MI0070035-01 (Standard On Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Therapy and/or Rehabilitative Medicine Services that result in meaningful improvement in your ability to perform functional day-to-day activities that are significant in your life role, physical and occupational therapy, speech therapy for treatment of medical diagnoses, biofeedback for treatment of medical diagnoses. NOTE: Covered physical and occupational therapy services include spinal manipulations by a chiropractor and all manipulations by osteopathic Physicians. Short-term Rehabilitative Medicine Services are Covered if: Treatment is provided for an Illness, Injury or congenital defect for which you have received corrective surgery, and they are provided in an outpatient setting or in the home, and and they result in meaningful improvement in your ability to do important day-to-day activities that are necessary in your life roles within 90 days of starting treatment, and a Participating Physician refers, directs, and monitors the services.

Diabetes Education

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Diabetes educational classes to ensure that persons with diabetes are trained as to proper self-management and treatment of their diabetes.

Home Health Care Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Intermittent skilled services furnished in the home by a physical therapist, occupational therapist, respiratory therapist, speech therapist, licensed practical nurse or registered nurse. Home Health Care is Covered when you are: (a) confined to the home, (b) under the care of a Physician, (c) receiving services under a plan of care established and periodically reviewed by a Physician, and (d) in need of intermittent skilled nursing care or physical, speech, or occupational therapy.

Exclusions: Custodial Care is not Covered, even if you receive Covered Home Health Care or Skilled Nursing Services at the same time you receive Custodial Care.

Laboratory Outpatient and Professional Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Your PCP may be a nurse practitioner or a physician assistant.

Preventive Care/Screening/Immunization

0.00%
Tier 1 in-network 0.00%
Out-of-network 100.00%

Covered preventive health care services include: (a) Immunizations (doses, recommended ages, and recommended populations vary), Certain vaccines-children from birth to age 18. Certain vaccines-all adults

Primary Care Visit to Treat an Injury or Illness

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Cost share applies to both in-person and telemedicine services. Your PCP provides your primary health care, orders lab tests and x-rays, prescribes medicines or therapies and arranges hospitalization when necessary. Your PCP may be a family practitioner, a general practitioner, an internal medicine specialist, a pediatrician, an obstetrician/gynecologist, a nurse practitioner or a physician assistant.You may choose to seek services from a Participating Provider without referral from your PCP at any time

Rehabilitative Occupational and Rehabilitative Physical Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Therapy and/or Rehabilitative Medicine Services that result in meaningful improvement in your ability to perform functional day-to-day activities that are significant in your life role, physical and occupational therapy, speech therapy for treatment of medical diagnoses, biofeedback for treatment of medical diagnoses. NOTE: Covered physical and occupational therapy services include spinal manipulations by a chiropractor and all manipulations by osteopathic Physicians. Short-term Rehabilitative Medicine Services are Covered if: Treatment is provided for an Illness, Injury or congenital defect for which you have received corrective surgery, and they are provided in an outpatient setting or in the home, and and they result in meaningful improvement in your ability to do important day-to-day activities that are necessary in your life roles within 90 days of starting treatment, and a Participating Physician refers, directs, and monitors the services.

Rehabilitative Speech Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Therapy and/or Rehabilitative Medicine Services that result in meaningful improvement in your ability to perform functional day-to-day activities that are significant in your life role, physical and occupational therapy, speech therapy for treatment of medical diagnoses, biofeedback for treatment of medical diagnoses. NOTE: Covered physical and occupational therapy services include spinal manipulations by a chiropractor and all manipulations by osteopathic Physicians. Short-term Rehabilitative Medicine Services are Covered if: Treatment is provided for an Illness, Injury or congenital defect for which you have received corrective surgery, and they are provided in an outpatient setting or in the home, and and they result in meaningful improvement in your ability to do important day-to-day activities that are necessary in your life roles within 90 days of starting treatment, and a Participating Physician refers, directs, and monitors the services.

Specialist Visit

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Cost share applies to both in-person and telemedicine services. Referral care is care provided by a Health Professional or Physician other than your PCP. You may request a second medical opinion from a Participating Specialist Provider who has skills and training substantially similar to those of the Physician making the original treatment recommendation without Prior Approval. If there are no Participating Providers with the skills and training needed to provide a second opinion on the proposed treatment, we may Cover a second medical opinion from a Non-Participating Specialist Provider. Prior Approval from Priority Health is required before the second opinion is obtained. Any tests, procedures, treatments or surgeries recommended by the consulting Provider must be performed by a Participating Provider unless we approve the services in advance.

Urgent Care Centers or Facilities

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. Medical Emergency care and Urgent Care services are Covered under this Certificate.

X-rays and Diagnostic Imaging

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$200.00
Tier 1 in-network $200.00
Out-of-network 100.00%

The following drugs are covered as medical benefits; Injectable and infusible drugs administered in an inpatient or emergency setting, injectable and infusible drugs requiring administration by a Health Professional in a medical office, home or outpatient facility.

Delivery and All Inpatient Services for Maternity Care

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

The per day copayment will apply for a maximum of three (3) days. Covered Services(a) Hospital and Provider care. Services and supplies furnished by a Hospital or Provider for prenatal care, including genetic testing, postnatal care, Hospital delivery, and care for the Complications of Pregnancy. The mother and Newborn have the right to an inpatient stay of no less than 48 hours following a normal vaginal delivery or no less than 96 hours following a cesarean section. If the mother and her attending Physician agree, the mother and the Newborn may be discharged from the Hospital sooner. (b) Newborn child care. A Newborn child (including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities) for the first 31 days from birth. Telephone assessment and home visits by a registered nurse shortly after the date of the mother's discharge for evaluation of the mother, Newborn and family. These services are only available if your Provider identifies a medical need. (d) Maternity education programs

Dialysis

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Therapy and/or Rehabilitative Medicine Services that result in meaningful improvement in your ability to perform functional day-to- day activities that are significant in your life roles

Durable Medical Equipment

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

DME is equipment intended for repeated use in order to serve a medical need, is generally not useful to a person in the absence of Illness or Injury, and is appropriate for use in the home. Examples of Covered DME are manual wheelchairs, CPAP machines and glucose monitoring devices.

Emergency Room Services

$500.00
Tier 1 in-network $500.00
Out-of-network $500.00

Medical Emergency care and Urgent Care services are Covered.

Emergency Transportation/Ambulance

$500.00
Tier 1 in-network $500.00
Out-of-network $500.00

Ambulance includes a motor vehicle or aircraft that is primarily used or designated as available to provide transportation and basic life support, limited advanced life support, or advanced life support. In a Medical Emergency, we will Cover EMT and ambulance service to the nearest medical facility that can provide Medical Emergency care. We will Cover ambulance transfers between facilities that we approve in advance.

Hospice Services

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

The following Hospice Care services, provided as part of an established hospice program are Covered when your Physician informs Priority Health that your condition is terminal and Hospice Care would be appropriate: (a) Inpatient Hospice Care. Short-term inpatient care in a licensed hospice facility is Covered when Skilled Nursing Services are required and cannot be provided in other settings. Prior Approval of inpatient Hospice Care is required. (b) Outpatient Hospice Care. Outpatient care is Covered when intermittent Skilled Nursing Services by a registered nurse or a licensed practical nurse are required or when medical social services under the direction of a Physician are required. Outpatient Hospice Care is any care provided in a setting other than a licensed hospice facility. Hospice Care provided while you are in a Hospital or skilled nursing facility is considered outpatient Hospice Care. (c) Respite Care. Respite care in a facility setting is Covered as outlined in our medical policies.

Exclusions: Custodial Care is not Covered even if you receive inpatient or outpatient Hospice Care along with Custodial Care.

Inpatient Hospital Services (e.g., Hospital Stay)

$1000.00 Copay per Day
Tier 1 in-network $1000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of three (3) days. (a) Hospital Inpatient Care. Hospital and long term acute inpatient services and supplies including services performed by Physicians and Health Professionals, room and board, general nursing care, drugs administered while you are confined as an inpatient, and related services and supplies.

Inpatient Physician and Surgical Services

$200.00
Tier 1 in-network $200.00
Out-of-network 100.00%

(a) Hospital Inpatient Care. Hospital and long term acute inpatient services and supplies including services performed by Physicians and Health Professionals, room and board, general nursing care, drugs administered while you are confined as an inpatient, and related services and supplies.

Mental/Behavioral Health Inpatient Services

$1000.00 Copay per Day
Tier 1 in-network $1000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of three (3) days. This plan Covers evaluation, consultation and treatment necessary to determine a diagnosis and treatment plan for both acute and chronic mental health conditions. Acute Inpatient Hospitalization.

Mental/Behavioral Health Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

This plan Covers evaluation, consultation and treatment necessary to determine a diagnosis and treatment plan for both acute and chronic mental health conditions. Both crisis intervention and solution-focused treatment are Covered.\nThe cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$500.00
Tier 1 in-network $500.00
Out-of-network 100.00%

Outpatient services and supplies furnished by a surgery center along with a Covered surgical procedure on the day of the procedure.

Outpatient Rehabilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/ pulmonary visits per contract year.

Outpatient Surgery Physician/Surgical Services

$200.00
Tier 1 in-network $200.00
Out-of-network 100.00%

Outpatient services and supplies furnished by a surgery center along with a Covered surgical procedure on the day of the procedure.

Radiation

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Diagnostic and therapeutic radiology services and laboratory tests..

Skilled Nursing Facility

$1000.00 Copay per Day
Tier 1 in-network $1000.00 Copay per Day
Out-of-network 100.00%

Limit: 45.0 Days per Year

The per day copayment will apply for a maximum of three (3) days. Care and treatment, including therapy, and room and board in semi-private accommodations, at a skilled nursing, subacute, or inpatient rehabilitation facility is Covered when we have approved a treatment plan in advance.

Substance Abuse Disorder Inpatient Services

$1000.00 Copay per Day
Tier 1 in-network $1000.00 Copay per Day
Out-of-network 100.00%

The per day copayment will apply for a maximum of three (3) days. Substance abuse services, including counseling, medical testing, diagnostic evaluation and detoxification are Covered in a variety of settings. You may be treated in an inpatient or outpatient setting, depending on your particular condition.

Substance Abuse Disorder Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Substance abuse services, including counseling, medical testing, diagnostic evaluation and detoxification are Covered in a variety of settings. You may be treated in an inpatient or outpatient setting, depending on your particular condition.\nThe cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Transplant

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Evaluations for transplants and transplants of the following organs, bone marrow or stem cell, cornea, heart, kidney, liver, lung, pancreas, and small bowel. In addition, we will cover the following expenses: computer organ bank searches and any subsequent testing necessary after a potential donor is identified, unless covered by another health plan, typing or screening of a potential donor only if the person proposed to receive the transplant is a member, donor's medical expenses directly related to or as a result of a donation surgery if the person receiving the transplant is a member and the donor's expenses are not covered by another health benefit plan, one comprehensive evaluation per transplant.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

0.00%
Tier 1 in-network 0.00%
Out-of-network 100.00%

Covered Services(a) Hospital and Provider care. Services and supplies furnished by a Hospital or Provider for prenatal care, including genetic testing, postnatal care, Hospital delivery, and care for the Complications of Pregnancy. The mother and Newborn have the right to an inpatient stay of no less than 48 hours following a normal vaginal delivery or no less than 96 hours following a cesarean section. If the mother and her attending Physician agree, the mother and the Newborn may be discharged from the Hospital sooner. (b) Newborn child care. A Newborn child (including necessary care and treatment of medically diagnosed congenital defects and birth abnormalities) for the first 31 days from birth. Telephone assessment and home visits by a registered nurse shortly after the date of the mother's discharge for evaluation of the mother, Newborn and family. These services are only available if your Provider identifies a medical need. (d) Maternity education programs

Routine Eye Exam for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Vision Screening-all children

Well Baby Visits and Care

0.00%
Tier 1 in-network 0.00%
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Tier 2 in-network $15.00
Out-of-network 100.00%

Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.

Non-Preferred Brand Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.

Preferred Brand Drugs

$75.00 Copay after deductible
Tier 1 in-network $75.00 Copay after deductible
Out-of-network 100.00%

Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered.

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prescription Drugs and Supplies, Drugs and supplies that are prescribed and received during a Covered inpatient stay are Covered as medical benefits.drugs for cancer therapy and the reasonable cost of administering them are Covered. Limited to a 30-day supply.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

The following drugs are covered as medical benefits; Injectable and infusible drugs administered in an inpatient or emergency setting, injectable and infusible drugs requiring administration by a Health Professional in a medical office, home or outpatient facility.

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 6.0 Visit(s) per Year

Covered Services Consultations with a Participating dietitian, upon referral from your PCP, up to a maximum of 6 visits per Contract Year.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Prosthetic and Orthotic/Support Devices. Covered Services Surgically implanted prosthetic devices, such as a replacement hip or heart pacemaker. Externally worn prosthetic devices. Purchased, repaired or replaced prosthetics and orthotics, repairs or replacement, fitting and adjustment of Covered prosthetic and orthotic/support devices that is need as the result of normal use, body growth or change.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Physician-supervised weight loss programs

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Allergy testing, evaluations and injections, including serum costs.

Exclusions: Skin titration (Rinkle Method), cytotoxicity testing (Bryan's Test), MAST testing, urine auto-injections, bronchial or oral allergen sensitization and provocative and neutralization testing for allergies.

Bariatric Surgery

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

Physician-supervised weight loss programs as outlined in our medical policies. (b) Certain surgical treatments when comorbid health conditions exist and all reasonable non-surgical options have been tried. NOTE: Surgical treatment of obesity is limited to once per lifetime unless Medically/Clinically Necessary to correct or reverse complications from a previous bariatric procedure.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Polycarbonate lenses are covered in full for children

Gender Affirming Care

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Habilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Therapy and/or Rehabilitative Medicine Services that result in meaningful improvement in your ability to perform functional day-to-day activities that are significant in your life role, physical and occupational therapy, speech therapy for treatment of medical diagnoses, biofeedback for treatment of medical diagnoses. NOTE: Covered physical and occupational therapy services include spinal manipulations by a chiropractor and all manipulations by osteopathic Physicians. Short-term Rehabilitative Medicine Services are Covered if: Treatment is provided for an Illness, Injury or congenital defect for which you have received corrective surgery, and they are provided in an outpatient setting or in the home, and and they result in meaningful improvement in your ability to do important day-to-day activities that are necessary in your life roles within 90 days of starting treatment, and a Participating Physician refers, directs, and monitors the services.

Imaging (CT/PET Scans, MRIs)

$375.00
Tier 1 in-network $375.00
Out-of-network 100.00%

Diagnostic and therapeutic radiology services and laboratory tests. All non-emergency laboratory tests, including high-tech radiology examinations, must be performed at a participating laboratory or facility. Radiology services and laboratory tests performed in a Hospital, either while you are an inpatient or an outpatient.

Infertility Treatment

$500.00
Tier 1 in-network $500.00
Out-of-network 100.00%

Diagnostic, counseling, and planning services for treatment of the underlying cause of infertility. Examples of Covered Services are sperm count, endometrial biopsy, hysterosalpingography, and diagnostic laparoscopy

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Reconstructive surgery to correct congenital birth defects and/or effects of Illness or Injury, if: The defects and/or effects of Illness or Injury cause clinical functional impairment. "Clinical functional impairment" exists when the defects and/or effects of Illness or Injury: causes significant Disability or major psychological trauma (psychological reasons do not represent a medical or surgical necessity unless you are undergoing psychotherapy for issues solely related to the Illness or Injury for which the reconstructive surgery is requested), interfere with employment or regular attendance at school, require surgery that is a component of a program of reconstructive surgery for a congenital deformity or trauma, or contribute to a major health problem.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Specified Sex-trait Modification Procedures (SSTMP)

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Treatment for Temporomandibular Joint Disorders

$500.00
Tier 1 in-network $500.00
Out-of-network 100.00%

Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

Variant attributes

Gold Elite Saver Plus · Variant 77739MI0070035-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

77739MI007

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

77739MI0070035-01

Plan Marketing Name

Gold Elite Saver Plus

Plan Variant Marketing Name

Gold Elite Saver Plus

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

77739

Issuer Marketplace Marketing Name

Oscar Insurance Company

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

MIN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Services Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency and Urgent Services Only

Service Area ID

MIS001

State Code

MI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.799923426

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

Inpatient Copayment Maximum Days

3

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

20.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$1,600

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,700

SBC Scenario, Having Diabetes, Deductible

$200

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$50

SBC Scenario, Treatment of a Simple Fracture, Copayment

$1,300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$17200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$17200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$8600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$8,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MIF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$400 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$200 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$200

Drug EHB Deductible, In Network (Tier 2), Family Per Group

$400 per group

Drug EHB Deductible, In Network (Tier 2), Family Per Person

$200 per person

Drug EHB Deductible, In Network (Tier 2), Individual

$200

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol

EHB Percent of Total Premium

0.99996

First Tier Utilization

44%

Import Date

10/28/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

EPO

QHP/Non QHP

Both

Second Tier Utilization

56%

Source Name

SERFF

Plan ID

77739MI0070035

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Michigan?

Gold Elite Saver Plus (77739MI0070035) is a Gold EPO from Oscar Insurance Company in Michigan for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Gold Elite Saver Plus support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Gold Elite Saver Plus HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Gold Elite Saver Plus support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Gold Elite Saver Plus?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol.

Is there out-of-country coverage for Gold Elite Saver Plus?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Services Only

Does Gold Elite Saver Plus cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency and Urgent Services Only

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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