Gold Elite
Starting at
$586
/month before subsidy
Gold Elite is a 2026 Gold EPO health insurance plan from Oscar Insurance Company, sold on the ACA Marketplace in Texas under plan ID 20069TX0100056. The monthly premium starts at $586 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $1,200 ($2,400 for a family), and the individual out-of-pocket maximum is $7,800 ($15,600 for a family). After the deductible, coinsurance is 30% for covered in-network care. The plan is not HSA-eligible.
- Plan ID
- 20069TX0100056
- Plan year
- 2026
- State
- Texas
- Metal level
- Gold
- Plan type
- EPO
- HSA-eligible
- No
Individual Deductible
$1,200
Family: $2,400
Out-of-Pocket Max
$7,800
Family: $15,600
Coinsurance
30%
You pay after deductible
Network Type
EPO
TXN001
Medical Services
Prescription Drugs
- Medical care
- Member experience
- Not rated
- Plan administration
How well doctors manage and coordinate care
Member-survey satisfaction with the plan
Customer service, billing, and access to information
Having a baby
Normal delivery
$4,000
your estimated cost
- Deductible
- $1,200
- Copays
- $200
- Coinsurance
- $2,600
Managing type 2 diabetes
A year of routine care
$1,900
your estimated cost
- Deductible
- $0
- Copays
- $1,900
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$1,900
your estimated cost
- Deductible
- $1,200
- Copays
- $400
- Coinsurance
- $300
Enter your ZIP code first to search nearby doctors.
This Gold EPO 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.
If you max out this year
$1,236/month
Annual Premium
$7,032
OOP Maximum
$7,800
💡 What this means:
With a $1,200 deductible, you pay 100% of costs until you've spent that much. After that, you pay 30% (coinsurance) until you hit $7,800 total. Then insurance covers everything else for the year.
More plans from Oscar Insurance Company in Texas
- Bronze Classic 4700from $433/mo
- Bronze Classic Standardfrom $428/mo
- Bronze Elite + PCP Saver Plusfrom $452/mo
- Bronze Simple Breathe Easy with Enhanced COPD Benefitsfrom $414/mo
- Bronze Simple Chronic Care CKMfrom $442/mo
- Bronze Simple Diabetesfrom $434/mo
- Silver Classicfrom $674/mo
- Silver Classic Standardfrom $665/mo
Frequently asked questions about Gold Elite
How much does Gold Elite cost per month?
Gold Elite from Oscar Insurance Company starts at $586 per month before any subsidy in Texas. 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 Elite?
The individual medical deductible is $1,200, and the family deductible is $2,400. 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 Elite?
The most you would pay in a year for covered in-network care is $7,800 for an individual and $15,600 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.
Is Gold Elite HSA-eligible?
No. Gold Elite 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 Elite use?
Gold Elite is a EPO plan. EPO plans cover in-network care only (except emergencies) and usually do not require referrals to see specialists.
Understand what you'd actually pay
- 2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
- How ACA subsidies work
Premium tax credits and who qualifies
- The 2026 subsidy cliff
Why income near 400% FPL matters again this year
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.