Oscar grows its county count 24% as ACA insurers set 2027 plans

Oscar Health and Centene released their 2027 Affordable Care Act (ACA) marketplace lineups on Oct 20, 12 days before open enrollment starts on Nov 1.

Oscar is entering South Carolina and will sell plans in 713 counties across 21 states, a 24% increase in counties from last year. Centene’s Ambetter Health says it serves more than 3.5 million members in 27 states and more than 1,700 counties, and will add 55 counties for 2027.

Plans built around one condition

Both insurers are expanding plans designed for people with a specific chronic condition, with $0 cost sharing on the drugs and visits that condition needs.

Ambetter is adding Enhanced Congestive Heart Failure Care plans in North Carolina and Ohio. Eligible members get $0 copays for certain heart failure drugs and up to four $0 cardiologist visits a year, plus covered cholesterol labs and EKGs. Its diabetes plans expand to Louisiana, Mississippi and Indiana, with $0 preferred insulin and $0 routine A1C labs. Its asthma and COPD plans add Georgia.

Oscar is taking HelloMeno, its menopause plan, to 15 states. It includes a $0 package of hormone replacement therapy, bone-density scans, insomnia drugs and cancer screenings. Oscar says its condition and life-stage plans deliver 15 to 25% in savings. Its footnote says that estimate covers select clinical programs and is measured against one specific benchmark, an ACA plan with a CSR 150 cost-sharing level.

A bridge to Medicare

Oscar’s new RetireEase plan is aimed at people who retire before Medicare age. It sets prices for preventive visits, lab work, physical therapy, heart care and bone-and-joint care, adds $0 generic drugs, and includes help with the move to Medicare. It is sold in Arizona, Florida, Ohio, South Carolina and Texas.

The employer angle

Oscar says workers whose employers offer CHOICE arrangements can pick from more than 250 Oscar products in 15 states. CHOICE is Oscar’s name for what it used to call ICHRA, the individual coverage health reimbursement arrangement. The employer puts in a set amount and the worker picks a plan. Oscar is also adding more than 250 plans with dental and vision bundled in.

Ambetter’s extras include up to $500 a year in My Health Pays rewards in participating states, with amounts that vary by state.

Why it matters

Condition-specific plans let insurers compete on benefit design for people with chronic illness, and Oscar is putting the same menu in front of workers whose employers fund individual coverage instead of a group plan.