GoldHMO

Gold Simple

Oscar Health Plan, Inc.

Starting at

$540

/month before subsidy

Key facts

Gold Simple is a 2026 Gold HMO health insurance plan from Oscar Health Plan, Inc., sold on the ACA Marketplace in Arizona under plan ID 13877AZ0070073. The monthly premium starts at $540 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $3,300 ($6,600 for a family), and the individual out-of-pocket maximum is $9,950 ($19,900 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is not HSA-eligible.

Plan ID
13877AZ0070073
Plan year
2026
State
Arizona
Metal level
Gold
Plan type
HMO
HSA-eligible
No

Individual Deductible

$3,300

Family: $6,600

Out-of-Pocket Max

$9,950

Family: $19,900

Coinsurance

20%

You pay after deductible

Network Type

HMO

AZN001

Cost Sharing
What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$5.00
Specialist Visit$10.00
Urgent Care$50.00
Emergency Room20.00% Coinsurance after deductible

Prescription Drugs

Generic Drugs$3.00
Brand Name Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible
CMS Quality Rating
The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.
3.0overall
Medical care

How well doctors manage and coordinate care

Member experience
Not rated

Member-survey satisfaction with the plan

Plan administration

Customer service, billing, and access to information

What you'd typically pay
Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$5,100

your estimated cost

Deductible
$3,500
Copays
$300
Coinsurance
$1,300

Managing type 2 diabetes

A year of routine care

$4,000

your estimated cost

Deductible
$3,500
Copays
$500
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,300

your estimated cost

Deductible
$2,100
Copays
$200
Coinsurance
$0
Is your medication or doctor covered?
Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.
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Official Plan Documents
Published by Oscar Health Plan, Inc.. These are the authoritative source for coverage details.
Who This Plan Is Best For

This Gold HMO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

  • Have ongoing health conditions requiring regular care
  • Take multiple prescription medications
  • Prefer lower costs at the time of service
  • Want peace of mind with comprehensive coverage

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost
What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,369/month

Annual Premium

$6,480

OOP Maximum

$9,950

💡 What this means:

With a $3,300 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $9,950 total. Then insurance covers everything else for the year.

More plans from Oscar Health Plan, Inc. in Arizona

View all Marketplace plans in Arizona

Frequently asked questions about Gold Simple

How much does Gold Simple cost per month?

Gold Simple from Oscar Health Plan, Inc. starts at $540 per month before any subsidy in Arizona. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for Gold Simple?

The individual medical deductible is $3,300, and the family deductible is $6,600. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for Gold Simple?

The most you would pay in a year for covered in-network care is $9,950 for an individual and $19,900 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Gold Simple HSA-eligible?

No. Gold Simple is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does Gold Simple use?

Gold Simple is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.

Understand what you'd actually pay

Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.